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1.
Epidemiology ; 35(2): 164-173, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38290139

RESUMO

BACKGROUND: In the United States, over 80% of tuberculosis (TB) disease cases are estimated to result from reactivation of latent TB infection (LTBI) acquired more than 2 years previously ("reactivation TB"). We estimated reactivation TB rates for the US population with LTBI, overall, by age, sex, race-ethnicity, and US-born status, and for selected comorbidities (diabetes, end-stage renal disease, and HIV). METHODS: We collated nationally representative data for 2011-2012. Reactivation TB incidence was based on TB cases reported to the National TB Surveillance System that were attributed to LTBI reactivation. Person-years at risk of reactivation TB were calculated using interferon-gamma release assay (IGRA) positivity from the National Health and Nutrition Examination Survey, published values for interferon-gamma release assay sensitivity and specificity, and population estimates from the American Community Survey. RESULTS: For persons aged ≥6 years with LTBI, the overall reactivation rate was estimated as 0.072 (95% uncertainty interval: 0.047, 0.12) per 100 person-years. Estimated reactivation rates declined with age. Compared to the overall population, estimated reactivation rates were higher for persons with diabetes (adjusted rate ratio [aRR] = 1.6 [1.5, 1.7]), end-stage renal disease (aRR = 9.8 [5.4, 19]), and HIV (aRR = 12 [10, 13]). CONCLUSIONS: In our study, individuals with LTBI faced small, non-negligible risks of reactivation TB. Risks were elevated for individuals with medical comorbidities that weaken immune function.


Assuntos
Diabetes Mellitus , Infecções por HIV , Falência Renal Crônica , Mycobacterium tuberculosis , Tuberculose , Humanos , Estados Unidos/epidemiologia , Inquéritos Nutricionais , Tuberculose/epidemiologia , Tuberculose/diagnóstico , Falência Renal Crônica/epidemiologia , Infecções por HIV/epidemiologia
2.
MMWR Morb Mortal Wkly Rep ; 72(5253): 1385-1389, 2024 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-38175804

RESUMO

During July 7-11, 2023, CDC received reports of two patients in different states with a tuberculosis (TB) diagnosis following spinal surgical procedures that used bone allografts containing live cells from the same deceased donor. An outbreak associated with a similar product manufactured by the same tissue establishment (i.e., manufacturer) occurred in 2021. Because of concern that these cases represented a second outbreak, CDC and the Food and Drug Administration worked with the tissue establishment to determine that this product was obtained from a donor different from the one implicated in the 2021 outbreak and learned that the bone allograft product was distributed to 13 health care facilities in seven states. Notifications to all seven states occurred on July 12. As of December 20, 2023, five of 36 surgical bone allograft recipients received laboratory-confirmed TB disease diagnoses; two patients died of TB. Whole-genome sequencing demonstrated close genetic relatedness between positive Mycobacterium tuberculosis cultures from surgical recipients and unused product. Although the bone product had tested negative by nucleic acid amplification testing before distribution, M. tuberculosis culture of unused product was not performed until after the outbreak was recognized. The public health response prevented up to 53 additional surgical procedures using allografts from that donor; additional measures to protect patients from tissue-transmitted M. tuberculosis are urgently needed.


Assuntos
Mycobacterium tuberculosis , Tuberculose , Humanos , Estados Unidos/epidemiologia , Tuberculose/epidemiologia , Tuberculose/diagnóstico , Mycobacterium tuberculosis/genética , Doadores de Tecidos , Surtos de Doenças , Aloenxertos
3.
Clin Infect Dis ; 76(10): 1847-1849, 2023 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-36660866

RESUMO

A nationwide tuberculosis outbreak linked to a viable bone allograft product contaminated with Mycobacterium tuberculosis was identified in June 2021. Our subsequent investigation identified 73 healthcare personnel with new latent tuberculosis infection following exposure to the contaminated product, product recipients, surgical instruments, or medical waste.


Assuntos
Mycobacterium tuberculosis , Tuberculose , Humanos , Estados Unidos/epidemiologia , Tuberculose/epidemiologia , Surtos de Doenças , Pessoal de Saúde , Atenção à Saúde
4.
MMWR Morb Mortal Wkly Rep ; 72(35): 957-960, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-37651293

RESUMO

An outbreak of multidrug-resistant (MDR) tuberculosis (TB) involved 13 persons in four households in a low-income, under-resourced urban Kansas community during November 2021-November 2022. A majority of the seven adults identified in the Kansas outbreak were born outside the United States in a country that had experienced an MDR TB outbreak with the same genotype during 2007-2009, whereas most of the six children in the Kansas outbreak were U.S.-born. Prompt identification, evaluation, and treatment of persons with MDR TB and their contacts is essential to limiting transmission.


Assuntos
Surtos de Doenças , Tuberculose Resistente a Múltiplos Medicamentos , Adulto , Criança , Humanos , Kansas/epidemiologia , Genótipo , Pobreza , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia
5.
MMWR Morb Mortal Wkly Rep ; 72(12): 313-316, 2023 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-36952279

RESUMO

U.S. clinical practice guidelines recommend directly observed therapy (DOT) as the standard of care for tuberculosis (TB) treatment (1). DOT, during which a health care worker observes a patient ingesting the TB medications, has typically been conducted in person. Video DOT (vDOT) uses video-enabled devices to facilitate remote interactions between patients and health care workers to promote medication adherence and clinical monitoring. Published systematic reviews, a published meta-analysis, and a literature search through 2022 demonstrate that vDOT is associated with a higher proportion of medication doses being observed and similar proportions of cases with treatment completion and microbiologic resolution when compared with in-person DOT (2-5). Based on this evidence, CDC has updated the recommendation for DOT during TB treatment to include vDOT as an equivalent alternative to in-person DOT. vDOT can assist health department TB programs meet the U.S. standard of care for patients undergoing TB treatment, while using resources efficiently.


Assuntos
Telemedicina , Tuberculose , Humanos , Estados Unidos , Terapia Diretamente Observada , Tuberculose/tratamento farmacológico , Antituberculosos/uso terapêutico , Adesão à Medicação
6.
Am J Public Health ; 112(8): 1170-1179, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35830666

RESUMO

Objectives. To understand the frequency, magnitude, geography, and characteristics of tuberculosis outbreaks in US state prisons. Methods. Using data from the National Tuberculosis Surveillance System, we identified all cases of tuberculosis during 2011 to 2019 that were reported as occurring among individuals incarcerated in a state prison at the time of diagnosis. We used whole-genome sequencing to define 3 or more cases within 2 single nucleotide polymorphisms within 3 years as clustered; we classified clusters with 6 or more cases during a 3-year period as tuberculosis outbreaks. Results. During 2011 to 2019, 566 tuberculosis cases occurred in 41 state prison systems (a median of 3 cases per state). A total of 19 tuberculosis genotype clusters comprising 134 cases were identified in 6 state prison systems; these clusters included a subset of 5 outbreaks in 2 states. Two Alabama outbreaks during 2011 to 2017 totaled 20 cases; 3 Texas outbreaks during 2014 to 2019 totaled 51 cases. Conclusions. Only Alabama and Texas reported outbreaks during the 9-year period; only Texas state prisons had ongoing transmission in 2019. Effective interventions are needed to stop tuberculosis outbreaks in Texas state prisons. (Am J Public Health. 2022;112(8):1170-1179. https://doi.org/10.2105/AJPH.2022.306864).


Assuntos
Prisioneiros , Tuberculose , Surtos de Doenças , Genótipo , Humanos , Prisões , Texas , Tuberculose/epidemiologia , Estados Unidos/epidemiologia
7.
Epidemiology ; 31(2): 248-258, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31764278

RESUMO

BACKGROUND: A single 2-year National Health and Nutrition Examination Survey (NHANES) cycle is designed to provide accurate and stable estimates of conditions with prevalence of at least 10%. Recent NHANES-based estimates of a tuberculin skin test (TST) ≥10 mm in the noninstitutionalized US civilian population are at most 6.3%. METHODS: NHANES included a TST in 1971-1972, 1999-2000, and 2011-2012. We examined the robustness of NHANES-based estimates of the US population prevalence of a skin test ≥10 mm with a bias analysis that considered the influence of non-US birth distributions and within-household skin test results, reclassified borderline-positive results, and adjusted for TST item nonresponse. RESULTS: The weighted non-US birth distribution among NHANES participants was similar to that in the overall US population; further adjustment was unnecessary. We found no evidence of bias due to sampling multiple participants per household. Prevalence estimates changed 0.3% with reclassification of borderline-positive TST results and 0.2%-0.3% with adjustment for item nonresponse. CONCLUSIONS: For estimating the national prevalence of a TST ≥10 mm during these three survey cycles, a conventional NHANES analysis using the standard participant weights and masked design parameters that are provided in the public-use datasets appears robust. See video abstract at, http://links.lww.com/EDE/B636.


Assuntos
Inquéritos Nutricionais , Teste Tuberculínico , Tuberculose , Humanos , Prevalência , Reprodutibilidade dos Testes , Teste Tuberculínico/estatística & dados numéricos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Estados Unidos/epidemiologia
8.
Emerg Infect Dis ; 25(10): 1949-1951, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31538921

RESUMO

To refine estimates of how many persons in the United States are candidates for treatment of latent tuberculosis, we removed from analysis persons who self-reported prior treatment on the National Health and Nutrition Examination Survey 2011-2012. We estimate that 12.6 million persons could benefit from treatment to prevent active tuberculosis.


Assuntos
Tuberculose Pulmonar/epidemiologia , Antineoplásicos/uso terapêutico , Humanos , Tuberculose Latente/tratamento farmacológico , Tuberculose Latente/epidemiologia , Inquéritos Nutricionais , Prevalência , Inquéritos e Questionários , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/prevenção & controle , Estados Unidos/epidemiologia
9.
Emerg Infect Dis ; 25(3): 451-456, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30789145

RESUMO

Mycobacterium bovis bacillus Calmette-Guérin (BCG) is used as a vaccine to protect against disseminated tuberculosis (TB) and as a treatment for bladder cancer. We describe characteristics of US TB patients reported to the National Tuberculosis Surveillance System (NTSS) whose disease was attributed to BCG. We identified 118 BCG cases and 91,065 TB cases reported to NTSS during 2004-2015. Most patients with BCG were US-born (86%), older (median age 75 years), and non-Hispanic white (81%). Only 17% of BCG cases had pulmonary involvement, in contrast with 84% of TB cases. Epidemiologic features of BCG cases differed from TB cases. Clinicians can use clinical history to discern probable BCG cases from TB cases, enabling optimal clinical management. Public health agencies can use this information to quickly identify probable BCG cases to avoid inappropriately reporting BCG cases to NTSS or expending resources on unnecessary public health interventions.


Assuntos
Vacina BCG/efeitos adversos , Notificação de Doenças , Tuberculose/epidemiologia , Tuberculose/microbiologia , Vacina BCG/genética , Notificação de Doenças/estatística & dados numéricos , Feminino , Genótipo , História do Século XXI , Humanos , Masculino , Vigilância da População , Tuberculose/diagnóstico , Tuberculose/história , Estados Unidos/epidemiologia
10.
Emerg Infect Dis ; 24(10): 1930-1933, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30226174

RESUMO

We used tuberculosis genotyping results to derive estimates of prevalence of latent tuberculosis infection in the United States. We estimated <1% prevalence in 1,981 US counties, 1%-<3% in 785 counties, and >3% in 377 counties. This method for estimating prevalence could be applied in any jurisdiction with an established tuberculosis surveillance system.


Assuntos
Tuberculose Latente/epidemiologia , Genótipo , Geografia Médica , História do Século XXI , Humanos , Incidência , Tuberculose Latente/história , Tuberculose Latente/microbiologia , Mycobacterium/classificação , Mycobacterium/genética , Vigilância da População , Prevalência , Estados Unidos/epidemiologia
11.
Clin Infect Dis ; 65(11): 1924-1926, 2017 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-29020169

RESUMO

We assessed characteristics associated with all-cause mortality among US patients with multidrug-resistant tuberculosis. Mortality decreased from 31% during 1993-2002 to 11% during 2003-2013. Directly observed therapy coverage increased from 74% to 95% and was protective against all-cause mortality after accounting for demographics, clinical characteristics, human immunodeficiency virus status, and period of treatment.


Assuntos
Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/mortalidade , Adulto , Antituberculosos/uso terapêutico , Demografia , Terapia Diretamente Observada , Feminino , Humanos , Masculino , Tuberculose Resistente a Múltiplos Medicamentos/etiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Estados Unidos/epidemiologia
12.
Am J Public Health ; 106(12): 2231-2237, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27631758

RESUMO

OBJECTIVES: To describe cases and estimate the annual incidence of tuberculosis in correctional facilities. METHODS: We analyzed 2002 to 2013 National Tuberculosis Surveillance System case reports to characterize individuals who were employed or incarcerated in correctional facilities at time they were diagnosed with tuberculosis. Incidence was estimated with Bureau of Justice Statistics denominators. RESULTS: Among 299 correctional employees with tuberculosis, 171 (57%) were US-born and 82 (27%) were female. Among 5579 persons incarcerated at the time of their tuberculosis diagnosis, 2520 (45%) were US-born and 495 (9%) were female. Median estimated annual tuberculosis incidence rates were 29 cases per 100 000 local jail inmates, 8 per 100 000 state prisoners, and 25 per 100 000 federal prisoners. The foreign-born proportion of incarcerated men 18 to 64 years old increased steadily from 33% in 2002 to 56% in 2013. Between 2009 and 2013, tuberculosis screenings were reported as leading to 10% of diagnoses among correctional employees, 47% among female inmates, and 42% among male inmates. CONCLUSIONS: Systematic screening and treatment of tuberculosis infection and disease among correctional employees and incarcerated individuals remain essential to tuberculosis prevention and control.


Assuntos
Prisões , Tuberculose/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Vigilância da População , Prisioneiros , Estados Unidos/epidemiologia , Adulto Jovem
13.
MMWR Morb Mortal Wkly Rep ; 65(11): 273-8, 2016 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-27010173

RESUMO

After 2 decades of progress toward tuberculosis (TB) elimination with annual decreases of ≥0.2 cases per 100,000 persons (1), TB incidence in the United States remained approximately 3.0 cases per 100,000 persons during 2013-2015. Preliminary data reported to the National Tuberculosis Surveillance System indicate that TB incidence among foreign-born persons in the United States (15.1 cases per 100,000) has remained approximately 13 times the incidence among U.S.-born persons (1.2 cases per 100,000). Resuming progress toward TB elimination in the United States will require intensification of efforts both in the United States and globally, including increasing U.S. efforts to detect and treat latent TB infection, strengthening systems to interrupt TB transmission in the United States and globally, accelerating reductions in TB globally, particularly in the countries of origin for most U.S.


Assuntos
Vigilância da População , Tuberculose/epidemiologia , Emigração e Imigração/estatística & dados numéricos , Humanos , Incidência , Estados Unidos/epidemiologia
14.
MMWR Morb Mortal Wkly Rep ; 65(11): 279-81, 2016 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-27010221

RESUMO

Tuberculosis (TB) is a contagious bacterial disease of global concern. During 2013, an estimated nine million incident TB cases occurred worldwide (1). The majority (82%) were diagnosed in 22 countries, including South Africa and the Philippines, where annual incidence was 860 TB cases per 100,000 persons and 292 TB cases per 100,000 persons, respectively (1). The 2013 TB incidence in the United States was three cases per 100,000 persons (2). Under the Immigration and Nationality Act, TB screening is required for persons seeking permanent residence in the United States (i.e., immigrants and refugees), but it is not routinely required for nonimmigrants who are issued temporary visas for school or work (3). A portion of the U.S. tourism industry relies on temporary visa holders to accommodate seasonal and fluctuating demand for service personnel (4). This report describes three foreign-born persons holding temporary visas who had infectious TB while working at tourist destinations in the United States during 2012-2014. Multiple factors, including dormitory-style housing, transient work patterns, and diagnostic delays might have contributed to increased opportunity for TB transmission. Clinicians in seasonally driven tourist destinations should be aware of the potential for imported TB disease in foreign-born seasonal workers and promptly report suspected cases to health officials.


Assuntos
Emprego/estatística & dados numéricos , Pessoal Profissional Estrangeiro/estatística & dados numéricos , Indústrias , Tuberculose/diagnóstico , Adulto , Emigração e Imigração/legislação & jurisprudência , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/legislação & jurisprudência , Pessoa de Meia-Idade , Filipinas/etnologia , África do Sul/etnologia , Tuberculose/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
16.
Emerg Infect Dis ; 21(3): 508-10, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25695665

RESUMO

A review of 26 tuberculosis outbreaks in the United States (2002-2011) showed that initial source case-patients had long infectious periods (median 10 months) and were characterized by substance abuse, incarceration, and homelessness. Improved timeliness of diagnosis and thorough contact investigations for such cases may reduce the risk for outbreaks.


Assuntos
Surtos de Doenças , Mycobacterium tuberculosis , Tuberculose/epidemiologia , Adolescente , Adulto , Feminino , História do Século XXI , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância de Evento Sentinela , Tuberculose/história , Estados Unidos/epidemiologia , Adulto Jovem
17.
J Pediatr ; 165(1): 99-103.e2, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24721470

RESUMO

OBJECTIVE: To characterize parental perceptions of the respective roles of families and the pediatrician in childhood weight management. STUDY DESIGN: Structured in-person interviews (n = 69) were conducted with parents of children ages 3-12 years visiting a pediatric clinic. Interview topics included perceptions of weight and associated problems, child weight status and concerns, and the pediatrician's role in weight management. Interviews were coded qualitatively and analyzed thematically. RESULTS: Nine major themes were developed from the findings. Parents were clear about the health consequences of excess weight but were not clear about the concept of body mass index, often relying on visual cues or symptoms to identify excess weight. Parents relied on pediatricians to identify weight problems and suggest diet and exercise plans, but few recognized them as a link to additional weight-management resources. Parents were divided on the role of the pediatrician in managing child weight and were most interested in receiving tailored nutrition information. Parents preferred family behavioral change strategies over singling out an overweight child. Although parents did not always define their child as overweight, many parents of overweight children did express concerns about their child's weight. CONCLUSIONS: Parents believe that pediatricians have a central role in identifying childhood weight problems by completing screening tests such as body mass index assessments, interpreting the health implications, and communicating those implications to parents. Ensuring that parents understand the health implications of excess weight is critical given gaps in parental knowledge and confidence with healthy lifestyle changes as well as parental ambivalence toward child-directed interventions.


Assuntos
Família/psicologia , Pais/psicologia , Obesidade Infantil/psicologia , Papel do Médico/psicologia , Adulto , Peso Corporal , Criança , Pré-Escolar , Feminino , Georgia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Infantil/terapia , Pediatria , Inquéritos e Questionários , Adulto Jovem
18.
Am J Infect Control ; 52(2): 225-228, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37355098

RESUMO

A systematic approach to contact investigations has long been a cornerstone of interrupting the transmission of tuberculosis in community settings. This paper describes the implementation of a systematic 10-step contact investigation within an acute care setting during a multistate outbreak of healthcare-associated tuberculosis. A systematic approach to contact investigations might have applicability to the prevention of other communicable infections within healthcare settings.


Assuntos
Tuberculose , Humanos , Tuberculose/epidemiologia , Busca de Comunicante , Atenção à Saúde , Surtos de Doenças/prevenção & controle , Instalações de Saúde
19.
Emerg Infect Dis ; 19(3): 493-6, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23621956

RESUMO

Groups of tuberculosis cases with indistinguishable Mycobacterium tuberculosis genotypes (clusters) might represent recent transmission. We compared geospatial concentration of genotype clusters with independent priority rankings determined by local public health officials; findings were highly correlated. Routine use of geospatial statistics could help health departments identify recent disease transmission.


Assuntos
Prioridades em Saúde , Tuberculose Pulmonar/epidemiologia , Análise por Conglomerados , Interpretação Estatística de Dados , Transmissão de Doença Infecciosa , Genótipo , Humanos , Mycobacterium tuberculosis/genética , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/transmissão , Washington/epidemiologia
20.
Int J Health Geogr ; 12: 15, 2013 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-23497235

RESUMO

BACKGROUND: Early identification of outbreaks remains a key component in continuing to reduce the burden of infectious disease in the United States. Previous studies have applied statistical methods to detect unexpected cases of disease in space or time. The objectives of our study were to assess the ability and timeliness of three spatio-temporal methods to detect known outbreaks of tuberculosis. METHODS: We used routinely available molecular and surveillance data to retrospectively assess the effectiveness of three statistical methods in detecting tuberculosis outbreaks: county-based log-likelihood ratio, cumulative sums, and a spatial scan statistic. RESULTS: Our methods identified 8 of the 9 outbreaks, and 6 outbreaks would have been identified 1-52 months (median=10 months) before local public health authorities identified them. Assuming no delays in data availability, 46 (59.7%) of the 77 patients in the 9 outbreaks were identified after our statistical methods would have detected the outbreak but before local public health authorities became aware of the problem. CONCLUSIONS: Statistical methods, when applied retrospectively to routinely collected tuberculosis data, can successfully detect known outbreaks, potentially months before local public health authorities become aware of the problem. The three methods showed similar results; no single method was clearly superior to the other two. Further study to elucidate the performance of these methods in detecting tuberculosis outbreaks will be done in a prospective analysis.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Técnicas de Genotipagem/métodos , Vigilância da População/métodos , Tuberculose/epidemiologia , Tuberculose/genética , Técnicas de Genotipagem/tendências , Humanos , Estudos Retrospectivos , Tuberculose/diagnóstico , Estados Unidos/epidemiologia
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