Management of Latent Tuberculosis Infections in Australia and New Zealand: A Review of Current Practice

Aim: To survey practices in the diagnosis and management of latent tuberculosis infection (LTBI) in Australia and New Zealand. Methods: Infectious diseases and respiratory physicians and trainees were invited to complete an online questionnaire concerning various aspects of LTBI management. Results: The questionnaire was completed by 126 clinicians self-reporting regular management of LTBI. Respondents were experienced physicians, with 95/126 (75.4%) having managed LTBI for more than 5 years. Forty-seven (37.3%) reported seeing more than 5 patients per month for assessment of LTBI. Substantial variation among clinicians was reported in relation to a number of common clinical scenarios. For instance, while 52/126 (43.7%) informed patients that the incidence of severe hepatotoxicity related to isoniazid monotherapy was 0.1–0.5%, 21/126 (15.7%) thought it was >5%. 36/126 (28.6%) clinicians would proceed with TNF-αtherapy following an indeterminate screening: interferon-γassay, while 78/126 (61.9%) would perform further investigations and 12/126 (9.5%) would initiate isoniazid therapy. Follow-up intervals during therapy varied from 1–3 monthly, with liver function testing performed routinely by 89/126 (70.6%). Conclusion: This study demonstrated a large degree of variation in clinical practice of LTBI management in Australia and New Zealand. Strategies for increasing uniformity of practice are required, including improved guidelines and physician education

Management of Latent Tuberculosis Infections in Australia and New Zealand: A Review of Current Practice

Aim: To survey practices in the diagnosis and management of latent tuberculosis infection (LTBI) in Australia and New Zealand. Methods: Infectious diseases and respiratory physicians and trainees were invited to complete an online questionnaire concerning various aspects of LTBI management. Results: The questionnaire was completed by 126 clinicians self-reporting regular management of LTBI. Respondents were experienced physicians, with 95/126 (75.4%) having managed LTBI for more than 5 years. Forty-seven (37.3%) reported seeing more than 5 patients per month for assessment of LTBI. Substantial variation among clinicians was reported in relation to a number of common clinical scenarios. For instance, while 52/126 (43.7%) informed patients that the incidence of severe hepatotoxicity related to isoniazid monotherapy was 0.1–0.5%, 21/126 (15.7%) thought it was >5%. 36/126 (28.6%) clinicians would proceed with TNF-αtherapy following an indeterminate screening: interferon-γassay, while 78/126 (61.9%) would perform further investigations and 12/126 (9.5%) would initiate isoniazid therapy. Follow-up intervals during therapy varied from 1–3 monthly, with liver function testing performed routinely by 89/126 (70.6%). Conclusion: This study demonstrated a large degree of variation in clinical practice of LTBI management in Australia and New Zealand. Strategies for increasing uniformity of practice are required, including improved guidelines and physician education

The use of anti-tuberculosis therapy for latent TB infection

Tuberculosis infection is of global public health significance, with millions of incident cases each year. Many cases, particularly in low-prevalence settings, result from the reactivation of latent tuberculosis infection (LTBI); potentially acquired years prior to active disease. Up to one-third of the world’s population has been infected with LTBI, and so may be at risk for future active TB disease. A variety of antituberculosis medications and treatment regimens have now been evaluated in the management of LTBI, with the aim of eradicating tuberculosis bacilli and reducing the likelihood of subsequent reactivation disease. This article reviews LTBI therapies and their use in clinical contexts, and considers future directions for individual and population-based strategies in LTBI management

Are we better-off? The benefits and costs of Australian COVID-19 lockdown

When compared with other countries, Australia has fared much better in COVID-19 outcomes, having experienced low COVID-19 cases, hospitalisations, and deaths. Although it is difficult to know with certainty what and to what degree led to these advantageous outcomes, many attributed this success to the early implementation of strict border closure limiting cross-border transmission and being an Island nation (1–3). Australia has been proceeding with the elimination strategy aiming to contain and crush emerging outbreaks quickly through a suite of public health interventions, with lockdowns playing a central role. However, as vaccination rates continue to rise in Australia, we opine that the lockdowns and other stringent non-pharmaceutical interventions should be phasedown as the cost to the individuals, community, and the economy is likely to outweigh the benefits of these restrictions. At the beginning of the pandemic, most countries followed and defended the implementation of lockdowns, with the early calculations suggesting that benefits far outweigh the costs (3–5). Some empirical studies also observed heterogeneity in the effectiveness of lockdowns and advocated for a careful consideration of demographic, economic, and societal factors before implementing stay-at-home orders, especially in developing countries in which many people rely on day-to-day economic resources (6, 7). However, using more recent data, others provided a different assessment arguing that lockdowns cause more harm than good even in developing countries—with the benefit-cost ratio being significantly overestimated (8, 9). Considering the burden of prolonged lockdown that Sydney and Melbourne have been experiencing and taking into account the increasing vaccination rates across the country, our governments need to carefully consider when and how to lift lockdown and other restrictions, as there is no doubt the cost of getting this wrong is very high. Following a critical review by Allen (10), we discuss the issues associated with the evaluation of lockdown costs and benefits and provide an opinion on lockdowns doing potentially more harm than good as Australia achieves high vaccination rates. This may be useful in timely discussions among the public, media, public health officials, and decision-makers

Delay effect and burden of weather related tuberculosis cases in Rajshahi province, Bangladesh, 2007–2012

Tuberculosis (TB) is a potentially fatal infectious disease that continues to be a public health problem in Bangladesh. Each year in Bangladesh an estimated 70,000 people die of TB and 300,000 new cases are projected. It is important to understand the association between TB incidence and weather factors in Bangladesh in order to develop proper intervention programs. In this study, we examine the delayed effect of weather variables on TB occurrence and estimate the burden of the disease that can be attributed to weather factors. We used generalized linear Poisson regression models to investigate the association between weather factors and TB cases reported to the Bangladesh National TB control program between 2007 and 2012 in three known endemic districts of North-East Bangladesh. The associated risk of TB in the three districts increases with prolonged exposure to temperature and rainfall, and persisted at lag periods beyond 6 quarters. The association between humidity and TB is strong and immediate at low humidity, but the risk decreases with increasing lag. Using the optimum weather values corresponding to the lowest risk of infection, the risk of TB is highest at low temperature, low humidity and low rainfall. Measures of the risk attributable to weather variables revealed that weather-TB cases attributed to humidity is higher than that of temperature and rainfall in each of the three districts. Our results highlight the high linearity of temporal lagged effects and magnitudes of the burden attributable to temperature, humidity, and rainfall on TB endemics. The results can hopefully advise the Bangladesh National TB control program and act as a practical reference for the early warning of TB cases

Mathematical analysis of a Wolbachia invasive model with imperfect maternal transmission and loss of Wolbachia infection

Arboviral infections, especially dengue, continue to cause significant health burden in their endemic regions. One of the strategies to tackle these infections is to replace the main vector agent, Ae. aegypti, with the ones incapable of transmitting the virus. Wolbachia, an intracellular bacterium, has shown promise in achieving this goal. However, key factors such as imperfect maternal transmission, loss of Wolbachia infection, reduced reproductive capacity and shortened life-span affect the dynamics of Wolbachia in different forms in the Ae. aegypti population. In this study, we developed a Wolbachia transmission dynamic model adjusting for imperfect maternal transmission and loss of Wolbachia infection. The invasive reproductive number that determines the likelihood of replacement of the Wolbachia-uninfected (WU) population is derived and with it, we established the local and global stability of the equilibrium points. This analysis clearly shows that cytoplasmic incompatibility (CI) does not guarantee establishment of the Wolbachia-infected (WI) mosquitoes as imperfect maternal transmission and loss of Wolbachia infection could outweigh the gains from CI. Optimal release programs depending on the level of imperfect maternal transmission and loss of Wolbachia infection are shown. Hence, it is left to decision makers to either aim for replacement or co-existence of both populations

Tropical Australian health-data linkage shows excess mortality following severe infectious disease is present in the short-term and long-term after hospital discharge

Background: In this study, we aimed to assess the risk factors associated with mortality due to an infectious disease over the short-, medium-, and long-term based on a data-linkage study for patients discharged from an infectious disease unit in North Queensland, Australia, between 2006 and 2011. Methods: Age-sex standardised mortality rates (SMR) for different subgroups were estimated, and the Kaplan-Meier method was used to estimate and compare the survival experience among different groups. Results: Overall, the mortality rate in the hospital cohort was higher than expected in comparison with the Queensland population (SMR: 15.3, 95%CI: 14.9–15.6). The long-term mortality risks were significantly higher for severe infectious diseases than non-infectious diseases for male sex, Indigenous, residential aged care and elderly individuals. Conclusion: In general, male sex, Indigenous status, age and comorbidity were associated with an increased hazard for all-cause death