A prospective longitudinal study of tuberculosis among household contacts of smear-positive tuberculosis cases in Lima, Peru

Background: Household contacts (HHCs) of TB cases are at increased risk for TB disease compared to the general population but the risk may be modified by individual or household factors. We conducted a study to determine incident TB among HHCs over two years after exposure and to identify individual and household level risk factors. Methods: Adults newly diagnosed with a first episode of smear-positive pulmonary TB (index cases) between March 2010 and December 2011 in eastern Lima, were interviewed to identify their HHC and household characteristics. TB registers were reviewed for up to two years after the index case diagnosis and house visits were made to ascertain TB cases among HHC. The TB incidence rate ratio among HHCs as a function of risk factors was determined using generalized linear mixed models. Results: The 1178 index cases reported 5466 HHCs. In 402/1178 (34.1 %) households, at least one HHC had experienced a TB episode ever. The TB incidence among HHCs was 1918 (95% CI 1669-2194) per 100,000 person-years overall, and was 2392 (95% CI 2005-2833) and 1435 (95% CI 1139-1787) per 100,000 person-years in the first and second year, respectively. Incident TB occurred more than six months following the index case's TB diagnosis in 121/205 (59.0 %) HHCs. In HHCs, bacillary load and time between symptoms and treatment initiation in the index case, as well as the relationship to the index case and the sex of the HHC all had a significant association with TB incidence in HHCs. Conclusions: Incidence of TB among HHCs was more than ten times higher than in the general population. Certain HHC and households were at higher risk of TB, we recommend studies to compare HHC investigation to households at highest risk versus current practice, in terms of efficiency

Progress towards eliminating tuberculosis in Ga West Municipality, Ghana: analysis of tuberculosis surveillance data, 2017

Objective: To assess the progress made towards the actualization of the 80% reduction in incident cases, monitor trends and to assess the quality of GWM TB surveillance data from 2012 to 2016.Design: The study was descriptive secondary data analysisData Source: Tuberculosis cases recorded in the District Health Information Management Systems (DHIMS) and municipal TB registers. The Municipal TB Coordinator was interviewed for clarification on the data. A TB patient was defined as one who coughed persistently for two weeks or more.Main outcome measure: Trend of TB cases in Ga West MunicipalityResults: A total of 441 TB cases were registered of which 68.9% were smear positive. Males were (67%). Age group 35-44 years were the most affected (28.6%). The incidence rose from 21.5 (2012) to 41.6 (2015). The 2016 incidence was 40.7 (± 5.63) per 100,000 population. This is significantly different from the current national incidence of 156 (p < 0.05). Data was 95% complete. Discrepancies existed between data in registers compared to the DHIMS but were not statistically significant.Conclusion: The 80% reduction in incident cases target may not be attained by the GWM due to the rising number of incident cases. However, data quality is good.Keywords: Tuberculosis, data analysis, DHIMS 2, tuberculosis, incident casesFunding: The study was funded by the author

Estimating the Impact of Newly Arrived Foreign-Born Persons on Tuberculosis in the United States

Background: Among approximately 163.5 million foreign-born persons admitted to the United States annually, only 500,000 immigrants and refugees are required to undergo overseas tuberculosis (TB) screening. It is unclear what extent of the unscreened nonimmigrant visitors contributes to the burden of foreign-born TB in the United States. Methodology/Principal Findings: We defined foreign-born persons within 1 year after arrival in the United States as ‘‘newly arrived’’, and utilized data from U.S. Department of Homeland Security, U.S. Centers for Disease Control and Prevention, and World Health Organization to estimate the incidence of TB among newly arrived foreign-born persons in the United States. During 2001 through 2008, 11,500 TB incident cases, including 291 multidrug-resistant TB incident cases, were estimated to occur among 20,989,738 person-years for the 1,479,542,654 newly arrived foreign-born persons in the United States. Of the 11,500 estimated TB incident cases, 41.6 % (4,783) occurred among immigrants and refugees, 36.6 % (4,211) among students/ exchange visitors and temporary workers, 13.8 % (1,589) among tourists and business travelers, and 7.3 % (834) among Canadian and Mexican nonimmigrant visitors without an I-94 form (e.g., arrival-departure record). The top 3 newly arrived foreign-born populations with the largest estimated TB incident cases per 100,000 admissions were immigrants and refugees from high-incidence countries (e.g., 2008 WHO-estimated TB incidence rate of $100 cases/100,000 population/ year; 235.8 cases/100,000 admissions, 95 % confidence interval [CI], 228.3 to 243.3), students/exchange visitors an

Decreasing household contribution to TB transmission with age: a retrospective geographic analysis of young people in a South African township

BACKGROUND: Tuberculosis (TB) transmission rates are exceptionally high in endemic TB settings. Adolescence represents a period of increasing TB infection and disease but little is known as to where adolescents acquire TB infection. We explored the relationship between residential exposure to adult TB cases and infection in children and adolescents in a South African community with high burdens of TB and HIV. METHODS: TB infection data were obtained from community, school-based tuberculin skin test (TST) surveys performed in 2006, 2007 and 2009. A subset of 2007 participants received a repeat TST in 2009, among which incident TB infections were identified. Using residential address, all adult TB cases notified by the community clinic between 1996 and 2009 were cross-referenced with childhood and adolescent TST results. Demographic and clinic data including HIV status were abstracted for TB cases. Multivariate logistic regression models examined the association of adult TB exposure with childhood and adolescent prevalent and incident TB infection. RESULTS: Of 1,100 children and adolescents included in the prevalent TB infection analysis, 480 (44%) were TST positive and 651 (59%) were exposed to an adult TB case on their residential plot. Prevalent TB infection in children aged 5-9 and 10-14 years was positively associated with residential exposure to an adult TB case (odds ratio [OR]:2.0; 95% confidence interval [CI]: 1.1-3.6 and OR:1.5; 95% CI: 1.0-2.3 respectively), but no association was found in adolescents [greater than or equal to]15years (OR:1.4; 95% CI: 0.9-2.0). HIV status of adult TB cases was not associated with TB infection (p=0.62). Of 67 previously TST negative children, 16 (24%) converted to a positive TST in 2009. These incident infections were not associated with residential exposure to an adult TB case (OR: 1.9; 95% CI: 0.5-7.3). CONCLUSIONS: TB infection among young children was strongly associated with residential exposure to an adult TB case, but prevalent and incident TB infection in adolescents was not associated with residential exposure. The HIV-status of adult TB cases was not a risk factor for transmission. The high rates of TB infection and disease among adolescents underscore the importance of identifying where infection occurs in this age group

Tuberculosis vaccine: pipeline approaches and future prospective

Tuberculosis (TB), despite anti-mycobacterial therapies and vaccine, is a deadly infectious disease with about 12 million incident cases worldwide. Existing Bacillus Calmette-Guérin (BCG) vaccine is unquestionably inexpensive, safe and effective against severe forms of childhood TB but appears to be limited in effectiveness against adult pulmonary disease in endemic areas. Genetic variation in the population is the major obstruction inhibiting validation of biomarkers for protective human immunity against TB. Since current TB cases are presenting new challenges with threats of HIV co-infection therefore various attempts at a global platform are being made to develop a new modified vaccine against it. Consequently, Modified Vaccinia Ankara virus (MVA) vectored MPT64 & Ag85A delivery and polyvalent DNA vaccine, expressing an ESAT6–Ag85B fusion protein etc. are preclinically tested for boosted immune effects. However, better vaccine approaches still need to be developed against M. tuberculosis which can be unbeaten in most infected areas

The predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: a cohort study

BACKGROUND: Low haemoglobin concentrations may be predictive of incident tuberculosis (TB) and death in HIV-infected patients receiving antiretroviral therapy (ART), but data are limited and inconsistent. We examined these relationships retrospectively in a long-term South African ART cohort with multiple time-updated haemoglobin measurements. METHODS: Prospectively collected clinical data on patients receiving ART for up to 8years in a community-based cohort were analysed. Time-updated haemoglobin concentrations, CD4 counts and HIV viral loads were recorded, and TB diagnoses and deaths from all causes were ascertained. Anaemia severity was classified using World Health Organization criteria. TB incidence and mortality rates were calculated and Poisson regression models were used to identify independent predictors of incident TB and mortality, respectively. RESULTS: During a median follow-up of 5.0years (IQR, 2.5-5.8) of 1,521 patients, 476 cases of incident TB and 192 deaths occurred during 6,459 person-years (PYs) of follow-up. TB incidence rates were strongly associated with time-updated anaemia severity; those without anaemia had a rate of 4.4 (95%CI, 3.8-5.1) cases/100 PYs compared to 10.0 (95%CI, 8.3-12.1), 26.6 (95%CI, 22.5-31.7) and 87.8 (95%CI, 57.0-138.2) cases/100 PYs in those with mild, moderate and severe anaemia, respectively. Similarly, mortality rates in those with no anaemia or mild, moderate and severe time-updated anaemia were 1.1 (95%CI, 0.8-1.5), 3.5 (95%CI, 2.7-4.8), 11.8 (95%CI, 9.5-14.8) and 28.2 (95%CI, 16.5-51.5) cases/100 PYs, respectively. Moderate and severe anaemia (time-updated) during ART were the strongest independent predictors for incident TB (adjusted IRR=3.8 [95%CI, 3.0-4.8] and 8.2 [95%CI, 5.3-12.7], respectively) and for mortality (adjusted IRR=6.0 [95%CI, 3.9-9.2] and adjusted IRR=8.0 [95%CI, 3.9-16.4], respectively). CONCLUSIONS: Increasing severity of anaemia was associated with exceptionally high rates of both incident TB and mortality during long-term ART. Patients receiving ART who have moderate or severe anaemia should be prioritized for TB screening using microbiological assays and may require adjunctive clinical interventions

Quantifying the Burden and Trends of Isoniazid Resistant Tuberculosis, 1994–2009

Quantifying isoniazid resistant (INH-R) tuberculosis (TB) is important because isoniazid resistance reduces the probability of treatment success, may facilitate the spread of multidrug resistance, and may reduce the effectiveness of isoniazid preventive therapy (IPT).We used data reported to the World Health Organization between 1994-2009 to estimate the INH-R burden among new and retreatment TB cases. We assessed geographical and temporal variation in INH-R and reported levels in high HIV prevalence countries (≥2%) to understand implications for IPT. 131 settings reported INH-R data since 1994. A single global estimate of the percentage of incident TB cases with INH-R was deemed inappropriate due to particularly high levels in the Eastern European region where 44.9% (95% CI: 34.0%, 55.8%) of incident TB cases had INH-R. In all other regions combined, 13.9% (95% CI: 12.6%, 15.2%) of incident cases had INH-R with the lowest regional levels seen in West/Central Europe and Africa. Where trend data existed, we found examples of rising and falling burdens of INH-R. 40% of high HIV prevalence countries reported national data on INH-R and 7.3% (95% CI: 5.5%, 9.1%) of cases in these settings had INH-R.Outside the Eastern European region, one in seven incident TB cases has INH-R, while this rises to nearly half within Eastern Europe. Many countries cannot assess trends in INH-R and the scarcity of data from high HIV prevalence areas limits insight into the implications for IPT. Further research is required to understand reasons for the observed time trends and to determine the effects of INH-R for control of TB

Impact of Demographic Characteristics and Therapy on Tuberculosis Incident Cases

For more than two decades, tuberculosis (TB) has ranked second among the top killers of infectious diseases, with an estimated 10.4 million incident cases in 2018. Demographic characteristics and drug susceptibility influence TB incidence worldwide. Using a retrospective cohort design, the purpose of this quantitative study was to investigate whether race/ethnicity, age, sex (gender), therapy completion within one year (COT), and testing for isoniazid and rifampin susceptibility (TIRS) were predictors of 672 cases of TB in New York-Newark-Jersey City from 1993 to 2017. Guided by the epidemiological triad theory, this research was conducted using a secondary TB dataset from the Center for Disease Control and Prevention. Analysis of the data with the Poisson regression model on SPSS revealed that Blacks, Hispanics, and Asians were respectively 2.4 (95% Cl, 2.364 to 2.512, p \u3c 0.001), 2.1 (95% Cl, 2.031 to 2.161; p \u3c 0.001), 1.8 (95% Cl, 1.782 to 1.899; p \u3c 0.001) times as likely to have TB compared to Whites. Younger age was significantly associated with higher incident cases of TB. Males were 1.58 (95% Cl, 1.554 to 1.613, p \u3c 0.001) times more likely than females to have the disease. The COT and TIRS were 0.175 (95% Cl, 0.170 to 0.180, p \u3c 0.001) and 2.935 (95% Cl, 2.853 to 3.019, p \u3c 0.001) times as likely to impact the TB incident cases in New York-Newark-Jersey City from 1993 to 2017. The findings of this research may create positive social change by informing public health professionals in the design of an effective TB intervention that addresses demographic and therapy-related risk factors for TB in New York-Newark-Jersey City

Understanding the decline of incident, active tuberculosis in people with HIV in Switzerland

BACKGROUND: People with human immunodeficiency virus type 1 (HIV) (PWH) are frequently coinfected with Mycobacterium tuberculosis (MTB) and at risk for progressing from asymptomatic latent TB infection (LTBI) to active tuberculosis (TB). LTBI testing and preventive treatment (TB specific prevention) are recommended, but its efficacy in low transmission settings is unclear. METHODS: We included PWH enrolled from 1988 to 2022 in the Swiss HIV Cohort study (SHCS). The outcome, incident TB, was defined as TB ≥6 months after SHCS inclusion. We assessed its risk factors using a time-updated hazard regression, modeled the potential impact of modifiable factors on TB incidence, performed mediation analysis to assess underlying causes of time trends, and evaluated preventive measures. RESULTS: In 21,528 PWH, LTBI prevalence declined from 15.1% in 2001 to 4.6% in 2021. Incident TB declined from 90.8 cases/1000 person-years in 1989 to 0.1 in 2021. A positive LTBI test showed a higher risk for incident TB (HR 9.8, 5.8-16.5) but only 10.5% of PWH with incident TB were tested positive. Preventive treatment reduced the risk in LTBI test positive PWH for active TB (relative risk reduction, 28.1%, absolute risk reduction 0.9%). On population level, the increase of CD4 T-cells and reduction of HIV viral load were the main driver of TB decrease. CONCLUSIONS: TB specific prevention is effective in selected patient groups. On a population level, control of HIV-1 remains the most important factor for incident TB reduction. Accurate identification of PWH at highest risk for TB is an unmet clinical need

Antimycobacterial Activities from Seagrass Enhalus sp. Associated Bacteria Against Multi Drug Resistance Tuberculosis (MDR TB) Bacteria

AbstractTuberculosis (TB) is caused by Mycobacterium tuberculosis and the most important public health problem in the world. In 2012, there were an estimated 8.6 million incident cases of TB globally, and estimeated 67,000 deaths among TB cases in 2012. Indonesia ranks 4th on the list of TB high burden countries in the world with 450,000 cases, estimated cases of MDR TB were 5700 and 65.000 deaths among TB cases in Indonesia, 2011.This research was conducted to isolate and characterize of seagrass Enhalus sp. -associated bacteria that having antimycobacterial activity against multi drug resistant tuberculosis bacteria. There were 9 isolates collected from Enhalus sp. One isolate from Enhalus sp.-associated bacteria were successfully screened for antimycobacterial against tuberculosis bacteria. EKJP9 was found to inhibit the growth of tuberculosis bacteria (MDR TB strain HE, SR, HR). Based on DNA Data Bank of Japan the accession number of EKJP9 is AB851799. It is Bacillus sp