Immigrant Arrival and Tuberculosis among Large Immigrant- and Refugee-Receiving Countries, 2005-2009.

Objective. Tuberculosis control in foreign-born populations is a major public health concern for Australia, Canada, New Zealand, United Kingdom, and the United States, large immigrant- and refugee-receiving countries that comprise the Immigration and Refugee Health Working Group (IRHWG). Identifying and comparing immigration and distribution of foreign-born tuberculosis cases are important for developing targeted and collaborative interventions. Methods. Data stratified by year and country of birth from 2005 to 2009 were received from these five countries. Immigration totals, tuberculosis case totals, and multidrug-resistant tuberculosis (MDR TB) case totals from source countries were analyzed and compared to reveal similarities and differences for each member of the group. Results. Between 2005 and 2009, there were a combined 31,785,002 arrivals, 77,905 tuberculosis cases, and 888 MDR TB cases notified at the federal level in the IRHWG countries. India, China, Vietnam, and the Philippines accounted for 41.4% of the total foreign-born tuberculosis cases and 42.7% of the foreign-born MDR tuberculosis cases to IRHWG. Interpretation. Collaborative efforts across a small number of countries have the potential to yield sizeable gains in tuberculosis control for these large immigrant- and refugee-receiving countries.

Towards tuberculosis elimination: an action framework for low-incidence countries.

This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.

Cost-benefit analysis of preventing nosocomial bloodstream infections among hemodialysis patients in Canada in 2004.

OBJECTIVES: Hemodialysis-associated bloodstream infection (BSI) is a significant public health problem because the number of hemodialysis patients in Canada had doubled from 1996 to 2005.Our study aimed to determine the costs of nosocomial BSIs in Canada and estimate the investment expenses for establishing infection control programs in general hospitals and conduct cost-benefit analysis. MATERIALS AND METHODS: The data from the Canadian Nosocomial Infection Surveillance Program was used to estimate the incidence rate of nosocomial BSI. We used Canadian Institute of Health Information data to estimate the extra costs of BSIs per stay across Canada in 2004. The cost of establishing and maintaining an infection control program in 1985 was estimated by the US Centers for Disease Control and Prevention and converted into 2004 Canadian costs. The possible 20% to 30% reduction of total nosocomial BSIs was hypothesized. RESULTS: A total of 2524 hemodialysis-associated BSIs were projected among 15,278 hemodialysis patients in Canada in 2004. The total annual costs to treat BSIs were estimated to be CDN$49.01 million. Total investment costs in prevention and human resources were CDN$8.15 million. The savings of avoidable medical costs after establishing infection control programs were CDN$14.52 million. The benefit/cost ratio was 1.0 to 1.8:1. CONCLUSION: Our study provides evidence that the economic benefit from implementing infection control programs could be expected to be well in excess of additional cost postinfection if the reduction of BSI can be reduced by 20% to 30%. Infection control offered double benefits: saving money while simultaneously improving the quality of care.

Rapid and accurate in vitro assays for detection of West Nile virus in blood and tissues.

West Nile virus (WNV) is a mosquito-borne single-stranded RNA virus, which has relatively recently emerged as a blood transfusion and organ transplantation transmissible pathogen. Low levels of WNV (viremia) are found in asymptomatic blood transfusion or cell/tissue donors with an infection, which poses a health threat to recipients. Since the introduction of nucleic acid testing (NAT) in 2003, many changes have occurred in the field of WNV detection and diagnosis. This review will focus on the recent progress in the in vitro assays for rapid and accurate detection of WNV in blood and tissues.