Randomised controlled trial comparing daily VerSus depot vitamin D3 therapy in 0-16-year-old newly settled refugees in Western Australia over a period of 40 weeks

Vitamin D deficiency is highly prevalent in newly settled refugees in Western Australia (WA). If adherence to daily vitamin D therapy is problematic, depot therapy is a therapeutic alternative. The aim of this studywas to compare daily versus depot treatment and factors influencing the therapeutic outcome. Newly settled refugees (n = 151) with 25(OH)D levels less than 78 nmol/L were randomised to receive daily or depot vitamin D therapy with eight weekly interval follow up to 40 weeks. Biochemical and clinical parameters were collected at each visit. Generalized LinearMixedModels (GLMM) examined the longitudinal changes over time controlling for confounders including age, gender, treatment arm, season, country of refuge/origin and sun exposure score. Participants were aged 5.5 months to 16.0 years (75 males, 83 females). Both treatment groups achieved vitamin D sufficiency. The daily treatment group had significantly higher 25(OH)D levels at each visit post baseline and a higher proportion of participants with levels above 50 nmol/L at all time points. Time, treatment group, calcium and sun exposure score were significant predictors of 25(OH)D serum levels. Depot vitamin D therapy is an alternative to daily treatment in this at-risk group of children and adolescents in whom treatment adherence is problemati

Factors Associated with the Performance of a Blood-Based Interferon-γ Release Assay in Diagnosing Tuberculosis

Background: Indeterminate results are a recognised limitation of interferon-γ release assays (IGRA) in the diagnosis of latent tuberculosis (TB) infection (LTBI) and TB disease, especially in children. We investigated whether age and common co-morbidities were associated with IGRA performance in an unselected cohort of resettled refugees. Methods: A retrospective cross-sectional study of refugees presenting for their post-resettlement health assessment during 2006 and 2007. Refugees were investigated for prevalent infectious diseases, including TB, and for common nutritional deficiencies and haematological abnormalities as part of standard clinical screening protocols. Tuberculosis screening was performed by IGRA; QuantiFERON-TB Gold in 2006 and QuantiFERON-TBGold In-Tube in 2007. Results: Complete data were available on 1130 refugees, of whom 573 (51%) were children less than 17 years and 1041 (92%) were from sub-Saharan Africa. All individuals were HIV negative. A definitive IGRA result was obtained in 1004 (89%) refugees, 264 (26%) of which were positive; 256 (97%) had LTBI and 8 (3%) had TB disease. An indeterminate IGRA result was obtained in 126 (11%) refugees (all failed positive mitogen control). In multivariate analysis, younger age (linear OR = 0.93 [95% CI 0.91-0.95],

The probability of an indeterminate IGRA based on age.

<p>This figure shows the estimated proportion of indeterminate IGRA results depending on the age at the MHU visit. <i>Not adjusted for other covariates in the multivariate model.</i></p

Characteristics associated with an indeterminate IGRA result (n = 1130).

*<p>CI = confidence interval.</p>+<p>Multivariate odds ratio and p value reported if significant (<i>P</i><0.05).</p>++<p>Age- and gender-adjusted variable.</p

Clinical characteristics of study population (n = 1130).

*<p>Estimate values represent mean ± standard deviation or median (interquartile range) or frequency (percent) of study population.</p>**<p>Screening through only the QuantiFERON®-TB Gold or QuantiFERON®-TB Gold In-tube assays.</p>+<p>Defined as a positive serology to either <i>Schistosoma</i> or <i>S. stercoralis</i>, or an eosinophil count >0.7×10⁹/L.</p>++<p>Defined as deficient (<27.5 nmol/L), insufficient (27.5–78 nmol/L) and sufficient (>78 nmol/L).</p

The probability of a positive IGRA based on age.

<p>This figure shows the estimated proportion of positive IGRA results, compared to negative IGRA results, depending on the age at assessment. <i>Not adjusted for other covariates in the multivariate model.</i></p

Demographic characteristics of study population (n = 1130).

*<p>Estimate values represent mean ± standard deviation or median (interquartile range) or frequency (percent) of study population.</p>**<p>Other represents 17 countries of birth in Africa with <4% of study population.</p>+<p>Other represents 2 countries of birth in Asia with <4% of study population.</p>++<p>Other represents 1 country of birth outside of Asia or Africa with <4% of study population.</p