Pregnancy in patients with tuberculosis: A TBNET cross-sectional survey

BACKGROUND: Objectives: To determine whether the incidence of tuberculosis with pregnancy is more common than would be expected from the crude birth rate; to see whether there is significant delay in the diagnosis of tuberculosis during pregnancy. METHOD: Design: A cross-sectional survey. SETTING: 13 tuberculosis clinics within different European countries and the USA. POPULATION/SAMPLE: All patients with tuberculosis seen at these clinics for a period\u2009>\u20091 year. INSTRUMENT: Questionnaire survey based on continuous data collection. MAIN OUTCOME MEASURES: number and proportion of women with tuberculosis who were pregnant; timing of diagnosis in relation to pregnancy, including those who were pregnant or delivered in the 3 months prior to the diagnosis of TB and those who developed TB within 3 months after delivery. RESULTS: Pregnancy occurred in 224 (1.5 %) of 15,217 TB patients and followed the expected rate predicted from the crude birth rate for the clinic populations. TB was diagnosed more commonly in the 3 months after delivery (n\u2009=\u2009103) than during pregnancy (n\u2009=\u200968; \u3c7 2\u2009=\u200925.1, P\u2009<\u20090.001). CONCLUSIONS: TB is diagnosed more frequently after delivery, despite variations in local TB incidence and healthcare systems

Impact of the COVID-19 pandemic on contact tracing of patients with pulmonary tuberculosis

Background: The COVID-19 pandemic could have negative effects on tuberculosis (TB) control. The objective was to assess the impact of the pandemic in contact tracing, TB and latent tuberculosis infection (LTBI) in contacts of patients with pulmonary TB in Catalonia (Spain). Methods: Contact tracing was carried out in cases of pulmonary TB detected during 14 months in the pre-pandemic period (1 January 2019 to 28 February 2020) and 14 months in the pandemic period (1 March 2020 to 30 April 2021). Contacts received the tuberculin skin test and/or interferon gamma release assay and it was determined whether they had TB or LTBI. Variables associated with TB or LTBI in contacts (study period and sociodemographic variables) were analyzed using adjusted odds ratio (aOR) and the 95% confidence intervals (95% CI). Results: The pre-pandemic and pandemic periods showed, respectively: 503 and 255 pulmonary TB reported cases (reduction of 50.7%); and 4676 and 1687 contacts studied (reduction of 36.1%). In these periods, the proportion of TB cases among the contacts was 1.9% (84/4307) and 2.2% (30/1381) (P = 0.608); and the proportion of LTBI was 25.3% (1090/4307) and 29.2% (403/1381) (P < 0.001). The pandemic period was associated to higher LTBI proportion (aOR = 1.3; 95% CI 1.1–1.5), taking into account the effect on LTBI of the other variables studied as sex, age, household contact and migrant status. Conclusions: COVID-19 is affecting TB control due to less exhaustive TB and LTBI case detection. An increase in LTBI was observed during the pandemic period. Efforts should be made to improve detection of TB and LTBI among contacts of TB cases.This study was supported by the Ministry of Science and Innovation, Institute of Health Carlos III (Project PI18/01751) and Fondo Europeo de Desarrollo Regional (FEDER-Una manera de hacer Europa)

Control of tuberculosis in large cities in developed countries: an organizational problem

Tuberculosis (TB) is still a serious public health issue, even in large cities in developed countries. Control of this old disease is based on complicated programs that require completion of long treatments and contact tracing. In an accompanying research article published in BMC Public Health, Bothamley and colleagues found that areas with a ratio lower than one nurse per forty notifications had increased rates with respect to TB notifications, smear-positive cases, loss to follow-up and treatment abandonment across the UK. Furthermore, in these areas there was less opportunity for directly observed therapy, assistance with complex needs, educational outreach and new-entrant screening. In this commentary, we discuss the importance of improving organizational aspects and evaluating TB control programs. According to Bothamley and colleagues, a ratio of one nurse per forty notifications is an effective method of reducing the high TB incidences observed in London and in other cities in developed countries, or to maintain the decline in incidence in cities with lower incidences. It is crucial to evaluate TB programs every year to detect gaps early

Tuberculosis en Barcelona: modelo predictivo basado en series temporales.

La tuberculosis (TB) a escala mundial sigue ocasionando cada año millones de casos nuevos y de muertes. La Organización Mundial de la Salud (OMS) ha estimado recientemente que en el 2007 se registraron 9.273.000 casos (incidencia de 139/100.000 habitantes) y 1.772.000 muertes atribuibles a esta vieja enfermedad, y en el año precedente la cifra absoluta fue ligeramente inferior (9.240.000 casos) mientras que la incidencia fue algo superior (140/100.000), por lo que se hace difícil precisar si hay declive o no. El objetivo de este trabajo es aplicar modelos predictivos a la TB, diferenciando entre población autóctona e inmigrante, en una ciudad en la que ha sido posible determinar el número anual de casos desde 1987. Se ha ajustado una tendencia segmentada también denominada regresión discontinua a tramos (piecewise regression o segmented regression) a las series de casos nuevos en la población autóctona e inmigrante de Barcelona. La evolución de esta enfermedad es radicalmente diferente; mientras que en la población autóctona presenta una tendencia a la baja, coincidiendo con el descenso de nuevos de casos de SIDA, en la población inmigrante, la tendencia es al alza. La estimación de nuevos casos para el años 2009 ha sido de 168 (IC 95% 109- 227) y en la población inmigrante de de 227 (IC 95%, 180- 275)

Estimation of the number of cases of meningococcical disease in Barcelona by means capture-recapture methodology

This study is aimed at estimating the number of cases fo meningococcical disease that appeared in Barcelona between the years 1993 and 1994. We develop long-linear models for capture-recapture methods when there are more than two incomplete lists. The capture-recapture model that we used allows for the sources being not independent and for heterogeneity in the probability of being in a source

Estimation of the number of cases of meningococcical disease in Barcelona by means capture-recapture methodology

This study is aimed at estimating the number of cases fo meningococcical disease that appeared in Barcelona between the years 1993 and 1994. We develop long-linear models for capture-recapture methods when there are more than two incomplete lists. The capture-recapture model that we used allows for the sources being not independent and for heterogeneity in the probability of being in a source.Postprint (published version

Estimation of the number of cases of meningococcical disease in Barcelona by means capture-recapture methodology

This study is aimed at estimating the number of cases fo meningococcical disease that appeared in Barcelona between the years 1993 and 1994. We develop long-linear models for capture-recapture methods when there are more than two incomplete lists. The capture-recapture model that we used allows for the sources being not independent and for heterogeneity in the probability of being in a source