Tuberculosis Prevention Efforts Research Articles

P-781. The Impact of Hepatitis B Virus Infection on the Management of Latent Tuberculosis Infection in Northern California, 2010-2022

Abstract Background Tuberculosis (TB) and hepatitis B virus (HBV) infection affect similar at-risk populations. However, there is limited data on how co-infection may influence clinicians’ decision to offer TB preventative treatment (TPT) over concern for hepatotoxicity. We compared TPT by HBV status, and determined factors associated with TPT initiation among HBV-infected persons at a community health center in Northern California serving a large non-U.S.-born Asian population. Methods We extracted electronic health record data for all persons aged ≥18 years old with latent TB infection (LTBI), defined by a positive tuberculin skin test or interferon-gamma release assay in the absence of a TB disease diagnosis from 2010-2022. HBV infection was defined by a single positive HBV DNA or HBV surface antigen assay. We conducted multivariate logistic regression to explore the impact of (a) HBV status and (b) clinical and demographic variables on TPT initiation. We also examined how these factors changed when Rifampin (RIF) usage for TPT increased at this community health center after 2014. Results A total of 11,711 persons had LTBI and 5,530 had HBV. Of all persons with LTBI, 833 (9.0%) of those tested for HBV had a co-infection including 41 (4.9%) on HBV antiviral treatment; while 34% of all HBV-infected persons screened for TB had LTBI. Adjusting for demographics and time period, TPT was significantly lower among those with co-infection than those without (43.5% versus 47.4%, adjusted Odds Ratio (aOR) 0.76, 95% Confidence Interval (CI) 0.66 – 0.88, p< 0.01). Among those with co-infection, increasing age (50-64, ≥65 years), and elevated alanine transaminase (ALT) levels were associated with decreased likelihood of TPT (Table 1). Treatment of co-infected individuals was significantly higher after 2014 when RIF prescribing increased (aOR 2.76, 95% CI 1.81-4.2); however, age over 65 was still associated with decreased TPT prescription (aOR 0.36, 95% 0.19 – 0.67, p < 0.01). Conclusion HBV-LTBI co-infection was associated with reduced odds of TPT. Increased use of Rifamycin based regimens and further guidance on TPT and monitoring of older individuals and persons with elevated ALT levels may be needed to improve TB prevention efforts among HBV-LTBI co-infected persons. Disclosures Robert J. Wong, MD, MS, Durect Corporation: Grant/Research Support|Exact Sciences: Grant/Research Support|Gilead Sciences: Grant/Research Support|Thera Technologies: Grant/Research Support

Empowerment of Pesantren Communities in Tuberculosis Prevention Efforts through Educational and Participatory Approaches according to Potential Needs and Local Socio-Culture

Empowerment of Pesantren Communities in Tuberculosis Prevention Efforts through Educational and Participatory Approaches according to Potential Needs and Local Socio-Culture

The Impact of Vaccination Programs on the Prevention of Infectious Disease Tuberculosis: A Case Study with Gasabo District in Rwanda

Introduction Tuberculosis (TB) remained a significant public health challenge globally, including in Gasabo District, Rwanda. Vaccination programs, particularly Bacille Calmette-Guérin (BCG) vaccination, played a crucial role in TB prevention. This study aimed to assess the impact of vaccination programs on TB prevention in Gasabo District, Rwanda, by analyzing vaccination coverage, TB incidence rates, demographic characteristics, and healthcare system factors.  Methods A retrospective cohort study design was employed, utilizing secondary data sources from healthcare facilities in Gasabo District. Data on vaccination coverage, TB incidence rates, demographic characteristics, and healthcare system factors were collected and analyzed. Statistical methods, including regression analysis and descriptive statistics, were used to assess the association between vaccination programs and TB prevention outcomes.  Findings The study found a significant association between BCG vaccination coverage and lower TB incidence rates in Gasabo District. Higher vaccination coverage was associated with reduced TB incidence rates, particularly among children. However, challenges such as incomplete vaccination data, potential confounding factors, and socio-economic disparities were identified. Despite these challenges, vaccination programs were found to be effective in reducing TB transmission and protecting vulnerable populations from TB infection.  Conclusion The findings highlighted the importance of vaccination programs in TB prevention efforts in Gasabo District, Rwanda. Strengthening vaccination coverage, enhancing healthcare system capacity, addressing socio-economic determinants, fostering collaborations, promoting research and innovation, and strengthening surveillance and monitoring systems are essential for optimizing TB prevention efforts. By implementing these recommendations, we can accelerate progress towards ending the TB epidemic and improving public health outcomes in Gasabo District and beyond.

Revisiting Bacille Calmette‐Guérin revaccination strategies: timing of immunization, Mycobacterium tuberculosis and non‐tuberculous mycobacteria infections, strain potency and standardization of randomized controlled trials

AbstractThe persistent threat of tuberculosis (TB) on a global scale hasprompted a reevaluation of preventive strategies, with a particular focus onthe Bacille Calmette‐Guérin (BCG) vaccine's role in revaccination. Theresurgence underscores an urgent need for enhanced measures, prompting acritical examination of BCG revaccination strategies. Drawing from the researchof Paulo Cesar Pereira dos Santos and a synthesis of randomized controlledtrials (RCTs), this review identifies key considerations for refining BCGrevaccination's efficacy against Mycobacterium tuberculosis (MTB) andTB. The main body of this review integrates four principal domains essentialfor optimizing BCG revaccination: the timing of revaccination, the assessmentof various BCG strains, the evaluation of the vaccine's effectiveness on MTBand non‐tuberculous mycobacteria (NTM) strains, and the enhancement of RCTmethodologies. Determining the optimal revaccination timing is paramount forbolstering immunity, especially in regions with high TB prevalence. Theanalysis of different BCG strains provides insights into strain‐specificimmunogenicity, informing vaccine deployment strategies. Additionally,understanding the vaccine's impact on a range of mycobacterial infections iscrucial for its broader application in various microbial contexts. The reviewemphasizes the refinement of RCT designs to ensure robust and consistentoutcomes, facilitating the reproducibility of results in diverse settings. Itproposes a strategy that not only suggests modifications to revaccinationpractices to increase global TB prevention effectiveness but also calls forcontinuous research to improve BCG revaccination methodologies. The paperadvocates for a standardized, evidence‐driven approach to global TB preventionthat takes into account regional epidemiological differences. In conclusion,this review significantly contributes to the discourse on TB prevention,advocating for evidence‐based, standardized approaches that could potentiallytransform the role of BCG revaccination in global TB prevention efforts. Thefindings support current initiatives aimed at developing policies based onsolid evidence, ensuring the scientific integrity and practical relevance ofBCG revaccination strategies.

The Relationship of the Level of Community Knowledge in the Family Environment with Tuberculosis Prevention Efforts

Tuberculosis is a disease that is transmitted very quickly. One way of transmitting Tuberculosis is through droplet nuclei when a patient coughs or sneezes, especially to those closest to the patient, namely the family who lives in the same house as the patient. Poor family and community knowledge about Tuberculosis have a greater risk of increasing Tuberculosis cases, while families and communities who have good knowledge about Tuberculosis can reduce the incidence of Tuberculosis cases. To determine the relationship between the level of community knowledge and efforts to prevent tuberculosis in the Pariaman Community Health Center work area in 2022. This research is correlational with a cross-sectional study approach. that of the 48 respondents, the majority of 37 (77.10%) people had a high level of public knowledge about preventing tuberculosis. more than 35 (72.90%) people experienced good Tuberculosis Prevention Efforts. It is known that tuberculosis prevention efforts are greater among respondents who have high knowledge than respondents who have low knowledge (68.80% and 4.20%) people. Based on statistical tests using chi-square, the p-value = 0.00 (p-value < α 0.05) means there is a significant relationship between the level of community knowledge and efforts to prevent tuberculosis. According to the researchers' analysis, knowledge and prevention efforts must be in sync because efforts to prevent lack of knowledge do not occur well, so knowledge and prevention efforts must work well and reduce the number of TB diseases that occur. Most of the community's level of knowledge regarding tuberculosis prevention efforts. Most efforts to prevent tuberculosis are good. There is a significant relationship between the level of community knowledge and efforts to prevent tuberculosis in the Pariaman Community Health Center working area in 2022.

THE EFFECTIVENESS OF HEALTH EDUCATION USING VIDEO MEDIA ON KNOWLEDGE OF PULMONARY TB PREVENTION IN NURSING STUDENT IN WAMENA

Indonesia is the fifth country in Southeast Asia with the most cases of pulmonary TB. Papua is one of the provinces with a high incidence of pulmonary TB. One of the efforts to reduce the number of pulmonary TB is providing health education about tuberculosis prevention efforts using audiovisual media. This study aims to determine the effectiveness of health education using video media on knowledge of pulmonary TB prevention. The research used the design of The One Group Pre Test – Post Test, with the type of research being Quasi Experiment. It was carried out in the Wamena Nursing DIII Study Program with a sample of 32 respondents. Respondents were given a pre-test questionnaire and a health education intervention using video. After ten days of providing health education, respondents were given a questionnaire (post-test). Statistical analysis using Wilcoxon. The results showed a significant increase in knowledge about pulmonary TB prevention between the pre-test and post-test (p=0.000). It was concluded that health education using audiovisual media was more effective in providing information on the prevention of pulmonary TB.

Hubungan Pengetahuan dan Sikap Masyarakat dengan Upaya Pencegahan Tuberkulosis Paru

Tuberculosis is still a very widespread disease found in developing countries such as Indonesia in both children and adults, which is also a source of infection. This disease is easily transmitted through droplets of people infected with bacilli. The purpose of this study was to determine whether there was a relationship between knowledge and attitudes toward pulmonary tuberculosis prevention efforts in Legok Village, Jambi City. This research is a quantitative descriptive study with a correlational design. The sample was taken by accidental random sampling and using a questionnaire instrument. This research was conducted on 9-11 August 2022 in Legok Village, Jambi City. The population in this study was the entire community in Legok Village; the results of the study were analyzed univariately and bivariately using the Spearman Rank test. Based on the research, it was found that from 30 respondents, knowledge had a correlation coefficient of 0.73. From 30 respondents, attitudes had a correlation coefficient of 0.45. It was concluded that there was a relationship between knowledge and efforts to prevent pulmonary tuberculosis in Legok Village, Jambi City. There is a relationship between attitudes and efforts to prevent pulmonary tuberculosis in Legok Village, Jambi City

Efektif Pengetahuan dan Sikap Masyarakat Dalam Upaya Pencegahan Tuberkulosis

Knowledge directly affects a person; attitudes arise due to the presence of knowledge from the individual. Tuberculosis is an infectious disease that causes death. Tuberculosis is transmitted through the air and is influenced by risk factors that play a role in transmission, such as people's attitudes, knowledge, and behaviour. This study aims to determine the influence of knowledge and community attitudes in preventing tuberculosis. The research design uses a descriptive survey with an observational approach. Accidental sampling method with a total of 52 respondents. Research instruments using questionnaires and observation sheets. Data analysis with multivariate linear regression test. The results of the statistical knowledge test with a p-value: of 0.811, an attitude of 0.599 and a multivariate logistic regression test showed that among the variables of understanding and attitude, the knowledge variable was more significantly related to efforts to prevent tuberculosis, as evidenced by the sig value. P value: 0.997 and Exp (B) 2.256. It can be concluded that the attitude and towards tuberculosis prevention efforts, but knowledge has partial value to Tubercollusis prevention efforts. Suggestions need to be made to educate them massively and continuously about tuberculosis, which are main causes, ways of transmission, and prevention.

Association of Area-Based Socioeconomic Measures with Tuberculosis Incidence in California

We assessed the association of area-based socio-economic status (SES) measures with tuberculosis (TB) incidence in California. We used TB disease data for 2012–2016 (n = 9901), population estimates, and SES measures to calculate incidence rates, rate ratios, and 95% confidence intervals (95% CI) by SES and birth country. SES was measured by census tract and was categorized by quartiles for education, crowding, and the California Healthy Places Index (HPI)and by specific cutoffs for poverty. The lowest SES areas defined by education, crowding, poverty, and HPI had 39%, 40%, 41%, and 33% of TB cases respectively. SES level was inversely associated with TB incidence across all SES measures and birth countries. TB rates were 3.2 (95% CI 3.0–3.4), 2.1 (95% CI 1.9–2.2), 3.6 (95% CI 3.3–3.8), and 2.0 (95% CI 1.9–2.1) times higher in lowest SES areas vs. highest SES areas as defined by education, crowding, poverty and HPI respectively. Area-based SES measures are associated with TB incidence in California. This information could inform TB prevention efforts in terms of materials, partnerships, and prioritization.

Tentang Upaya Pencegahan Penularan Tuberculosis Paru Hubungan Tingkat Pengetahuan dengan Sikap Masyarakat

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Tuberculosis is still a global public health problem that is a worldwide challenge. One of the causes of the lack of general knowledge in efforts to prevent the transmission of Tuberculosis is the lack of information and education from health workers or posyandu cadres about Tuberculosis, resulting in a lack of public knowledge about Tuberculosis. This study aims to explain "Correlation Between Knowledge Level And Attitude Of The Community About The Prevention Of Transmission Of Lung Tuberculosis" based on data through the Literature Review method. They are using the Literature Review method. Journal searches use an academic database, namely Google Scholar, published in 2017-2020 using Indonesian and English. Cross-sectional study design. Of the six journals, three journals state a relationship between knowledge and public attitudes about efforts to prevent Tuberculosis transmission p value = 0.05). At the same time, three journals say that there is no relationship between knowledge and measures to avoid Tuberculosis, but there is a relationship between attitudes and Tuberculosis prevention efforts. One of the causes of the lack of public knowledge in efforts to prevent the transmission of Tuberculosis is the lack of information and education from health workers or posyandu cadres about Tuberculosis, causing a lack of public knowledge about Tuberculosis. Other factors that can influence a person's attitude such as family, the influence of friends, personal experience, and information obtained from various sources.

Literature Review: Hubungan Pengetahuan terhadap Sikap Masyarakat tentang Upaya Pencegahan Penularan Tuberculosis

Tuberculosis is an infectious disease caused by the bacteria Mycobacterium tuberculosis. Tuberculosis is still a global public health problem that is a global challenge. One of the causes of the lack of public knowledge in efforts to prevent the transmission of Tuberculosis is the lack of information and education from health workers cadres about Tuberculosis, resulting in a lack of public knowledge about Tuberculosis. This study aims to explain " Correlation Between Knowledge Level And Attitude Of The Community About The Prevention Of Transmission Of Lung Tuberculosis" based on data through the Literature Review method. Using the Literature Review method. Journal searches use an academic database, namely Google Scholar which was published in 2017-2020 using Indonesian and English. Cross-sectional study design. Of the 6 journals, there are 3 journals that state that there is a relationship between knowledge and public attitudes about efforts to prevent Tuberculosis transmission with a p-value = 0.05). while 3 journals state that there is no relationship between knowledge and efforts to prevent Tuberculosis there is a relationship between attitudes and Tuberculosis prevention efforts. One of the causes of the lack of public knowledge in efforts to prevent the transmission of Tuberculosis is the lack of information and education from health workers or posyandu cadres about Tuberculosis, causing a lack of public knowledge about Tuberculosis. Other factors that can influence a person's attitude such as family, the influence of friends, personal experience, and information obtained from various sources.

High-resolution estimates of tuberculosis incidence among non-U.S.-born persons residing in the United States, 2000–2016

In the United States, new tuberculosis cases are increasingly concentrated within non-native-born populations. We estimated trends and differences in tuberculosis incidence rates for the non-U.S.-born population, at a resolution unobtainable from raw data.We obtained non-U.S.-born tuberculosis case reports for 2000–2016 from the National Tuberculosis Surveillance System, and population data from the American Community Survey and 2000 U.S. Census. We constructed generalized additive regression models to estimate incidence rates in terms of birth country, entry year, age at entry, and number of years since entry into the United States and described how these factors contribute to overall tuberculosis risk.Controlling for other factors, tuberculosis incidence rates were lower for more recent immigration cohorts, with an incidence risk ratio (IRR) of 10.2 (95 % confidence interval 7.0, 14.7) for the 1950 entry cohort compared to its 2016 counterpart. Greater years since entry and younger age at entry were associated with substantially lower incidence rates. IRRs for birth country varied between 8.86 (6.78, 11.52) for Somalia and 0.02 (0.01, 0.03) for Canada, compared to all non-U.S.-born residents in 2016. IRRs were positively correlated with WHO predicted incidence rate and negatively associated with wealth level for the birth country. Lower country wealth level was also associated with shallower declines in tuberculosis over time.Tuberculosis risks differ by several orders of magnitude within the non-U.S.-born population. A better understanding of these differences will allow more effective targeting of tuberculosis prevention efforts. The methods presented here may also be relevant for understanding tuberculosis trends in other high-income countries.

Pengaruh Pendidikan Kesehatan terhadap Perilaku Keluarga Penderita TB dalam Upaya Penanggulangan TB Dewasa di Kabupaten ABC Sumatera Barat

Tuberculosis (TB) is an infectious disease that attacks the lungs and other organs caused by mycobacterium tuberculosis. Tuberculosis is one of the biggest contributors to death in the world. Various TB control efforts have been undertaken by the government but have not yet reached maximum results. In efforts to control TB, it takes the role of the family in caring for family members who suffer from TB. This study aims to determine the effect of health education on family behavior in TB prevention efforts in one district in West Sumatra. The sample of this study was the families of adult TB sufferers in Dharmasraya District who met the inclusion criteria of 30 people consisting of intervention and control groups. Data collection using a questionnaire. The results showed that there was an influence of health education on the family behavior of TB patients in efforts to overcome adult TB including pre-test knowledge (p value 0.044) and post test (p value 0.001), pre-test attitude (p value 0.325) and post test (p value 0.001 ), pre test (p value 0.348) and post test (p value 0.001). Health education can change family behavior in TB control efforts. It is hoped that further researchers will develop a family monitoring book for TB sufferers.

Trends in tuberculosis incidence rates in the Region of Sousse (Tunisia) from 1992 to 2016

Abstract Introduction In 1993, the World Health Organization declared that tuberculosis is a public health emergency of global concern. All efforts were made in accordance with the Millennium Development Goals (MDGs) to reduce the burden of Tuberculosis. The MDG framework built into national priorities and development strategies has, in fact, strengthened epidemiological surveillance and the use of reliable data to make decisions based on objective data. These data are essential for planning, managing the activities of the National Tuberculosis program, monitoring and ongoing evaluation of its performance. In this context, we conducted this study to trace the trend of Tuberculosis incidence rate recorded in the Sousse Region between 1992 and 2016. Methods This is a longitudinal study of the registered data of tuberculosis cases in Sousse between 1992 and 2016. For the trend analysis the software JOINPOINT version 4.5.0.1 was used. This software offers the closest possible regression model of the different points and gives an annual percentage change (APC) with a 95% confidence interval. Results The highest TB incidence rates was recorded in 1993 (85.66 cases per 100 000 inhabitants). Between 1992 and 1997, there was a significant downward trend of TB incidence (APC = -23.2; 95% CI [-28.8, 1]). Between 1997 and 2004 the trend was stable. Between 2004 and 2016, there was a significant upward trend (APC = 8.3; 95% CI: [4.3, 12.4]). Conclusions At the national level, between 1992 and 2002, tuberculosis experienced a fall in incidence rates, as a result of an improvement in the socio-economic level and the organization of tuberculosis control. Since 2004, the trend has been rising. Increased tuberculosis control is advocated to end tuberculosis by 2030 in line with sustainable development goals. Key messages After a significant decrease, the tuberculosis incidence has increased significantly since 2004. The tuberculosis prevention efforts should be intensified to reverse the current trend.

Tuberculosis in Nepal: Situation, Challenges and Ways Forward

Introduction: Globally, tuberculosis is a major public health problem. Moreover, the emergence of drug resistant forms of TB has threatened TB prevention and treatment efforts. Despite the long history of tuberculosis prevention efforts, tuberculosis still ranks among the top ten causes of deaths in Nepal. Furthermore, Nepal being land locked with two high TB burden countries i.e. India and China, it has added difficulties to National Tuberculosis program. Hence this study aims to review the situation of National Tuberculosis Program in Nepal and explore the possible challenges and ways forward for NTP to strengthen the TB diagnostics and treatment services in Nepal.
 Methods: This study is based on the review of available literatures and data sources related to tuberculosis prevention, care and control. Secondary data published by National Tuberculosis Program in the annual report for the year 2015, 2016 and 2017 were considered for the situation analysis of tuberculosis in Nepal. We used different platforms like Google scholar, PubMed to search relevant literatures.
 Results: This has been a huge gap between WHO TB estimates and TB cases notification by the national system. It was 22% in 2015, 27% in 2016 and 29% in 2017. However National Tuberculosis Program has maintained treatment success rate consistently above 90%. Tuberculosis program has yet not achieved universal HIV testing, although HIV testing among TB patients has increased rapidly. Similarly, only 75%, 1994 received DST out of 2601 retreatment TB cases have received DST in 2017 despite guideline suggest mandatory drug susceptibility testing for retreatment TB cases.
 Conclusion: Case notification has reduced gradually. It is difficult to achieve the target envisioned by NSP 2016-21 if the current case notification trend persists. NTP needs to expand service sites ensuring minimum quality standards as well as scale up targeted intervention addressing human right issues to identify the missing TB cases. NTP needs to regulate the quality of diagnosis and treatment TB services offered by private sector.

Progression of chronic kidney disease and the risk of tuberculosis: an observational cohort study.

<sec id="st1"> <title>BACKGROUND</title> Little is known about tuberculosis (TB) risk in the earlier stages of chronic kidney disease (CKD). </sec> <sec id="st2"> <title>OBJECTIVE</title> To investigate the relationship between CKD at all stages and the risk of incident TB. </sec> <sec id="st3"> <title>METHODS</title> We conducted a cohort study using 100 058 participants of a community-based health screening programme in northern Taiwan, 2005-2008. Renal function was ascertained at baseline using serum creatinine level and the urine dipstick test. The occurrence of active TB was ascertained using the National Tuberculosis Registry. Cox proportional hazards regression was used to estimate the association between CKD and TB. </sec> <sec id="st4"> <title>RESULTS</title> During a median follow-up of 7.5 years, TB incidence was 472. In the Cox regression analyses, individuals with Stage 1-4 CKD had a 25% increase in TB hazard than those without disease (adjusted hazard ratio [aHR] 1.25, 95%CI 1.02-1.54). A positive correlation between CKD stage and TB was observed (P = 0.02 for trend). TB risk increased by 5.1% with every 10 ml/min/1.73 m² decrease in the estimated glomerular filtration rate (aHR 1.05, 95%CI 0.99-1.12). </sec> <sec id="st5"> <title>CONCLUSIONS</title> Our results suggested an increased risk of TB in early-stage CKD. TB prevention efforts should consider individuals with earlier stages of CKD. </sec>.

752. Geographic Analysis of Latent Tuberculosis Screening: A Health System Approach

BackgroundTargeted testing and treatment of latent tuberculosis infection is a key element of tuberculosis (TB) elimination in the United States. In particular, foreign-born persons from TB-endemic countries are high priority for latent TB screening.MethodsWe used the DEDUCE interface to query the electronic medical records of all patients presenting to Duke University Health System from January 1, 2010 to November 1, 2017. Latent tuberculosis screening was identified using CPT codes for the tuberculin skin test (TST) and/or interferon gamma release assays (IGRA). Patients’ home addresses were mapped to census tracts; demographic data for these tracts were obtained from the American Community Survey. Higher-risk foreign born persons were defined as persons born in Africa, Asia, or Latin America.ResultsThirty-six thousand eight hundred and twenty-five patients received 48,419 TSTs and 5,366 received 5,746 IGRAs during the study period. Excluding census tracts with fewer than 20 Health System patients (to reduce referral bias), census tracts with a higher proportion of higher risk residents had a greater proportion of Health System patients screened for latent TB (P < 0.001, figure). Health system patients residing in census tracts with greater proportions of higher risk foreign born residents were more likely to be screened with TST than with an IGRA (P < 0.001).ConclusionLatent TB screening was significantly but weakly associated with a greater proportion of higher risk foreign born persons in a given census tract, and persons residing in such tracts were more likely to be screened with TST, which is not preferred due to cross-reaction with the BCG vaccine. Focusing latent TB screening on higher risk areas and using more IGRAs will be necessary to optimize TB prevention efforts. Disclosures All authors: No reported disclosures.

Latent tuberculosis infection: Opportunities and challenges.

Diagnosing and treating latent tuberculosis (TB) infection (LTBI) is recognized by the World Health Organization as an important strategy to accelerate the decline in global TB and achieve TB elimination. Even among low-TB burden countries that have achieved high rates of detection and successful treatment for active TB, a number of barriers have prevented implementing or expanding LTBI treatment programmes. Of those infected with TB, relatively few will develop active disease and the current diagnostic tests have a low predictive value. LTBI treatment using isoniazid (INH) has low completion rates due to the long duration of therapy and poor tolerability. Both patients and physicians often perceive the risk of toxicity to be greater than the risk of reactivation TB. As a result, LTBI treatment has had a limited or negligible role outside of countries with high resources and low burden of disease. New tools have emerged including the interferon-gamma release assays that more accurately diagnose LTBI, particularly in people vaccinated with Bacillus Calmette-Guerin (BCG). Shorter, better tolerated treatment using rifamycins are proving safe and effective alternatives to INH. While still imperfect, TB prevention using these new diagnostic and treatment tools appear cost effective in modelling studies in the United States and have the potential to improve TB prevention efforts globally. Continued research to understand the host-organism interactions within the spectrum of LTBI is needed to develop better tools. Until then, overcoming the barriers and optimizing our current tools is essential for progressing toward TB elimination.

Transmission of Mycobacterium Tuberculosis in Households and the Community: A Systematic Review and Meta-Analysis.

The individual- and population-level impact of household tuberculosis exposure on transmission is unclear but may have implications for the effectiveness and implementation of control interventions. We systematically searched for and included studies in which latent tuberculosis infection was assessed in 2 groups: children exposed and unexposed to a household member with tuberculosis. We also extracted data on the smear and culture status of index cases, the age and bacillus Calmette-Guérin vaccination status of contacts, and study design characteristics. Of 6,176 citations identified from our search strategy, 26 studies (13,999 children with household exposure to tuberculosis and 174,097 children without) from 1929-2015 met inclusion criteria. Exposed children were 3.79 (95% confidence interval (CI): 3.01, 4.78) times more likely to be infected than were their community counterparts. Metaregression demonstrated higher infection among children aged 0-4 years of age compared with children aged 10-14 years (ratio of odds ratios=2.24, 95% CI: 1.43, 3.51) and among smear-positive versus smear-negative index cases (ratio of odds ratios=5.45, 95% CI: 3.43, 8.64). At the population level, we estimated that a small proportion (<20%) of transmission was attributable to household exposure. Our results suggest that targeting tuberculosis prevention efforts to household contacts is highly effective. However, a large proportion of transmission at the population level may occur outside the household.

Mycobacterium tuberculosis in solid organ transplantation: incidence before and after expanded isoniazid prophylaxis.

The risk of tuberculosis is increased in solid organ transplantation. Rates remain high in developed and developing countries. We developed protocols to better identify transplant recipients at risk of tuberculosis and initiate interventions to prevent tuberculosis. Report tuberculosis incidence in solid-organ transplant recipients and the results of expanded isoniazid prophylaxis in deceased-donor renal transplantation. Retrospective cohort study, comparing two time periods. Large transplantation center in a WHO-medium endemicity country for tuberculosis. In a cohort of all solid-organ transplant recipients performed between 2003 and 2012, tuberculosis-free transplantation follow-up is used for incidence calculation. Rates of tuberculosis in renal transplant recipients are compared before and after implementation of expanded isoniazid prophylaxis. Active tuberculosis post-transplantation. Of 1966 solid-organ transplant recipients (kidney: 1391, liver: 426, heart: 114, lung: 35), 20 recipients (1.02%) developed tuberculosis. Twelve cases (60%) developed tuberculosis within one year of transplantation. The incidence was 248 cases per 100 000 transplant-years. The proportion of transplant recipients (incidence of tuberculosis per 100 000 transplant-years) for specific organs were kidney 0.58% (127), liver 1.88% (594), heart: 1.75% (570), and lung 5.71% (4750). In the survival analysis, lung transplant recipients had significantly higher rates of tuberculosis compared to recipients of kidneys from living donors (P=.0001) with a rate ratio of 45.3 (95% CI: 7-313). Mortality was 5% among tuberculosis patients. After implementing expanded isoniazid prophylaxis among deceased-donor kidney recipients, no tuberculosis occurred in 177 recipients, compared to 3 out of 155 (2%) recipients before implementation. Rates of tuberculosis among our solid transplant recipients are decreasing. Universal iso-niazid prophylaxis in transplant recipients could reduce transplant-associated tuberculosis in endemic areas. Donor data on tuberculosis exposure and prevention and tuberculosis prevention efforts before referral to our center are not available for all patients.