Control Of Tuberculosis Transmission Research Articles

Evaluation of Clinical and Economic Efficiency and Impact of Mass Fluorography Screening on Tuberculosis Epidemiological Rates in Four Federal Districts of the Russian Federation with Different Levels of Population Coverage with Mass Fluorography Screening

The objective: to evaluate the clinical and economic efficiency and impact of mass fluorography screening of the population on tuberculosis mortality and rates of timely tuberculosis detection in four federal districts of the Russian Federation with different levels of tuberculosis detection and coverage of the population with fluorography mass screening.Subjects and Methods. Analytical materials of the Federal Center for Monitoring of Tuberculosis Transmission Control in the Russian Federation posted on official websites were used. The rates were analyzed by applied statistics methods. All statistical calculations were performed with 0.95 significance.Results. A correlation analysis was performed between the coverage, effectiveness of tuberculosis detection by mass fluorography screening of the population and main rates reflecting the epidemic situation and timeliness of tuberculosis detection in the Russian Federation and its four federal districts. There was no correlation between the detection effectiveness and main markers of timeliness of tuberculosis detection. It was found out that against the background of increased costs for mass fluorography screening, its implementation did not provide significant positive results in reducing tuberculosis incidence and mortality which indicated their low clinical and economic efficiency.

Diagnostic accuracy of different bronchoscopic specimens in sputum Xpert MBT/RIF- negative pulmonary TB patients.

Tuberculosis (TB) control remains a critical public health problem worldwide. Rapid diagnosis and proper treatment are beneficial for the effective control of tuberculosis transmission. Diagnostic challenges arise when a patient has a clinical and radiological suspicion of tuberculosis but cannot produce sputum, sputum acid-fast bacilli, or Xpert Mycobacterium tuberculosis/rifampicin (Xpert MTB/RIF) is negative, resulting in suboptimal management. As a result, more invasive techniques must be used on these patients to establish the diagnosis. A retrospective study recruited 330 suspected pulmonary TB patients with negative sputum of Xpert MBT/RIF who underwent bronchoscopy between March 2018 and December 2021. The diagnostic yields of bronchoalveolar lavage fluid (acid-fast bacilli, Xpert MTB/RIF, and culture) and histopathologic examination (HPE) were calculated and compared to the final diagnosis and culture as a gold standard. Out of 330 suspected pulmonary TB patients, 181 had a final diagnosis of TB, and 149 had non-TB. The sensitivity of BALF (culture, Xpert, acid-fast bacilli) and trans-bronchial lung biopsy (HPE) was 80.7%, 72.9%, 21.1%, and 87.1%, respectively. Multiple nodules were associated with significantly higher BALF Xpert MTB, bronchoalveolar lavage fluid culture, and trans-bronchial lung biopsy (HPE) positivity. Bronchoscopic specimens are essential for accurate and rapid diagnosis of sputum Xpert MBT/RIF negative patients with high clinical and radiological suspicion of tuberculosis.

Chapter 14: Prevention and control of tuberculosis transmission in healthcare settings

Chapter 14: Prevention and control of tuberculosis transmission in healthcare settings

A New Surveillance Model of Tuberculosis Transmission Control Based on Geographic Information System in the Primary Health Care.

Tuberculosis can cause a substantial challenge against public health, especially in the developing countries which have low level of socio-economic condition that does not support the control over tuberculosis transmission and infection. To find a new surveillance model of tuberculosis transmission control based on geographic information system data in improving the tuberculosis transmission control and treatment outcome. Effectiveness test of the self-monitoring of calendar documentation on the tuberculosis transmission control and outcome treatment with quasi-experimental post-test only with control group design. The analytical unit consisted of 96 tuberculosis cases as the self-monitoring group of calendar documentation (intervention) and 87 tuberculosis cases as the control group sourced of two different primary health care. The self-monitoring intervention of calendar documentation increased the average treatment effect on medicines intake control 0.11 (95% CI: 0.01-0.21), environment control 0.32 (95% CI: 0.19-46), droplets nuclei control 0.49 (95% CI: 0.36-0.61), cured 0.22 (95% CI: 0.09-0.36), completed 0.18 (95% CI: 0.09-0.26), drop out 0.09 (95% CI: 0.01-0.16), and failure of treatment 0.18 (95% CI: 0.09-0.26) of the control group (baseline). The final result of this research found a new surveillance model of tuberculosis transmission control in google earth mapping aplication based on Geographic Information system.

FAST tuberculosis transmission control strategy speeds the start of tuberculosis treatment at a general hospital in Lima, Peru.

Objective:To evaluate the effect of the FAST (Find cases Actively, Separate safely, Treat effectively) strategy on time to tuberculosis diagnosis and treatment for patients at a general hospital in a tuberculosis-endemic setting.Design:Prospective cohort study with historical controls.Participants:Patients diagnosed with pulmonary tuberculosis during hospitalization at Hospital Nacional Hipolito Unanue in Lima, Peru.Methods:The FAST strategy was implemented from July 24, 2016, to December 31, 2019. We compared the proportion of patients with drug susceptibility testing and tuberculosis treatment during FAST to the 6-month period prior to FAST. Times to diagnosis and tuberculosis treatment were also compared using Kaplan-Meier plots and Cox regressions.Results:We analyzed 75 patients diagnosed with pulmonary tuberculosis through FAST. The historical cohort comprised 76 patients. More FAST patients underwent drug susceptibility testing (98.7% vs 57.8%; OR, 53.8; P < .001), which led to the diagnosis of drug-resistant tuberculosis in 18 (24.3%) of 74 of the prospective cohort and 4 (9%) of 44 of the historical cohort (OR, 3.2; P = .03). Overall, 55 FAST patients (73.3%) started tuberculosis treatment during hospitalization compared to 39 (51.3%) controls (OR, 2.44; P = .012). FAST reduced the time from hospital admission to the start of TB treatment (HR, 2.11; 95% CI, 1.39–3.21; P < .001).Conclusions:Using the FAST strategy improved the diagnosis of drug-resistant tuberculosis and the likelihood and speed of starting treatment among patients with pulmonary tuberculosis at a general hospital in a tuberculosis-endemic setting. In these settings, the FAST strategy should be considered to reduce tuberculosis transmission while simultaneously improving the quality of care.

Evolution Control for parallel ANN-assisted simulation-based optimization application to Tuberculosis Transmission Control

In many optimal design searches, the function to optimize is a simulator that is computationally expensive. While current High Performance Computing (HPC) methods are not able to solve such problems efficiently, parallelism can be coupled with approximate models (surrogates or meta-models) that imitate the simulator in timely fashion to achieve better results. This combined approach reduces the number of simulations thanks to surrogate use whereas the remaining evaluations are handled by supercomputers. While the surrogates’ ability to limit computational times is very attractive, integrating them into the overarching optimization process can be challenging. Indeed, it is critical to address the major trade-off between the quality (precision) and the efficiency (execution time) of the resolution. In this article, we investigate Evolution Controls (ECs) which are strategies that define the alternation between the simulator and the surrogate within the optimization process. We propose a new EC based on the prediction uncertainty obtained from Monte Carlo Dropout (MCDropout), a technique originally dedicated to quantifying uncertainty in deep learning. Investigations of such uncertainty-aware ECs remain uncommon in surrogate-assisted evolutionary optimization. In addition, we use parallel computing in a complementary way to address the high computational burden. Our new strategy is implemented in the context of a pioneering application to Tuberculosis Transmission Control. The reported results show that the MCDropout-based EC coupled with massively parallel computing outperforms strategies previously proposed in the field of surrogate-assisted optimization.

Parallel surrogate-assisted optimization: Batched Bayesian Neural Network-assisted GA versus q-EGO

Surrogate-based optimization is widely used to deal with long-running black-box simulation-based objective functions. Actually, the use of a surrogate model such as Kriging or Artificial Neural Network allows to reduce the number of calls to the CPU time-intensive simulator. Bayesian optimization uses the ability of surrogates to provide useful information to help guiding effectively the optimization process. In this paper, the Efficient Global Optimization (EGO) reference framework is challenged by a Bayesian Neural Network-assisted Genetic Algorithm, namely BNN-GA. The Bayesian Neural Network (BNN) surrogate is chosen for its ability to provide an uncertainty measure of the prediction that allows to compute the Expected Improvement of a candidate solution in order to improve the exploration of the objective space. BNN is also more reliable than Kriging models for high-dimensional problems and faster to set up thanks to its incremental training. In addition, we propose a batch-based approach for the parallelization of BNN-GA that is challenged by a parallel version of EGO, called q-EGO. Parallel computing is a highly important complementary way (to surrogates) to deal with the computational burden of simulation-based optimization. The comparison of the two parallel approaches is experimentally performed through several benchmark functions and two real-world problems within the scope of Tuberculosis Transmission Control (TBTC). The study presented in this paper proves that parallel batched BNN-GA is a viable alternative to q-EGO approaches being more suitable for high-dimensional problems, parallelization impact, bigger data-bases and moderate search budgets. Moreover, a significant improvement of the solutions is obtained for the two TBTC problems tackled.

Trends in Mycobacterium tuberculosis Transmission During a 10-year Period (2006-2016) in the Northwest of Iran by MIRU-VNTR Molecular Typing

Background: Mycobacterium tuberculosis is one of the biggest health challenges all over the world. The Caucasian region is one of the places with a high prevalence of drug-resistant M. tuberculosis. Objectives: In this study, we aimed to investigate the trends in M. tuberculosis transmission during a 10-year period in the northwest of Iran. Methods: We collected 166 M. tuberculosis isolates from 2005 to 2006 and 119 M. tuberculosis isolates from 2015 to 2016 and subjected them to MIRU-VNTR and ETR-VNTR typing by a polymerase chain reaction and compared them by phylogenic tools. Results: In the 2006 isolates, 104 different patterns were observed including 75 unique patterns and 91 isolates were clustered in 29 different clusters. In the 2016 isolates, 98 different patterns were observed with 86 unique patterns and 33 isolates were clustered in 12 different clusters. One cluster had a shared member from the 2006 and 2016 isolates, indicating the transmission of a single isolate during these years. The minimum estimate for the tuberculosis proportion, which is due to the recent transmission of tuberculosis, was 36.7% for the 2006 isolates and 17.6% for the 2016 isolates. Conclusions: In spite of the reduced number of tuberculosis patients, the isolates were more resistant and had a close relationship with worldwide strains. Cross-border immigration for treatment from Republic of Azerbaijan had significant participation in the recent transmission of tuberculosis in this region. In conclusion, the strict control of patients commuting and developing new tuberculosis clinics inside Republic of Azerbaijan can play a key role in the control of tuberculosis transmission in the northwest of Iran.

Review of economic evaluations of mask and respirator use for protection against respiratory infection transmission.

BackgroundThere has been increasing debate surrounding mask and respirator interventions to control respiratory infection transmission in both healthcare and community settings. As decision makers are considering the recommendations they should evaluate how to provide the most efficient protection strategies with minimum costs. The aim of this review is to identify and evaluate the existing economic evaluation literature in this area and to offer advice on how future evaluations on this topic should be conducted.MethodsWe searched the Scopus database for all literature on economic evaluation of mask or respirator use to control respiratory infection transmission. Reference lists from the identified studies were also manually searched. Seven studies met our inclusion criteria from the initial 806 studies identified by the search strategy and our manual search.ResultsFive studies considered interventions for seasonal and/or pandemic influenza, with one also considering SARS (Severe Acute Respiratory Syndrome). The other two studies focussed on tuberculosis transmission control interventions. The settings and methodologies of the studies varied greatly. No low-middle income settings were identified. Only one of the reviewed studies cited clinical evidence to inform their mask/respirator intervention effectiveness parameters. Mask and respirator interventions were generally reported by the study authors to be cost saving or cost-effective when compared to no intervention or other control measures, however the evaluations had important limitations.ConclusionsGiven the large cost differential between masks and respirators, there is a need for more comprehensive economic evaluations to compare the relative costs and benefits of these interventions in situations and settings where alternative options are potentially applicable. There are at present insufficient well conducted cost-effectiveness studies to inform decision-makers on the value for money of alternative mask/respirator options.

Association of the FCN2 Gene Single Nucleotide Polymorphisms with Susceptibility to Pulmonary Tuberculosis.

Ficolin-2 (FCN2) is an innate immune pattern recognition molecule that can activate the complement pathway, opsonophagocytosis, and elimination of the pathogens. The present study aimed to investigate the association of the FCN2 gene single nucleotide polymorphisms (SNPs) with susceptibility to pulmonary tuberculosis (TB). A total of seven SNPs in exon 8 (+6359 C>T and +6424 G>T) and in the promoter region (-986 G>A, -602 G>A, -557 A>G, -64 A>C and -4 A>G) of the FCN2 gene were genotyped using the PCR amplification and DNA sequencing methods in the healthy controls group (n = 254) and the pulmonary TB group (n = 282). The correlation between SNPs and pulmonary TB was analyzed using the logistic regression method. The results showed that there were no significant differences in the distribution of allelic frequencies of seven SNPs between the pulmonary TB group and the healthy controls group. However, the frequency of the variant homozygous genotype (P = 0.037, -557 A>G; P = 0.038, -64 A>C; P = 0.024, +6424 G>T) in the TB group was significantly lower than the control group. After adjustment for age and gender, these variant homozygous genotypes were found to be recessive models in association with pulmonary TB. In addition, -64 A>C (P = 0.047) and +6424 G>T (P = 0.03) were found to be codominant models in association with pulmonary TB. There was strong linkage disequilibrium (r2 > 0.80, P < 0.0001) between 7 SNPs except the -602 G>A site. Therefore, -557 A>G, -64 A>C and +6424 G>T SNPs of the FCN2 gene were correlated with pulmonary TB, and may be protective factors for TB. This study provides a novel idea for the prevention and control of TB transmission from a genetics perspective.

Regional transport and its association with tuberculosis in the Shandong province of China, 2009–2011

Human mobility has played a major role in the spread of infectious diseases such as tuberculosis (TB) through transportation; however, its pattern and mechanism have remained unclear. This study used transport networks as a proxy for human mobility to generate the spatial process of TB incidence. It examined the association between TB incidence and four types of transport networks at the provincial level: provincial roads, national roads, highways, and railways. Geographical information systems and geospatial analysis were used to examine the spatial distribution of 2217 smear-positive TB cases reported between 2009 and 2011 in the Shandong province. The study involved factors such as population density and elevation difference in conjunction with the types of transport networks to predict the disease occurrence in space. It identified spatial clusters of TB incidence linked not only with transport networks of the regions but also differentiated by elevation. Our research findings provide evidence of targeting populous regions with well-connected transport networks for effective surveillance and control of TB transmission in Shandong.

Genotypic and Spatial Analysis of Mycobacterium tuberculosis Transmission in a High-Incidence Urban Setting.

Genotyping Mycobacterium tuberculosis isolates allows study of dynamics of tuberculosis transmission, while geoprocessing allows spatial analysis of clinical and epidemiological data. Here, genotyping data and spatial analysis were combined to characterize tuberculosis transmission in Vitória, Brazil, to identify distinct neighborhoods and risk factors associated with recent tuberculosis transmission. From 2003 to 2007, 503 isolates were genotyped by IS6110 restriction fragment length polymorphism (RFLP) and spoligotyping. The analysis included kernel density estimation, K-function analysis, and a t test distance analysis. Mycobacterium tuberculosis isolates belonging to identical RFLP patterns (clusters) were considered to represent recent tuberculosis infection (cases). Of 503 genotyped isolates, 242 (48%) were categorized into 70 distinct clusters belonging to 12 RFLP families. The proportion of recent transmission was 34.2%. Kernel density maps indicated 3 areas of intense concentration of cases. K-function analysis of the largest RFLP clusters and families showed they co-localized in space. The distance analysis confirmed these results and demonstrated that unique strain patterns (controls) randomly distributed in space. A logit model identified young age, positive smear test, and lower Index of Quality of Urban Municipality as risk factors for recent transmission. The predicted probabilities for each neighborhood were mapped and identified neighborhoods with high risk for recent transmission. Spatial and genotypic clustering of M. tuberculosis isolates revealed ongoing active transmission of tuberculosis caused by a small subset of strains in specific neighborhoods of the city. Such information provides an opportunity to target tuberculosis transmission control, such as through rigorous and more focused contact investigation programs.

F-A-S-T: a refocused, intensified, administrative tuberculosis transmission control strategy.

TRANSMISSION is driving the global tuberculosis (TB) epidemic, especially where human immunodeficiency virus (HIV) co-infection is prevalent.1,2 More than half of multidrug-resistant TB cases worldwide occur in persons who have not been treated previously, i.e., as a result of transmission.3 Transmission occurs in the community, of course, but TB is believed to spread most efficiently in congregate settings such as hospitals, clinics, prisons and refugee camps. The wellpublicized transmission of extensively drug-resistant TB (XDR-TB) in rural South Africa, and the six-fold higher risk of multidrug-resistant TB (MDR-TB) reported among hospitalized, adherent, drug-susceptible patients in Tomsk, Siberia, are two compelling examples of hospital transmission of drug-resistant TB in very different parts of the world.4,5

Molecular epidemiology and clinical characteristics of drug-resistant Mycobacterium tuberculosis in a tuberculosis referral hospital in China.

BackgroundDespite the large number of drug-resistant tuberculosis (TB) cases in China, few studies have comprehensively analyzed the drug resistance-associated gene mutations and genotypes in relation to the clinical characteristics of M. tuberculosis (Mtb) isolates.Methodology/Principal FindingsWe thus analyzed the phenotypic and genotypic drug resistance profiles of 115 Mtb clinical isolates recovered from a tuberculosis referral hospital in Beijing, China. We also performed genotyping by 28 loci MIRU-VNTR analysis. Socio-demographic and clinical data were retrieved from medical records and analyzed. In total, 78 types of mutations (including 42 previously reported and 36 newly identified ones) were identified in 115 Mtb clinical isolates. There was significant correlation between phenotypic and genotypic drug resistance rates for first-line anti-TB drugs (P<0.001). Genotyping revealed 101 MIRU-VNTR types, with 20 isolates (17.4%) being clustered and 95 isolates (82.6%) having unique genotypes. Higher proportion of re-treatment cases was observed among patients with clustered isolates than those with unique MIRU-VNTR genotypes (75.0% vs. 41.1%). Moreover, clinical epidemiological links were identified among patients infected by Mtb strains belonging to the same clusters, suggesting a potential of transmission among patients.Conclusions/SignificanceOur study provided information on novel potential drug resistance-associated mutations in Mtb. In addition, the genotyping data from our study suggested that enforcement of the implementation of genotyping in diagnostic routines would provide important information for better monitor and control of TB transmission.

Yield of tuberculosis contact investigation in a low-incidence country

Tuberculosis (TB) contact tracing is a valid public health measure to control the spread of TB infection in low-burden settings. The aim of this study was to assess the yield of the Piedmont TB contact investigation program and to evaluate the role of its main determinants. The Piedmont TB notification systems were used to identify index TB cases. All cases were classified by contagiousness (sputum-smear-positive, AFB+; culture-positive, CULT+; other-than-defined). TB contacts were screened for active and latent TB infection by clinical manifestations and Tuberculin Skin Test (TST). 833 index TB cases with at least one contact were identified; 4441 contacts were screened, and 3942 (82.8%) were evaluated. TB contacts aged ≤ 35 years, regular and household contacts had a higher probability of being evaluated; foreign-born TB contacts were the least traceable. Higher rates of TB infection were observed in contacts at 35 years of age or younger who also lived in the same household with index cases or exposed to AFB+ or CULT+ index cases. More efforts should be focused on young TB contacts, since they are likely to be new infections. An early identification and treatment of TB Infection in this group contributes to the prevention and control of TB transmission. The program should also be extended to the contacts of CULT+ cases.

Detection of First- and Second-Line Drug Resistance in Mycobacterium tuberculosis Clinical Isolates by Pyrosequencing

Conventional phenotypic drug susceptibility testing (DST) methods for Mycobacterium tuberculosis are laborious and very time-consuming. Early detection of drug-resistant tuberculosis (TB) is essential for prevention and control of TB transmission. We have developed a pyrosequencing method for simultaneous detection of mutations associated with resistance to rifampin, isoniazid, ethambutol, amikacin, kanamycin, capreomycin, and ofloxacin. Seven pyrosequencing assays were optimized for following loci: rpoB, katG, embB, rrs, gyrA, and the promoter regions of inhA and eis. The molecular method was evaluated on a panel of 290 clinical isolates of M. tuberculosis. In comparison to phenotypic DST, the pyrosequencing method demonstrated high specificity (100%) and sensitivity (94.6%) for detection of multidrug-resistant M. tuberculosis as well as high specificity (99.3%) and sensitivity (86.9%) for detection of extensively drug-resistant M. tuberculosis. The short turnaround time combined with multilocus sequencing of several isolates in parallel makes pyrosequencing an attractive method for drug resistance screening in M. tuberculosis.

The application of ultraviolet germicidal irradiation to control transmission of airborne disease: bioterrorism countermeasure.

Bioterrorism is an area of increasing public health concern. The intent of this article is to review the air cleansing technologies available to protect building occupants from the intentional release of bioterror agents into congregate spaces (such as offices, schools, auditoriums, and transportation centers), as well as through outside air intakes and by way of recirculation air ducts. Current available technologies include increased ventilation, filtration, and ultraviolet germicidal irradiation (UVGI) UVGI is a common tool in laboratories and health care facilities, but is not familiar to the public, or to some heating, ventilation, and air conditioning engineers. Interest in UVGI is increasing as concern about a possible malicious release of bioterror agents mounts. Recent applications of UVGI have focused on control of tuberculosis transmission, but a wide range of airborne respiratory pathogens are susceptible to deactivation by UVGI. In this article, the authors provide an overview of air disinfection technologies, and an in-depth analysis of UVGI-its history, applications, and effectiveness.

Rapid assay for mycobacterial growth and antibiotic susceptibility using gel microdrop encapsulation.

Effective control of tuberculosis transmission in vulnerable population groups is dependent on rapid identification of the infectious agent and its drug susceptibility. However, the slow growth rate of mycobacteria has undermined the ability to quickly identify antimicrobial resistance. These studies describe a mycobacterial growth assay based on microencapsulation technology used in conjunction with flow cytometric analysis. Mycobacteria were encapsulated in agarose gel microdrops approximately 25 microns in diameter, and colony growth was monitored by using flow cytometry to evaluate the intensity of auramine staining after culture for various times at 37 degrees C. By this method, colony growth of Mycobacterium bovis and M. smegmatis could be quantified within 1 to 3 days after encapsulation. Inhibition of growth by rifampin and isoniazid was also evaluated in this time period, and the presence of an isoniazid-resistant subpopulation representing 3% of the total microorganisms could be detected. This use of encapsulation and flow cytometry has the potential to facilitate rapid and automated evaluation of inhibition of growth by antimicrobial agents and shorten the time frame for analysis of clinical specimens.

Control of tuberculosis transmission in health care settings: A joint statement of the International Union Against Tuberculosis and Lung Disease (IUATLD) and the tuberculosis programme of the World Health Organization (WHO)

Control of tuberculosis transmission in health care settings: A joint statement of the International Union Against Tuberculosis and Lung Disease (IUATLD) and the tuberculosis programme of the World Health Organization (WHO)