Meningococcus this Winter : what was going on?

There was a time in the not very distant past when meningococcus was not being recognised locally. While laboratory sensitivity used to isolate Neisseria meningitidis has not changed in Malta, the frequency of its detection has increased, more so in the last few months. In this discussion, it is assumed that the sensitivity of detection and degree of reporting of the condition has remained stable throughout the past eleven year period, so that the observed trend remains interpretable. Early, aggressive treatment with antimicrobials makes subsequent microbiological ascertainment difficult. Although meningococcal disease is notifiable by law, it is assumed that reporting of the recognised condition may not be full.peer-reviewe

Escherichia coli O157:H7 in Malta for the first time

The emergence of E coli O157:H7 in Malta is a sign of the times. It represents one of the newly emerging infections associated with food. The first two documented cases of E coli 0157:H7 infection in Malta occurred in July and August, 1996. Food types classically incriminated were surveyed by the Department of Public Health. Epidemiological investigation aimed to trace the environmental sources of infection.• Microbiology was performed jointly by diagnostic and public health laboratories. Facts about infection and control of the disease are highlighted with a view to alerting local practitioners to the condition.peer-reviewe

A study of seroprevalence of rubella IgG in Maltese adolescents

The objective of this study was to determine the seroprevalence of rubella IgG antibodies in Maltese adolescents, through a cross-sectional study, with mailed questionnaire and blood sampling. The subjects tested were 172 individuals, aged 14-15 years from Malta and Gozo for the prevalence of vaccination and seropositivity (IgG) for rubella. The results of the 85% individuals vaccinated seropositivity was detected in 168 youths (97.7%). The study showed a high level of detectable humoral immunity to rubella but this could not be definitively attributed to vaccination alone.peer-reviewe

Hepatitis C : an emerging concern

Hepatitis C has surfaced worldwide as a formidable concern to public health. Recent developments have sharpened methods of serological detectability, epidemiological study and patient treatment. In the light of the global situation, this article briefly presents known local epidemiology about hepatitis C derived from routine data and personal communication from some key workers. The occurrence of a serious, potentially progressive, transmissible condition in a young population will incur high-costs to patients, contacts and care services. The article concludes by highlighting the areas offering greatest scope to check this condition through prevention and patient management.peer-reviewe

Tuberculosis and the strategy for the New Millennium: not simply “more of same”

Since the beginning of human history, tuberculosis (TB) has threatened the wellbeing of mankind. The last Global Tuberculosis Report, published by the World Health Organization (WHO) in 2013, highlighted the significant burden in morbidity and mortality that Mycobacterium tuberculosis still bears in the world today [1]...

A Systematic Review of Reported Cost for Smear and Culture Tests during Multidrug-Resistant Tuberculosis Treatment

Background: In 2011, World Health Organization revised its recommendation for microbiological monitoring during treatment for multidrug-resistant tuberculosis (MDR-TB) by increasing the frequency of culture examination from quarterly to monthly after culture conversion. Implementing the recommendation requires substantial additional investment in laboratory infrastructure. The objective of this review is to provide cost evidence that is needed for national TB programs to budget for optimal monitoring strategies. Methods and Findings: We conducted the first systematic literature review on unit cost estimates of three monitoring strategies: 1) smear only; 2) culture only; 3) combined smear and culture. 26 peer-reviewed studies were selected by searching 10 databases in English and Chinese for literature published between 1995 and 2012. Cost estimates were converted into 2010 constant USD and international dollars. We assessed the quality of the estimates using a matrix with five essential elements and provided a cost projection for the combined smear and culture tests where the data were available. The 26 studies reported the cost estimates in 16 predominantly high- or middle-income countries from 1993 to 2009. The estimated unit cost for smear, culture, and combined tests ranges from $0.26 to$10.50, $1.63 to$62.01, and $26.73 to$39.57, respectively. The ratio of culture to smear costs varies from 1.35 to 11.98. The wide range of estimates is likely attributable to using different laboratory methods in different regions and years and differing practices in collecting and reporting cost data. Most studies did not report information critical for generalizing their conclusions. Conclusion: The paucity and low quality of unit cost estimates for TB monitoring in resource-poor settings impose technical challenges in predicting the resources needed for strengthening microbiological monitoring. To improve the validity and comparability of the cost data, we strongly advocate the data collection, estimation, and reporting follow protocols proposed by WHO

The impact of the COVID-19 pandemic on the global tuberculosis epidemic

Tuberculosis (TB) is a major cause of ill health worldwide. Until the coronavirus (COVID-19) pandemic, TB was the leading cause of death from a single infectious agent. COVID-19 has caused enormous health, social and economic upheavals since 2020, impairing access to essential TB services. In marked contrast to the steady global increase in TB detection between 2017 and 2019, TB notifications dropped substantially in 2020 compared with 2019 (-18%), with only a partial recovery in 2021. TB epidemiology worsened during the pandemic: the estimated 10.6 million people who fell ill with TB worldwide in 2021 is an increase of 4.5% from the previous year, reversing many years of slow decline. The annual number of TB deaths worldwide fell steadily between 2005 and 2019, reaching 1.4 million in 2019, but this trend was reversed in 2020 (1.5 million), and by 2021 global TB deaths were back to the level of 2017 (1.6 million). Intensified efforts backed by increased funding are urgently required to reverse the negative impacts of COVID-19 on TB worldwide, made more pressing by ongoing conflicts, a global energy crisis and uncertainties in food security that are likely to worsen the broader determinants of TB

Multidrug-resistant Tuberculosis in Central Asia

Multidrug-resistant tuberculosis (MDR-TB) has emerged as a major threat to TB control, particularly in the former Soviet Union. To determine levels of drug resistance within a directly observed treatment strategy (DOTS) program supported by Médecins Sans Frontières in two regions in Uzbekistan and Turkmenistan, Central Asia, we conducted a cross-sectional survey of smear-positive TB patients in selected districts of Karakalpakstan (Uzbekistan) and Dashoguz (Turkmenistan). High levels of MDR-TB were found in both regions. In Karakalpakstan, 14 (13%) of 106 new patients were infected with MDR-TB; 43 (40%) of 107 previously treated patients were similarly infected. The proportions for Dashoguz were 4% (4/105 patients) and 18% (18/98 patients), respectively. Overall, 27% of patients with positive smear results whose infections were treated through the DOTS program in Karakalpakstan and 11% of similar patients in Dashoguz were infected with multidrug-resistant strains of TB on admission. These results show the need for concerted action by the international community to contain transmission and reduce the effects of MDR-TB

Safety and Availability of Clofazimine in the Treatment of Multidrug and Extensively Drug-Resistant Tuberculosis: Analysis of Published Guidance and Meta-Analysis of Cohort Studies

Objectives: Given the spread of multidrug-resistant tuberculosis (MDR-TB), new therapies are urgently needed, including the repurposing of existing drugs. We aimed to assess key considerations for the clinical and programmatic use of clofazimine (Cfz), a riminophenazine with anti-mycobacterial activity currently used to treat leprosy. Design: Fixed and random effects meta-analysis of cohort studies and systematic review Setting: Electronic and manual searches were combined. Inclusion criteria: Observational studies on treatment of multidrug- and extremely drug- resistant tuberculosis with clofazimine or a clofazimine-containing regimen, and published guidance and documents relating to cost and availability were eligible. Results: Five observational studies enrolled 861 patients, of which 602 received Cfz. The pooled proportion of adverse drug reactions requiring discontinuation of Cfz treatment was 0.1% (95% CI: [0.0, 0.6%]), and the median frequency of all adverse events was 5.1%. Cfz showed in vitro efficacy against Mycobacterium tuberculosis, and Cfz-containing regimens may have had a useful role in the treatment of patients with drug-resistant strains and who had limited alternative treatment options. However, Cfz uptake remains insufficient to meet global needs; there is only one internationally quality-assured manufacturer, which produces a limited quantity of the drug prioritised for treatment of leprosy, the only indication for which the drug is registered. Conclusions: While the data were limited, Cfz was associated with a risk for adverse drug reactions comparable to that of first-line TB treatment, which could be reasonably managed under programmatic conditions. However, low market availability and high cost are important barriers to access to Cfz for MDR-TB patients.Other Research Uni

Modelling the effect of short-course multidrug-resistant tuberculosis treatment in Karakalpakstan, Uzbekistan

Background: Multidrug-resistant tuberculosis (MDR-TB) is a major threat to global TB control. MDR-TB treatment regimens typically have a high pill burden, last 20 months or more and often lead to unsatisfactory outcomes. A 9-11 month regimen with seven antibiotics has shown high success rates among selected MDR-TB patients in different settings and is conditionally recommended by the World Health Organization. Methods: We construct a transmission-dynamic model of TB to estimate the likely impact of a shorter MDR-TB regimen when applied in a low HIV prevalence region of Uzbekistan (Karakalpakstan) with high rates of drug resistance, good access to diagnostics and a well-established community-based MDR-TB treatment programme providing treatment to around 400 patients. The model incorporates acquisition of additional drug resistance and incorrect regimen assignment. It is calibrated to local epidemiology and used to compare the impact of shorter treatment against four alternative programmatic interventions. Results: Based on empirical outcomes among MDR-TB patients and assuming no improvement in treatment success rates, the shorter regimen reduced MDR-TB incidence from 15.2 to 9.7 cases per 100,000 population per year and MDR-TB mortality from 3.0 to 1.7 deaths per 100,000 per year, achieving comparable or greater gains than the alternative interventions. No significant increase in the burden of higher levels of resistance was predicted. Effects are probably conservative given that the regimen is likely to improve success rates. Conclusions: In addition to benefits to individual patients, we find that shorter MDR-TB treatment regimens also have the potential to reduce transmission of resistant strains. These findings are in the epidemiological setting of treatment availability being an important bottleneck due to high numbers of patients being eligible for treatment, and may differ in other contexts. The high proportion of MDR-TB with additional antibiotic resistance simulated was not exacerbated by programmatic responses and greater gains may be possible in contexts where the regimen is more widely applicable