Treatment completion for latent tuberculosis infection in Norway: a prospective cohort study

Background: Successful treatment of latent tuberculosis infection (LTBI) is essential to reduce tuberculosis (TB) incidence rates in low-burden countries. This study measures treatment completion and determinants of non-completion of LTBI treatment in Norway in 2016. Methods: This prospective cohort study included all individuals notified with LTBI treatment to the Norwegian Surveillance System for Infectious Diseases (MSIS) in 2016. We obtained data from MSIS and from a standardized form that was sent to health care providers at the time of patient notification to MSIS. We determined completion rates. Pearson’s chi squared test was used to study associations between pairs of categorical variables and separate crude and multivariable logistic regression models were used to identify factors associated with treatment completion and adverse drug effects. Results: We obtained information on treatment completion from 719 of the 726 individuals notified for LTBI treatment in 2016. Overall, 91% completed treatment. Treatment completion was highest in the foreign-born group [foreign-born, n = 562 (92%) vs Norwegian-born, n = 115 (85%), p = 0.007]. Treatment completion did not differ significantly between prescribed regimens (p = 0.124). Adverse events were the most common reason for incomplete treatment. We found no significant differences in adverse events when comparing weekly rifapentine (3RPH) with three months daily isoniazid and rifampicin (3RH). However, there were significantly fewer adverse events with 3RPH compared to other regimens (p = 0.037). Age over 35 years was significantly associated with adverse events irrespective of regimen (p = 0.024), whereas immunosuppression was not significantly associated with adverse events after adjusting for other variables (p = 0.306). Treatment under direct observation had a significant effect on treatment completion for foreign-born (multivariate Wald p-value = 0.017), but not for Norwegian-born (multivariate Wald p-value = 0.408) individuals. Conclusions: We report a very high treatment completion rate, especially among individuals from countries with high TB incidence. The follow-up from tuberculosis-coordinators and the frequent use of directly observed treatment probably contributes to this. Few severe adverse events were reported, even with increased age and in individuals that are more susceptible. While these results are promising, issues of cost-effectiveness and targeting treatment to individuals at highest risk of TB are important components of public health impact.publishedVersio

Targeting TB or MRSA in Norwegian municipalities during ‘the refugee crisis’ of 2015: a framework for priority setting in screening

Introduction In 2015, there was an increase in the number of asylum seekers arriving in Europe. Like in other countries, deciding screening priorities for tuberculosis (TB) and meticillin-resistant Staphylococcus aureus (MRSA) was a challenge. At least five of 428 municipalities chose to screen asylum seekers for MRSA before TB; the Norwegian Institute for Public Health advised against this. Aim To evaluate the MRSA/TB screening results from 2014 to 2016 and create a generalised framework for screening prioritisation in Norway through simulation modelling. Methods This is a register-based cohort study of asylum seekers using data from the Norwegian Surveillance System for Communicable Diseases from 2014 to 2016. We used survey data from municipalities that screened all asylum seekers for MRSA and denominator data from the Directorate of Immigration. A comparative risk assessment model was built to investigate the outcomes of prioritising between TB and MRSA in screening regimes. Results Of 46,090 asylum seekers, 137 (0.30%) were diagnosed with active TB (notification rate: 300/100,000 person-years). In the municipalities that screened all asylum seekers for MRSA, 13 of 1,768 (0.74%) were found to be infected with MRSA. The model estimated that screening for MRSA would prevent eight MRSA infections while prioritising TB screening would prevent 24 cases of active TB and one death. Conclusion Our findings support the decision to advise against screening for MRSA before TB among newly arrived asylum seekers. The model was an effective tool for comparing screening priorities and can be applied to other scenarios in other countries

Targeting TB or MRSA in Norwegian municipalities during ‘the refugee crisis’ of 2015: a framework for priority setting in screening

Introduction In 2015, there was an increase in the number of asylum seekers arriving in Europe. Like in other countries, deciding screening priorities for tuberculosis (TB) and meticillin-resistant Staphylococcus aureus (MRSA) was a challenge. At least five of 428 municipalities chose to screen asylum seekers for MRSA before TB; the Norwegian Institute for Public Health advised against this. Aim To evaluate the MRSA/TB screening results from 2014 to 2016 and create a generalised framework for screening prioritisation in Norway through simulation modelling. Methods This is a register-based cohort study of asylum seekers using data from the Norwegian Surveillance System for Communicable Diseases from 2014 to 2016. We used survey data from municipalities that screened all asylum seekers for MRSA and denominator data from the Directorate of Immigration. A comparative risk assessment model was built to investigate the outcomes of prioritising between TB and MRSA in screening regimes. Results Of 46,090 asylum seekers, 137 (0.30%) were diagnosed with active TB (notification rate: 300/100,000 person-years). In the municipalities that screened all asylum seekers for MRSA, 13 of 1,768 (0.74%) were found to be infected with MRSA. The model estimated that screening for MRSA would prevent eight MRSA infections while prioritising TB screening would prevent 24 cases of active TB and one death. Conclusion Our findings support the decision to advise against screening for MRSA before TB among newly arrived asylum seekers. The model was an effective tool for comparing screening priorities and can be applied to other scenarios in other countries

Tuberkulose i Norge 2021 – med behandlingsresultater for 2020

Hovedbudskap Denne rapporten oppsummerer epidemiologisk informasjon om tuberkulose meldt i Norge i 2021, og smittesporing og for behandlingsresultater for pasienter meldt I 2020. Det ble meldt 154 tilfeller av tuberkulose i Norge i 2021. Dette er det laveste totalantallet meldt av tuberkulose i Norge noensinne Det tilsvarer en insidens på 3 per 100 000, som er en av de laveste tuberkuloseforekomstene i Europa. Av disse 154 var 26 norskfødte, hvilket tilsvarer en enda lavere insidens på 0,4 per 100 000. Antall utenlandsfødte med tuberkulose var 128, en vesentlig reduksjon sammenlignet med foregående år. Dette må ses i sammenheng med redusert innvandring til Norge under covid-19-pandemien. Redusert innvandring forklarer også at en høyere andel (57 %) hadde bodd mer enn 5 år i Norge på diagnosetidspunktet og at en lavere andel (9 %) ble funnet ved ankomstscreening. Over 80 % av tuberkulosetilfellene i Norge er dyrkningsbekreftede, uendret fra tidligere. Det ble meldt 10 tilfeller av multiresistent tuberkulose (MDR TB), det vil si tuberkulose resistent mot rifampicin og isoniazid. Sammenholdt med et lavt totalt antall TB-tilfeller, utgjør dette en markant økning i andelen MDR etter to år med henholdsvis ett og to tilfeller av MDR TB. I smittesporinger fra 2020, som er det siste året med komplette data, ble det funnet 802 nærkontakter til tuberkulosepasienter. For disse foreligger det svar på IGRA for 701, hvorav 116 testet positivt. 10 ble diagnostisert med tuberkulosesykdom og 61 startet forebyggende behandling. På verdensbasis antas covid-19 pandemien å ha ført til et betydelig tilbakeslag for tuberkulosearbeidet, med økning av tuberkuloseforekomsten og dødeligheten, men ser ikke ut til å ha hatt negative konsekvenser for tuberkulosesituasjonen i Norge