Use of targeted mobile X-ray screening and computer-aided detection software to identify tuberculosis among high-risk groups in Romania: descriptive results of the E-DETECT TB active case-finding project.

OBJECTIVE: To implement and assess the mobile X-ray unit (MXU) equipped with digital radiography, computer-aided detection (CAD) software and molecular point of care tests to improve early tuberculosis (TB) diagnosis in vulnerable populations in a TB outreach screening programme in Romania. DESIGN: Descriptive study. SETTINGS: Prisons in Bucharest and other cities in the southern part of Romania, homeless shelters and services for problem drug users in Bucharest, and Roma populations in Bucharest and Craiova. PARTICIPANTS: 5510 individuals attended the MXU service; 5003 persons were radiologically screened, 61% prisoners, 15% prison staff, 11% Roma population, 10% homeless persons and/or problem drug users and 3% other. INTERVENTIONS: Radiological digital chest X-ray (CXR) screening of people at risk for TB, followed by CAD and human reading of the CXRs, and further TB diagnostics when the pulmonologist classified the CXR as suggestive for TB. PRIMARY AND SECONDARY OUTCOME MEASURES: Ten bacteriologically confirmed TB cases were identified translating into an overall yield of 200 per 100 000 persons screened (95% CIs of 109 to 368 per 100 000). Prevalence rates among homeless persons and/or problem drug users (826/100 000; 95% CI 326 to 2105/100 000) and the Roma population (345/100 000; 95% CI 95 to 1251/100 000) were particularly high. RESULTS: The human reader classified 6.4% (n=317) of the CXRs as suspect for TB (of which 32 were highly suggestive for TB); 16.3% of all CXRs had a CAD4TB version 6 score >50. All 10 diagnosed TB patients had a CAD4TB score >50; 9 had a CAD4TB score >60. CONCLUSIONS: Given the high TB prevalence rates found among homeless persons and problem drug users and in the Roma population, targeted active case finding has the potential to deliver a major contribution to TB control in Romania.

[Prudent optimism and the evolution of the main indicators of endemic tuberculosis in Romania in 2012]. / Optimismul prudent si evolutia principalilor indicatori ai endemiei tuberculoase în anul 2012, în România.

The implementation of programmes for Tuberculosis Control (NPTC) in the medium term, starting in 1997, who under the auspices and the coordination of the Ministry of Health, was the guarantor of the achievements in these years in TB control, therapeutic success rate of cases being a constant source of 80%. The global incidence of TB (IG) (new cases and relapses) has decreased in the past 10 years with 42%, from a maximum of 142.2per 100 thousand in 2002, to 79.2 per 100 thousand in 2012. The incidence of TB in children between 0 and 14 years of age has dropped significantly, from 48.2 per 100 thousand in 2002 (1843) a t28.3per 100 thousand in 2011 (770). Mortality declined from 10.8% in 2002 to 6% in 2011. To increase the control of TB, and in accordance with the envisaged country strategy for the period 2013-2017, the anti-TB Programme will give priority to the following measures: gradual introduction of rapid molecular techniques able to identify in the shortest time TB and chemoresistancies; centralized procurement anti-TB drugs; better integration ofpractices of diagnosis and treatment of TB in children with standard practices for tuberculosis control; for a proper diagnosis and treatment to all people suffering from MDR-TB (until 2015).

[Tuberculosis in children in Romania]. / Tuberculoza la copii în Romania.

According to the World Health Organization and Stop TB Partnership, tuberculosis among children often remains undiagnosed, the main reported causes being lack of access to health services or because health professionals unrecognizing the signs and symptoms of tuberculosis in this age group. In Romania, consistent with TB endemic levels, the overall incidence progressively decreased from 142.2%ooo in 2002 to 82.8%ooo in 2011, incidence of TB in children 0-14 years dropped steadily from 47.2 %ooo (1784 cases) in the same "peak year"2002 to 23.6% ooo (766 cases) in 2011. The distribution of TB disease in children by counties shows variations between these, the explanations may be related both to differences in offer of the bacilli between different areas (prevalence of pulmonary patients smear and/or culture positive) and by deficiencies in the detection of cases and lack of rigor in diagnosis (variation in the incidence of TB in 0-14 years from 2.S%ooo in Salaj county up to 53.2%ooo in Maramures county in 2011). The number of serious cases of TB in children (meningoencephalitis, miliary, cavitary) still maintains a constant high annual rate (65 cases in 2011), which demonstrates the severity of endemic TB in our country. Prompt assurance of TB diagnostic and also the accurate management of TB treatment constitute the guarantee of the decrease of this disease, goal applies to all age groups.

[Mortality of tuberculosis in Romania, a marker for severity of the endemic]. / Mortalitatea prin tuberculoza in România, un marker al gravitatii endemiei.

After reaching the lowest level of tuberculosis mortality rate in 1980, 3.7% hundred thousand (830 deaths), followed by a few years with low levels of mortality, the period following the year 1985 was marked by a gradual increase in the mortality rate and in 1995 it reached 11.3% hundred thousand (2560 deaths). The implementation since 1997 of TB control programmes on medium-term (under technical assistance of WHO experts) has led to a decrease in tuberculosis mortality rate to 1482 deaths, 6.9% hundred thousand, in 2010. Compared to standardized TB mortality rate in Europe, Romania is far from the countries of Western and Central Europe, with a rate 6.6 times greater than in the EU. Standardized mortality rate by sex reveals that the rate for males in Romania, in 2009, was 6.5 times higher than in women. Similar to 2009, in 2010, the deaths have reached a maximum per age group at 45-54 years old. In 2010 the tuberculosis fatality was 4.7% and the lethality was 0.6%. Consistency of tuberculosis control strategy, regarding both measures for early detection of tuberculosis and establishing TB treatment under the direct observation, represent the safety elements in the reduction of tuberculosis mortality rate. It should be reminded that one of the goals of Stop TB Partnership is reducing mortality rate in 2012 at half compared to 1990, Romania being one of the 18 countries included in this plan initiated by the WHO Europe Region Office.