WHO's End TB Strategy Research Articles

Frequency Distribution and Risk Factors for Latent Tuberculosis in Contact Persons: Cologne 2012-2016

As part of tuberculosis control and the WHO end-TB strategy, contact persons of tuberculosis patients in Germany are examined for a possible infection with latent tuberculosis (LTBI). Activation of LTBI contributes a considerable proportion of newly reported tuberculosis cases in low-incidence countries such as Germany. Therefore, the aim is to detect cases of LTBI and, through chemopreventive treatment of these cases, prevent future, post-primary, active tuberculosis.In Germany, the rate of LTBI among contact persons of people diagnosed with active tuberculosis is not systematically recorded. The aim of the present work was to close this data gap for Cologne, a major city in Germany with a TB incidence of around 9/100,000 in the past years. The study further aimed to describe risk factors for LTBI and to reevaluate the standard inclusion criteria for contact investigation for tuberculosis under routine conditions in Germany. For the period 07/2012 to 12/2016, the retrospective cohort study examined the rate of LTBI diagnoses among contact persons of those with pulmonary tuberculosis notified at the Cologne public health department, as well as factors that increase the LTBI infection risk of contact persons. The diagnosis of latent tuberculosis was made when the interferon-gamma release assay (IGRA) was positive and there were no signs of active tuberculosis. The study included contact persons who cumulatively had a previously defined minimum total contact time with a tuberculosis patient, who were at least 5 years old at the time of the study and who were registered in Cologne. Statistical evaluation was carried out descriptively as absolute and relative frequency with a significance level of p ≤ 0.05. The analytical evaluation was carried out with univariate and multivariate logistic regression. Of a total of 3862 IGRA examinations among contact persons, 2834 cases met the inclusion criteria. A median of seven contact persons per index patient was reported. 12.5 % ​​of the study group tested positive for LTBI. In contact persons of microscopically open index patients, the positivity rate was 11.4 %, in culturally open but microscopically negative index patients, it was 14.3 %. Factors associated with a higher risk of LTBI included male sex (OR = 1.95), age ≥ 50 years (OR = 1.8) and household exposure (OR = 2.37). Using the German standard criteria, the positivity rate of IGRA testing and the diagnosis of LTBI among contacts in the present study was 12.5 %, which is lower than in other similar studies. Factors identified in the cohort for an increased risk of LTBI confirm known constellations. The significantly higher positivity rate among contact persons of microscopically negative but culturally positive index patients (p = 0.033) underscores the need to conduct a detailed contact examination of individuals of this group as well.

Case fatality and recurrent tuberculosis among patients managed in the private sector: A cohort study in Patna, India.

BackgroundA key component of the WHO End TB Strategy is quality of care, for which case fatality is a critical marker. Half of India’s nearly 3 million TB patients are treated in the highly unregulated private sector, yet little is known about the outcomes of these patients. Using a retrospective cohort design, we estimated the case fatality ratio (CFR) and rate of recurrent TB among patients managed in the private healthcare sector in Patna, India.MethodsWorld Health Partners’ Private Provider Interface Agencies (PPIA) pilot project in Patna has treated 89,906 private sector TB patients since 2013. A random sample of 4,000 patients treated from 2014 to 2016 were surveyed in 2018 for case fatality and recurrent TB. CFR is defined as the proportion of patients who die during the period of interest. Treatment CFRs, post-treatment CFRs and rates of recurrent TB were estimated. Predictors for fatality and recurrence were identified using Cox proportional hazards modelling. Survey non-response was adjusted for using inverse probability selection weighting.ResultsThe survey response rate was 56.0%. The weighted average follow-up times were 8.7 months in the treatment phase and 26.4 months in the post-treatment phase. Unobserved patients were more likely to have less than one month of treatment adherence (32.0% vs. 13.5%) and were more likely to live in rural Patna (21.9% vs. 15.0%). The adjusted treatment phase CFR was 7.27% (5.97%, 8.49%) and at 24 months post-treatment was 3.32% (2.36%, 4.42%). The adjusted 24 month post-treatment phase recurrent TB rate was 3.56% (2.54%, 4.79%).ConclusionsOur cohort study provides critical estimates of TB patient outcomes in the Indian private sector, and accounts for selection bias. Patients in the private sector in Patna experienced a moderate treatment CFR but rates of recurrent TB and post-treatment fatality were low.

The need to prioritise childhood tuberculosis case detection

The need to prioritise childhood tuberculosis case detection

Using molecular testing and whole-genome sequencing for tuberculosis diagnosis in a low-burden setting: a cost-effectiveness analysis using transmission-dynamic modelling

BackgroundDespite progress in TB control in low-burden countries like England and Wales, there are still diagnostic delays. Molecular testing and/or whole-genome sequencing (WGS) provide more rapid diagnosis but their cost-effectiveness...

Современные возможности оздоровления детей, инфицированных микобактериями туберкулеза, в дошкольном образовательном учреждении

The WHO End TB Strategy for 2016–2035 aimed at elimination of tuberculosis makes the search for new criteria for assessing the effectiveness of anti-tuberculosis measures highly relevant. According to the literature, insufficient attention is paid to the rehabilitation of children infected with Mycobacterium tuberculosis (MBT) in special kindergartens. Objective. To assess the effectiveness of rehabilitation in special kindergartens for children infected with MBT. Patients and methods. We analyzed anthropometric data, parameters of adaptive potential (AP), frequency and duration of respiratory infections, dynamics of sensitivity to tuberculin in response to preventive measures in children who attended special kindergartens for rehabilitation (n = 28) and regular kindergartens (n = 29). Results. Children attending special kindergartens for rehabilitation demonstrated greater increase in their height (from 108.93 ± ± 2.05 cm to 113.36 ± 2,04 cm; р = 0.000), significantly lower increase of the AP (0.08 ± 0.01 and 0.16 ± 0.02; р = 0.04), fewer days missed due to acute respiratory infections (ARIs) (11.57 ± 1.44 and 17.00 ± 1.73; р = 0.020), and fewer ARI episodes (1.75 ± 0.18 and 2.66 ± 0.27; р = 0.007). Conclusion. Our findings suggest high effectiveness of special kindergartens for the rehabilitation of children with MBT infection. In addition to generally accepted tuberculin skin tests, we recommend the assessment of AP dynamics in children with MBT infection in order to evaluate the efficiency of preventive measures. Key words: children, infection with Mycobacterium tuberculosis, rehabilitation, adaptive potential, kindergartens

Analysis and predication of tuberculosis registration rates in Henan Province, China: an exponential smoothing model study

BackgroundThe World Health Organization End TB Strategy meant that compared with 2015 baseline, the reduction in pulmonary tuberculosis (PTB) incidence should be 20 and 50% in 2020 and 2025, respectively. The case number of PTB in China accounted for 9% of the global total in 2018, which ranked the second high in the world. From 2007 to 2019, 854 672 active PTB cases were registered and treated in Henan Province, China. This study was to assess whether the WHO milestones could be achieved in Henan Province.MethodsThe active PTB numbers in Henan Province from 2007 to 2019, registered in Chinese Tuberculosis Information Management System were analyzed to predict the active PTB registration rates in 2020 and 2025, which is conductive to early response measures to ensure the achievement of the WHO milestones. The time series model was created by monthly active PTB registration rates from 2007 to 2016, and the optimal model was verified by data from 2017 to 2019. The Ljung-Box Q statistic was used to evaluate the model. The statistically significant level is α = 0.05. Monthly active PTB registration rates and 95% confidence interval (CI) from 2020 to 2025 were predicted.ResultsHigh active PTB registration rates in March, April, May and June showed the seasonal variations. The exponential smoothing winter’s multiplication model was selected as the best-fitting model. The predicted values were approximately consistent with the observed ones from 2017 to 2019. The annual active PTB registration rates were predicted as 49.1 (95% CI: 36.2–62.0) per 100 000 population and 34.4 (95% CI: 18.6–50.2) per 100 000 population in 2020 and 2025, respectively. Compared with the active PTB registration rate in 2015, the reduction will reach 23.7% (95% CI, 3.2–44.1%) and 46.8% (95% CI, 21.4–72.1%) in 2020 and 2025, respectively.ConclusionsThe high active PTB registration rates in spring and early summer indicate that high risk of tuberculosis infection in late autumn and winter in Henan Province. Without regard to the CI, the first milestone of WHO End TB Strategy in 2020 will be achieved. However, the second milestone in 2025 will not be easily achieved unless there are early response measures in Henan Province, China.

A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam

BackgroundTo achieve the WHO End TB Strategy targets, it is necessary to detect and treat more people with active TB early. Scale–up of active case finding (ACF) may be one strategy to achieve that goal. Given human resource constraints in the health systems of most high TB burden countries, volunteer community health workers (CHW) have been widely used to economically scale up TB ACF. However, more evidence is needed on the most cost-effective compensation models for these CHWs and their potential impact on case finding to inform optimal scale-up policies.MethodsWe conducted a two-year, controlled intervention study in 12 districts of Ho Chi Minh City, Viet Nam. We engaged CHWs as salaried employees (3 districts) or incentivized volunteers (3 districts) to conduct ACF among contacts of people with TB and urban priority groups. Eligible persons were asked to attend health services for radiographic screening and rapid molecular diagnosis or smear microscopy. Individuals diagnosed with TB were linked to appropriate care. Six districts providing routine NTP care served as control area. We evaluated additional cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF by human resource model on TB case notifications.ResultsWe verbally screened 321,020 persons in the community, of whom 70,439 were eligible for testing and 1138 of them started TB treatment. ACF activities resulted in a + 15.9% [95% CI: + 15.0%, + 16.7%] rise in All Forms TB notifications in the intervention areas compared to control areas. The ITS analyses detected significant positive post-intervention trend differences in All Forms TB notification rates between the intervention and control areas (p = 0.001), as well as between the employee and volunteer human resource models (p = 0.021).ConclusionsBoth salaried and volunteer CHW human resource models demonstrated additionality in case notifications compared to routine case finding by the government TB program. The salaried employee CHW model achieved a greater impact on notifications and should be prioritized for scale-up, given sufficient resources.

Scaling up tuberculosis preventive therapy for contacts in high transmission settings

Tuberculosis is the world's deadliest infectious disease, with 1·5 million deaths globally in 2018.1 Airborne epidemic spread, particularly of drug-resistant tuberculosis, is a threat to global health security because of the human and economic impact, which is most pronounced in low-income and middle-income countries. The target of elimination of tuberculosis by 2030 cannot be achieved without a strategy to address latent infection that is subclinical or quiescent.2 Effective treatment of latent tuberculosis infection to prevent active disease, known as tuberculosis preventive treatment, is a critical component of the WHO End TB Strategy.

Bayesian spatio-temporal models for mapping TB mortality risk and its relationship with social inequities in a region from Brazilian Legal Amazon.

Reducing TB mortality is a great challenge in Brazil due to its territorial extension, cultural variations and economic and political crises, which impact the health system. This study aimed to estimate in space and time the risk of TB mortality and test its relationship with social inequities. This was an ecological study that included deaths from TB between 2006 and 2016 in Cuiabá, Brazilian Legal Amazon. Bayesian models based on the integrated nested Laplace approximation approach were used to estimate spatio-temporal RRs. RRs for TB mortality were obtained according to the covariables representative of social inequities. The risk of TB mortality was stable between 2006 and 2016 and high-risk areas were identified throughout the municipality studied. Regarding social inequities, income was an important factor associated with TB mortality risk, as an increase of 1 SD in income resulted in a 35.4% (RR0.646; CI 95%0.476 to 0.837) decrease in risk. The results provided evidence of areas with higher TB mortality risks that have persisted over time and are related to social inequities. Advancing social policies and protections in these areas will contribute to achieving the WHO's End TB strategy.

Ending tuberculosis in the sustainable development era in China: what are the health system challenges? A mixed-methods study

BackgroundThe UN Sustainable Development Goals include ending the tuberculosis epidemic globally by 2030. China is a high burden country of both drug-susceptible and multidrug-resistant tuberculosis. This study examined China's progress in meeting the tuberculosis milestones and targets laid out by the WHO End TB Strategy, and analysed key health system challenges to be overcome towards ending the tuberculosis epidemic in China. MethodsWe used estimates of tuberculosis incidence and number of tuberculosis deaths in China from the Global Burden of Disease Study 2016 to conduct current situation analysis and a projection for 2030. We also reviewed national strategy and implementation guidelines in relation to tuberculosis control in China. We conducted semi-structured qualitative interviews, including key-informant interviews with decision makers and policy implementers at national and provincial levels (n=4), and in-depth interviews with experts in tuberculosis control (n=3). Senior researchers invited participants to take part in interviews through personal contacts, and undertook the interviews after obtaining verbal consent from the participants. Thematic analysis was applied to identify themes and develop interpretations. FindingsBetween 1990 and 2016, the estimated tuberculosis incidence declined from 156 cases per 100 000 individuals to 86 cases per 100 000 individuals, and the number of tuberculosis deaths decreased from 178 515 to 40 120, in China. The tuberculosis incidence was projected to drop to 62 cases per 100 000 individuals, and the number of tuberculosis deaths to drop to 17 218 by 2030, both above the WHO 2030 targets of an 80% reduction in tuberculosis incidence (17 cases per 100 000 individuals) and a 90% reduction in the number of tuberculosis deaths (4130), compared with 2015. Of the four key informants, three said that many patients with tuberculosis, particularly multidrug-resistant tuberculosis, suffered from catastrophic payment for tuberculosis care. Qualitative interviews also revealed several key health system challenges in the access to high quality and affordable tuberculosis care, including: (1) insufficient funding and workforce for tuberculosis control; (2) difficulty in scaling up new tuberculosis and multidrug-resistant tuberculosis diagnostic tools; (3) inefficient cooperation across anti-tuberculosis health facilities; and (4) inconsistency among health insurance policies, public hospital reforms, and tuberculosis control strategies. InterpretationChina cannot meet the End TB Strategy targets by 2030, unless synergistic tuberculosis control policies and strategies can be developed and implemented, and multi-sector cooperation can be improved to enhance the delivery of tuberculosis care. FundingThe Bill & Melinda Gates Foundation (grant number OOP1148464).

Assessing tuberculosis control priorities in high-burden settings: a modelling approach

In the context of WHO's End TB strategy, there is a need to focus future control efforts on those interventions and innovations that would be most effective in accelerating declines in tuberculosis burden. Using a modelling approach to link the tuberculosis care cascade to transmission, we aimed to identify which improvements in the cascade would yield the greatest effect on incidence and mortality. We engaged with national tuberculosis programmes in three country settings (India, Kenya, and Moldova) as illustrative examples of settings with a large private sector (India), a high HIV burden (Kenya), and a high burden of multidrug resistance (Moldova). We collated WHO country burden estimates, routine surveillance data, and tuberculosis prevalence surveys from 2011 (for India) and 2016 (for Kenya). Linking the tuberculosis care cascade to tuberculosis transmission using a mathematical model with Bayesian melding in each setting, we examined which cascade shortfalls would have the greatest effect on incidence and mortality, and how the cascade could be used to monitor future control efforts. Modelling suggests that combined measures to strengthen the care cascade could reduce cumulative tuberculosis incidence by 38% (95% Bayesian credible intervals 27-43) in India, 31% (25-41) in Kenya, and 27% (17-41) in Moldova between 2018 and 2035. For both incidence and mortality, modelling suggests that the most important cascade losses are the proportion of patients visiting the private health-care sector in India, missed diagnosis in health-care settings in Kenya, and drug sensitivity testing in Moldova. In all settings, the most influential delay is the interval before a patient's first presentation for care. In future interventions, the proportion of individuals with tuberculosis who are on high-quality treatment could offer a more robust monitoring tool than routine notifications of tuberculosis. Linked to transmission, the care cascade can be valuable, not only for improving patient outcomes but also in identifying and monitoring programmatic priorities to reduce tuberculosis incidence and mortality. US Agency for International Development, Stop TB Partnership, UK Medical Research Council, and Department for International Development.

Xpert MTB/RIF Ultra for Tuberculosis Testing in Children: A Mini-Review and Commentary.

Tuberculosis (TB) remains a significant, yet under-recognized cause of death in the pediatric population, with a WHO estimate of 1 million new cases of childhood TB in 2016 resulting in 250,000 deaths. Diagnosis is notoriously difficult; manifestations are protean due to the high proportion of cases of extra-pulmonary TB in children, and logistical problems exist in obtaining suitable specimens. These issues are compounded by the paucibacillary nature of disease with the result that an estimated 96% of pediatric TB-associated mortality occurs prior to commencing anti-tuberculous treatment. Further development of sensitive, rapid diagnostic tests and their incorporation into diagnostic algorithms is vital in this population, and central to the WHO End-TB strategy. Initial gains were made with the expansion of nucleic acid amplification technology, particularly the introduction of the GeneXpert fully-automated PCR Xpert MTB/Rif assay in 2010, and more recently, the Xpert MTB/Rif Ultra (Ultra) assay in 2017. Ultra provides increased analytical sensitivity when compared with the initial Xpert assay in vitro; a finding now also supported by six clinical studies to date, two of which included pediatric samples. Here, we review the published evidence for the performance of Ultra in TB diagnosis in children, as well as studies in adults with paucibacillary disease providing results relevant to the pediatric population. Following on from this, we speculate upon future directions for Ultra, with focus on its potential use with alternative diagnostic specimens, which may be of particular utility in children.

The Challenge of Eliminating Childhood Tuberculosis in Cuba

WHO's 2015 End Tuberculosis Strategy can succeed only through universal health coverage, social protection, poverty alleviation and effective multisector actions to tackle social determinants in general. The pediatric age group is particularly vulnerable to tuberculosis and historically neglected worldwide. However, this group is a priority within Cuba's National Tuberculosis Control Pro-gram that has functioned since 1970, and Cuba is considered a low-incidence country with rates < 7 per 100,000 population since 2011. Tuberculosis incidence in children aged <15 years is <1 per 100,000, similar to that reported in high-income countries and rep-resenting less than 2% of total cases in Cuba. Since 1999, no deaths from tuberculosis, coinfection with HIV or resistance to the two first-line TB drugs have been reported in affected children, and most diagnosed cases correspond to early, primary forms of the disease. These results place Cuba among the countries on track to eliminate TB by 2050. This article reviews the pillars and components of the 2015 End TB Strategy and the strategies devel-oped by the National Tuberculosis Control Program that enabled Cuba to bring incidence below the 2035 targets of WHO's End TB strategy. The article also proposes other actions Cuba can take, despite limited resources, to eliminate TB, particularly in the pedi-atric age group.KEYWORDS Tuberculosis, communicable disease control, disease control programs, preventive health services, child health, World Health Organization, Cuba.

Emerging treatment trends in pediatric TB

The WHO's End TB Strategy and the United Nations' (UN) Sustainable Development Goals (SDGs) share the common aim to end the global TB epidemic. Specific targets have been set in the End TB Strategy, for the period 2016–2035, which include a 90% reduction in TB deaths and an 80% reduction in TB incidence (new cases per year) by 2030, in comparison with 2015. Globally, though the TB incidence and mortality is falling at the rate of about 2% and 3% per year, by 2020, these figures need to improve to 4–5% per year and 10%, respectively, so that incidence can fall faster to reach the first (2020) milestones of the End TB Strategy3. Newer treatment trends have emerged to achieve these targets in children.

Digital technologies good choice to meet WHO's End TB Strategy goals

Digital technologies good choice to meet WHO's End TB Strategy goals

Integrating Non-human Primate, Human, and Mathematical Studies to Determine the Influence of BCG Timing on H56 Vaccine Outcomes.

Tuberculosis (TB) is the leading cause of death by an infectious agent, and developing an effective vaccine is an important component of the WHO's EndTB Strategy. Non-human primate (NHP) models of vaccination are crucial to TB vaccine development and have informed design of subsequent human trials. However, challenges emerge when translating results from animal models to human applications, and connecting post-vaccination immunological measurements to infection outcomes. The H56:IC31 vaccine is a candidate currently in phase I/IIa trials. H56 is a subunit vaccine that is comprised of 3 mycobacterial antigens: ESAT6, Ag85B, and Rv2660, formulated in IC31 adjuvant. H56, as a boost to Bacillus Calmette-Guérin (BCG, the TB vaccine that is currently used in most countries world-wide) demonstrates improved protection (compared to BCG alone) in mouse and NHP models of TB, and the first human study of H56 reported strong antigen-specific T cell responses to the vaccine. We integrated NHP and human data with mathematical modeling approaches to improve our understanding of NHP and human response to vaccine. We use a mathematical model to describe T-cell priming, proliferation, and differentiation in lymph nodes and blood, and calibrate the model to NHP and human blood data. Using the model, we demonstrate the impact of BCG timing on H56 vaccination response and reveal a general immunogenic response to H56 following BCG prime. Further, we use uncertainty and sensitivity analyses to isolate mechanisms driving differences in vaccination response observed between NHP and human datasets. This study highlights the power of a systems biology approach: integration of multiple modalities to better understand a complex biological system.

Utility of the T-SPOT®.TB test's borderline category to increase test resolution for results around the cut-off point

BackgroundAccurate identification of individuals with TB infection, is required to achieve the WHO's End TB Strategy goals. While there is general acceptance that the T-SPOT.TB test borderline category provides an opportunity to increase test resolution of results around the test cut-off point, this has not been investigated. Methods645,947 tests were analyzed to determine frequency of borderline results, effect of age and time between tests and associations between subjects' clinical risk factors and retest results. Results645,947 tests produced 93.5% negatives, 4% positives, 0.6% invalids, and 1.8% borderlines. Within the borderline results, 5044 were repeated, with 59.2%, 20.0% and 20.2% resolving to negative, positive and borderline, respectively. Age of subject did not affect retest results; however, time between tests indicated that retest resolution occurred with greatest frequency after 90 days. TB risk factors were provided for 2640 subjects and 17% of low risk subjects with a high initial borderline resolved to negative while 27.6% of subjects with high risk and an initial low borderline resolved to positive, suggesting that these subjects could have been inappropriately classified if using a single cut-off point test with no borderline category. ConclusionThis study demonstrates the utility of the T-SPOT.TB test's borderline category to increase test resolution around the test cut-off point.

Catastrophic costs potentially averted by tuberculosis control in India and South Africa: a modelling study

SummaryBackgroundThe economic burden on households affected by tuberculosis through costs to patients can be catastrophic. WHO's End TB Strategy recognises and aims to eliminate these potentially devastating economic effects. We assessed whether aggressive expansion of tuberculosis services might reduce catastrophic costs.MethodsWe estimated the reduction in tuberculosis-related catastrophic costs with an aggressive expansion of tuberculosis services in India and South Africa from 2016 to 2035, in line with the End TB Strategy. Using modelled incidence and mortality for tuberculosis and patient-incurred cost estimates, we investigated three intervention scenarios: improved treatment of drug-sensitive tuberculosis; improved treatment of multidrug-resistant tuberculosis; and expansion of access to tuberculosis care through intensified case finding (South Africa only). We defined tuberculosis-related catastrophic costs as the sum of direct medical, direct non-medical, and indirect costs to patients exceeding 20% of total annual household income. Intervention effects were quantified as changes in the number of households incurring catastrophic costs and were assessed by quintiles of household income.FindingsIn India and South Africa, improvements in treatment for drug-sensitive and multidrug-resistant tuberculosis could reduce the number of households incurring tuberculosis-related catastrophic costs by 6–19%. The benefits would be greatest for the poorest households. In South Africa, expanded access to care could decrease household tuberculosis-related catastrophic costs by 5–20%, but gains would be seen largely after 5–10 years.InterpretationAggressive expansion of tuberculosis services in India and South Africa could lessen, although not eliminate, the catastrophic financial burden on affected households.FundingBill & Melinda Gates Foundation.

Latent tuberculosis infection in rural China: who will develop tuberculosis?

Screening people at risk of developing tuberculosis because of latent infection and offering preventive treatment to those with positive results is now regarded as one of the components of the WHO End TB Strategy. 1 Getahun H Matteelli A Abubakar I et al. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J. 2015; 46: 1563-1576 Crossref PubMed Scopus (392) Google Scholar In The Lancet Infectious Diseases, Lei Gao and colleagues 2 Gao L Li X Liu J et al. Incidence of active tuberculosis in individuals with latent tuberculosis infection in rural China: follow-up results of a population-based, multicentre, prospective cohort study. Lancet Infect Dis. 2017; (published online July 14.)http://dx.doi.org/10.1016/S1473-3099(17)30402-4 Google Scholar present the results of a 2-year follow-up study in four rural regions of China, assessing patients with latent tuberculosis infection, defined by a positive tuberculin skin test (TST) or a positive interferon-γ release assay (IGRA) QuantiFERON-TB Gold In-Tube (QFT), which has been described in previous publications. 3 Gao L Lu W Bai L et al. Latent tuberculosis infection in rural China: baseline results of a population-based, multicentre, prospective cohort study. Lancet Infect Dis. 2015; 15: 310-319 Summary Full Text Full Text PDF PubMed Scopus (149) Google Scholar , 4 Gao L Bai L Liu J et al. Annual risk of tuberculosis infection in rural China: a population-based prospective study. Eur Respir J. 2016; 48: 168-178 Crossref PubMed Scopus (26) Google Scholar The authors report an incidence rate of tuberculosis of 0·87 (95% CI 0·68–1·07) per 100 person-years in people with QFT positivity and 0·50 (0·38–0·63) per 100 person-years in the group with a positive TST. 2 Gao L Li X Liu J et al. Incidence of active tuberculosis in individuals with latent tuberculosis infection in rural China: follow-up results of a population-based, multicentre, prospective cohort study. Lancet Infect Dis. 2017; (published online July 14.)http://dx.doi.org/10.1016/S1473-3099(17)30402-4 Google Scholar The main risk factors for the development of active tuberculosis during the observation period are male sex and a history of tuberculosis. Gao and colleagues conclude that targeted screening of population groups with a high risk of tuberculosis and provision of a preventive treatment might reduce the pool of future tuberculosis cases. Incidence of active tuberculosis in individuals with latent tuberculosis infection in rural China: follow-up results of a population-based, multicentre, prospective cohort studyOur results suggest that high-risk populations in communities in rural China, such as individuals at a high risk of disease reactivation from previous tuberculosis, should be targeted for latent infection screening and treatment with an interferon-γ releasing assay rather than a TST. Full-Text PDF

ЗАБОЛЕВАЕМОСТЬ, СМЕРТНОСТЬ И РАСПРОСТРАНЕННОСТЬ КАК ПОКАЗАТЕЛИ БРЕМЕНИ ТУБЕРКУЛЕЗА В РЕГИОНАХ ВОЗ, СТРАНАХ МИРА И В РОССИЙСКОЙ ФЕДЕРАЦИИ ЧАСТЬ 2. Смертность от туберкулеза

The article presents data on one of the main epidemiological rates defining the burden of tuberculosis in the system of WHO global statistics – tuberculosis mortality. The article describes in detail the WHO assessment of this rate and provides main data on the evaluation and notification of lethal cases due to tuberculosis in certain countries, WHO regions and worldwide. Data presented in the article include the comparison of definitions of mortality and values of registered mortality due to tuberculosis, obtained in Russia, worldwide and countries of WHO European Region. The article discusses if it is possible to achieve indicators set up in the WHO Stop TB Strategy (1990-2015) and WHO End TB Strategy (2016-2035).