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1.
N Engl J Med ; 381(25): 2429-2439, 2019 12 19.
Artículo en Inglés | MEDLINE | ID: mdl-31661198

RESUMEN

BACKGROUND: Results of an earlier analysis of a trial of the M72/AS01E candidate vaccine against Mycobacterium tuberculosis showed that in infected adults, the vaccine provided 54.0% protection against active pulmonary tuberculosis disease, without evident safety concerns. We now report the results of the 3-year final analysis of efficacy, safety, and immunogenicity. METHODS: From August 2014 through November 2015, we enrolled adults 18 to 50 years of age with M. tuberculosis infection (defined by positive results on interferon-γ release assay) without evidence of active tuberculosis disease at centers in Kenya, South Africa, and Zambia. Participants were randomly assigned in a 1:1 ratio to receive two doses of either M72/AS01E or placebo, administered 1 month apart. The primary objective was to evaluate the efficacy of M72/AS01E to prevent active pulmonary tuberculosis disease according to the first case definition (bacteriologically confirmed pulmonary tuberculosis not associated with human immunodeficiency virus infection). Participants were followed for 3 years after the second dose. Participants with clinical suspicion of tuberculosis provided sputum samples for polymerase-chain-reaction assay, mycobacterial culture, or both. Humoral and cell-mediated immune responses were evaluated until month 36 in a subgroup of 300 participants. Safety was assessed in all participants who received at least one dose of M72/AS01E or placebo. RESULTS: A total of 3575 participants underwent randomization, of whom 3573 received at least one dose of M72/AS01E or placebo, and 3330 received both planned doses. Among the 3289 participants in the according-to-protocol efficacy cohort, 13 of the 1626 participants in the M72/AS01E group, as compared with 26 of the 1663 participants in the placebo group, had cases of tuberculosis that met the first case definition (incidence, 0.3 vs. 0.6 cases per 100 person-years). The vaccine efficacy at month 36 was 49.7% (90% confidence interval [CI], 12.1 to 71.2; 95% CI, 2.1 to 74.2). Among participants in the M72/AS01E group, the concentrations of M72-specific antibodies and the frequencies of M72-specific CD4+ T cells increased after the first dose and were sustained throughout the follow-up period. Serious adverse events, potential immune-mediated diseases, and deaths occurred with similar frequencies in the two groups. CONCLUSIONS: Among adults infected with M. tuberculosis, vaccination with M72/AS01E elicited an immune response and provided protection against progression to pulmonary tuberculosis disease for at least 3 years. (Funded by GlaxoSmithKline Biologicals and Aeras; ClinicalTrials.gov number, NCT01755598.).


Asunto(s)
Inmunogenicidad Vacunal , Tuberculosis Latente/terapia , Mycobacterium tuberculosis/inmunología , Vacunas contra la Tuberculosis/inmunología , Tuberculosis Pulmonar/prevención & control , Adolescente , Adulto , África , Progresión de la Enfermedad , Método Doble Ciego , Femenino , Estudios de Seguimiento , Seronegatividad para VIH , Humanos , Tuberculosis Latente/inmunología , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Adulto Joven
2.
Saudi Med J ; 40(10): 1008-1012, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31588479

RESUMEN

OBJECTIVES: To determine the ideal number of sputum acid-fast bacilli (AFB) smears and polymerase chain reaction (PCR) required for discontinuing TB isolation among patients with suspected pulmonary TB.  Methods: This was a single-center, record-based retrospective study of all admitted patients diagnosed with culture-proven pulmonary TB between 2010 and 2018. The study was conducted at Prince Sultan Military Medical City (PSMMC) in Riyadh, Saudi Arabia, a large tertiary care center consisting of 1,200 beds. Data were obtained from our TB notification records. Patients with smear-positive TB were investigated. Only the first 3 sputum smears for AFB were included in the analysis. The  PCR results for Mycobacterium tuberculosis (MTB) were also included in the study. The incremental yield of the second and third smears was assessed.  Results: Overall, 240 patients were MTB-culture positive. A total of 126 (52.5%) patients were smear and culture positive, whereas 114 were culture positive but smear negative. Of 126 patients who were AFB smear positive, 98 (77.8%) were detected in the first specimen, 13 (10.3%) in the second specimen, and only 9 (7.1%) in the third specimen. Polymerase chain reaction for MTB was positive in 122 (96.8%) smear-positive patients. Four patients did not undergo a PCR test.  Conclusion:  A single Xpert MTB/resistance to rifampicin test detected all smear-positive patients, whereas the third smear did not significantly contribute to MTB isolation.


Asunto(s)
Aislamiento de Pacientes/métodos , Tuberculosis Pulmonar/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis , Reacción en Cadena de la Polimerasa , Estudios Retrospectivos , Arabia Saudita , Esputo/microbiología , Factores de Tiempo , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/terapia , Adulto Joven
3.
Infect Immun ; 88(1)2019 12 17.
Artículo en Inglés | MEDLINE | ID: mdl-31591165

RESUMEN

Despite the great increase in the understanding of the biology and pathogenesis of Mycobacterium tuberculosis achieved by the scientific community in recent decades, tuberculosis (TB) still represents one of the major threats to global human health. The only available vaccine (Mycobacterium bovis BCG) protects children from disseminated forms of TB but does not effectively protect adults from the respiratory form of the disease, making the development of new and more-efficacious vaccines against the pulmonary forms of TB a major goal for the improvement of global health. Among the different strategies being developed to reach this goal is the construction of attenuated strains more efficacious and safer than BCG. We recently showed that a sigE mutant of M. tuberculosis was more attenuated and more efficacious than BCG in a mouse model of infection. In this paper, we describe the construction and characterization of an M. tuberculosis sigE fadD26 unmarked double mutant fulfilling the criteria of the Geneva Consensus for entering human clinical trials. The data presented suggest that this mutant is even more attenuated and slightly more efficacious than the previous sigE mutant in different mouse models of infection and is equivalent to BCG in a guinea pig model of infection.


Asunto(s)
Ligasas/deficiencia , Mycobacterium tuberculosis/inmunología , Factor sigma/deficiencia , Vacunas contra la Tuberculosis/inmunología , Tuberculosis Pulmonar/prevención & control , Animales , Proteínas Bacterianas , Modelos Animales de Enfermedad , Cobayas , Ratones , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/patogenicidad , Vacunas contra la Tuberculosis/efectos adversos , Vacunas contra la Tuberculosis/genética , Vacunas Atenuadas/efectos adversos , Vacunas Atenuadas/genética , Vacunas Atenuadas/inmunología , Virulencia
5.
N Engl J Med ; 381(14): 1347-1357, 2019 10 03.
Artículo en Inglés | MEDLINE | ID: mdl-31577876

RESUMEN

BACKGROUND: The World Health Organization has set ambitious targets for the global elimination of tuberculosis. However, these targets will not be achieved at the current rate of progress. METHODS: We performed a cluster-randomized, controlled trial in Ca Mau Province, Vietnam, to evaluate the effectiveness of active community-wide screening, as compared with standard passive case detection alone, for reducing the prevalence of tuberculosis. Persons 15 years of age or older who resided in 60 intervention clusters (subcommunes) were screened for pulmonary tuberculosis, regardless of symptoms, annually for 3 years, beginning in 2014, by means of rapid nucleic acid amplification testing of spontaneously expectorated sputum samples. Active screening was not performed in the 60 control clusters in the first 3 years. The primary outcome, measured in the fourth year, was the prevalence of microbiologically confirmed pulmonary tuberculosis among persons 15 years of age or older. The secondary outcome was the prevalence of tuberculosis infection, as assessed by an interferon gamma release assay in the fourth year, among children born in 2012. RESULTS: In the fourth-year prevalence survey, we tested 42,150 participants in the intervention group and 41,680 participants in the control group. A total of 53 participants in the intervention group (126 per 100,000 population) and 94 participants in the control group (226 per 100,000) had pulmonary tuberculosis, as confirmed by a positive nucleic acid amplification test for Mycobacterium tuberculosis (prevalence ratio, 0.56; 95% confidence interval [CI], 0.40 to 0.78; P<0.001). The prevalence of tuberculosis infection in children born in 2012 was 3.3% in the intervention group and 2.6% in the control group (prevalence ratio, 1.29; 95% CI, 0.70 to 2.36; P = 0.42). CONCLUSIONS: Three years of community-wide screening in persons 15 years of age or older who resided in Ca Mau Province, Vietnam, resulted in a lower prevalence of pulmonary tuberculosis in the fourth year than standard passive case detection alone. (Funded by the Australian National Health and Medical Research Council; ACT3 Australian New Zealand Clinical Trials Registry number, ACTRN12614000372684.).


Asunto(s)
Enfermedades Endémicas/prevención & control , Tamizaje Masivo/métodos , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Pulmonar/diagnóstico , Adolescente , Adulto , Niño , Servicios de Salud Comunitaria , Femenino , Humanos , Análisis de Intención de Tratar , Masculino , Mycobacterium tuberculosis/genética , Técnicas de Amplificación de Ácido Nucleico , Prevalencia , Esputo/microbiología , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/prevención & control , Vietnam/epidemiología , Adulto Joven
6.
BMC Public Health ; 19(1): 1274, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533689

RESUMEN

BACKGROUND: Source case investigation, for children with tuberculosis (TB), is conducted to establish the source of infection and to minimize the extent of on-going transmission from infectious persons in the community. The aim of the study was to evaluate the secondary TB cases and to investigate the risk factors in developing TB among the household contacts (HHC) of children with active TB. METHODS: A prospective cross-sectional study was conducted where 443 caregivers, of 508 children with active TB receiving treatment, were interviewed using a structured questionnaire. Logistic regression analysis was used to examine the risk factors for TB. RESULTS: A total of 2397 family members at the median of 5 persons were recorded. Of these, 223 (9.3%) were screened on symptoms basis and 35 (15.7%) of these contacts were diagnosed with TB. Multivariate analysis revealed HHC with TB (OR = 15.288, 95% CI: 5.378-43.457), HHC with smoking (OR = 7.094, 95% CI: 2.128-23.648), and contact of > 18 h with TB individual (OR = 4.681, 95% CI: 1.198-18.294) as statistically significant risk factors of TB among the HHC. CONCLUSION: With the current system of contact screening for TB, only 9.3% of all HHC were screened. The low rates of contacts screened are possibly a repercussion of the passive nature of the program, which mainly depend on distinctive clinical symptoms being experienced by the contacts. Strategies are required to certify adherence with contact screening among children with active TB and to critically consider the factors responsible for TB transmission.


Asunto(s)
Trazado de Contacto/métodos , Composición Familiar , Tuberculosis Pulmonar/prevención & control , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Malasia , Masculino , Estudios Prospectivos , Factores de Riesgo , Tuberculosis/prevención & control , Tuberculosis Pulmonar/epidemiología
7.
Indian J Tuberc ; 66(3): 382-387, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31439184

RESUMEN

Collaborative TB and HIV prevention and management activities are essential for reducing the burden of TB disease and achieving favorable outcomes by ensuring early initiation of antiretroviral therapy in the comorbid patients. The Mobile population of truckers and helpers is at higher risk of HIV and also TB infection. OBJECTIVE: The present study assessed the feasibility and opportunities for integrating TB screening and anti-tubercular drug dispensation services to truckers as an additional service utilizing the existing infrastructure and human resources of a targeted intervention (TI) based STI (Khushi) clinic and an integrated counseling and testing center (ICTC) operating at a transport hub and transshipment site in Delhi, India. METHODS: This exploratory operational research study was conducted at the Sanjay Gandhi Transport Nagar (SGTN), off the GT-Karnal highway, in North-west district of Delhi, the Indian capital city during May-Nov' 2016. The proposed methodology for integration of comprehensive TB services within the existing STI/HIV services for the trucker population included a prevention and awareness component using interpersonal sessions, transporter meeting, one-on-one group session and IEC/BCC sessions utilizing a surround and engage technique. TB diagnostic testing and treatment services were provided through the collaboration with the TI/Khushi clinic and ICTC center staff aided by the field assistants. RESULTS: Overall, a total of 833 activity sessions were conducted during the study period among the truckers at the SGTN. During these sessions, 14644 truckers and 1444 other individuals were covered. A total of 297 truckers and 30 other people were referred for testing out of which 283 truckers and 33 others were tested for TB. Of these, ten truckers and four other individuals were found positive for TB. DISCUSSION: The present study provides the first patient (truckers) level evidence from India that routine, provider-initiated voluntary TB testing of truckers coming to avail services at STI and ICTC clinics for prevention and screening of HIV-AIDS is possible. The current practice of referral of HIV patients from the ICTC center to the chest clinic is inefficient since the opportunity costs and financial implications involved may deter patients from testing while the HIV negative but presumptive TB patients are likely to be missed. However, for this collaborative partnership to be successful, further investment regarding human and financial resources is necessary. Existing staff needs sensitization, training and proper incentives for conducting TB related IEC/BCC activities along with that for HIV-AIDS. Furthermore, the deployment of additional personnel is preferable for sputum collection and TB testing with the availability of early reporting at site.


Asunto(s)
Tamizaje Masivo , Vehículos a Motor , Enfermedades Profesionales/prevención & control , Tuberculosis Pulmonar/prevención & control , Antituberculosos/administración & dosificación , Antituberculosos/uso terapéutico , Humanos , India/epidemiología , Mycobacterium tuberculosis , Enfermedades Profesionales/tratamiento farmacológico , Enfermedades Profesionales/epidemiología , Derivación y Consulta , Esputo/microbiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología
8.
Indian J Tuberc ; 66(3): 394-401, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31439186

RESUMEN

BACKGROUND: Multi-drug-resistant TB (MDR-TB) has become a significant public health problem and an obstacle to effective TB control. Rapid diagnostic tests for anti tubercular drugs sensitivity have significantly reduced total time in initiation of treatment. Still there is a significant gap between MDR diagnosis and start of category IV treatment. Delay in establishing the diagnosis may cause disease progression, transmission, lost to follow up and death. This study was planned to assess the actual delay from day one of sputum examination to the day of initiation of category IV in operational settings. METHODOLOGY: MDR-TB suspected patients attending the Respiratory medicine department, JLNMC, Ajmer from June-15 to July-16 were followed from sputum examination to sample deposition for drug sensitivity testing (LPA/CBNAAT) to MDR detection to category IV initiation, for assessment of procedural delay at various steps. RESULTS: LPA group (371 patients): Sputum smear to LPA deposition mean duration was 8.02 days, LPA deposition to LPA result upload mean duration was 3.78 days, LPA deposition to patients received LPA reports mean duration was 21.73 days and reports received to PMDT site admission (if drug resistant) mean duration was 3.61 days. Total time duration in category IV initiation was 32.63 days. CBNAAT group (50 patients): Sputum smear to CBNAAT deposition mean duration was 6.70 days, CBNAAT deposition to CBNAAT result upload mean duration was 1.13 days, CBNAAT deposition to patients received CBNAAT reports mean duration was 6.53 days and reports received to PMDT site admission (if R-resistant) mean duration was 3.8 days. Total time duration in category IV initiation was 12.4 days. CONCLUSION: Major delay seen on part of receiving sensitivity reports indicates the need to stress upon field staff motivation, appropriate training, sensitisation and expert counselling.


Asunto(s)
Antituberculosos/uso terapéutico , Diagnóstico Tardío , Programas Nacionales de Salud/normas , Rifampin/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Pulmonar/diagnóstico , Antituberculosos/administración & dosificación , Benchmarking , Esquema de Medicación , Humanos , India , Mycobacterium tuberculosis/aislamiento & purificación , Rifampin/administración & dosificación , Esputo/microbiología , Centros de Atención Terciaria , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/prevención & control , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/prevención & control
9.
Indian J Tuberc ; 66(3): 407-410, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31439188

RESUMEN

BACKGROUND: Byssinosis is an occupational lung disease observed among workers exposed to cotton, flax, and hemp dust. The severity and extent of Byssinosis are well recognised in the high-income countries and control measures have been implemented to prevent the disease. In India, there are conflicting evidence on burden estimation of the disease, followed by inadequate prevention and control of Byssinosis. DESIGN/METHODS: We did a cross-sectional study to assess the prevalence of Byssinosis in "home-based" power-loom workers in Mominpura, an administrative ward of Burhanpur Municipality with 2800 population in the state of Madhya Pradesh, India. 290 adults working from "home-based" power loom units were randomly selected, profiled and screened for Byssinosis like symptoms with the help of a semi-structured questionnaire and simple hand-held peak expiratory flow monitor. For epidemiological purposes the symptoms were classified based on Schilling's classification. Chest x-rays were done for selected subjects. Sputum smear microscopy for detecting TB was done for those who had Byssinosis like symptoms. RESULTS: Prevalence of Byssinosis among "home based" powerloom workers was found to be 98% [n = 283, 95 CI (95.65-98.96)]. Peak expiratory flow rate (PEFR) was reduced in 44% (n = 124), of which 81 (29%) had more than 50% PEFR reduction, and of these, 69 (29%) were in early stage of Byssinosis (Grade 0.5). 11% of study participants who had Byssinosis like symptoms, also had TB. CONCLUSIONS: Byssinosis is highly prevalent in "home-based" power loom units in Madhya Pradesh. Adequate advocacy on awareness and prevention; prompt diagnosis and linkages to treatment services in "home-based" power loom units are urgently required to address Byssinosis at an early disease stage.


Asunto(s)
Bisinosis/epidemiología , Características de la Residencia , Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Contaminantes Ocupacionales del Aire/efectos adversos , Bisinosis/etiología , Bisinosis/prevención & control , Cannabis/efectos adversos , Estudios Transversales , Polvo , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Exposición Profesional/prevención & control , Prevalencia , Encuestas y Cuestionarios , Tuberculosis Pulmonar/etiología , Tuberculosis Pulmonar/prevención & control , Adulto Joven
10.
Vet Immunol Immunopathol ; 215: 109884, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31420066

RESUMEN

Many vaccines against childhood diseases are administered early after birth, but vaccine development studies frequently test efficacy in adult rather than in neonatal animal models. In countries with endemic tuberculosis (TB), Bacillus Calmette-Guerin (BCG) is administered as part of the neonatal vaccine regimen because it prevents against the disseminated form of TB in children, although it has variable efficacy against pulmonary TB. Several promising new vaccines against TB are currently being tested in adult animal models. Here we evaluated neonatal piglets as an animal model to test vaccine efficacy. For this purpose, minipigs were vaccinated or not with BCG 48 h after birth and their immune response followed longitudinally until adolescence. We characterized the memory and activation phenotype of T cells, cytokine profile, and monocyte activation in response to BCG stimulation from 4 weeks of age into adolescence- age of 24 weeks. Immunological responses in vaccinated and non-vaccinated animals were further monitored upon infection with a low dose exposure to Mycobacterium tuberculosis strain HN878 via the aerosol route. Comparing the immunological response elicited by BCG vaccination in minipigs vs similar studies in infants, suggest that minipigs have the potential to serve as an effective neonatal animal model for vaccine development.


Asunto(s)
Vacuna BCG/inmunología , Modelos Animales de Enfermedad , Mycobacterium tuberculosis/inmunología , Porcinos Enanos/inmunología , Tuberculosis Pulmonar/inmunología , Animales , Animales Recién Nacidos , Citocinas/metabolismo , Evaluación Preclínica de Medicamentos/métodos , Femenino , Inmunogenicidad Vacunal , Memoria Inmunológica , Inmunofenotipificación , Estudios Longitudinales , Activación de Linfocitos , Masculino , Monocitos/inmunología , Porcinos , Tuberculosis/inmunología , Tuberculosis Pulmonar/prevención & control
11.
BMC Med Ethics ; 20(1): 43, 2019 07 04.
Artículo en Inglés | MEDLINE | ID: mdl-31272443

RESUMEN

BACKGROUND: Emerging genomic technologies promise more efficient infectious disease control. Whole genome sequencing (WGS) is increasingly being used in tuberculosis (TB) diagnosis, surveillance, and epidemiology. However, while the use of WGS by public health agencies may raise ethical, legal, and socio-political concerns, these challenges are poorly understood. METHOD: Between November 2017 and April 2018, we conducted semi-structured interviews with 22 key stakeholders across the fields of governance and policy, public health, and laboratory sciences representing the major jurisdictions currently using WGS in national TB programs. Thematic analysis of the interviews was conducted using NVivo 11. RESULTS: Respondents identified several ethical and practical challenges associated with WGS in TB care and surveillance, all related to issues of trust, including: 1) the power of public health; 2) data sharing and profits derived from surveillance efforts; and 3) concerns regarding who has access to, and can benefit from, the technology. Additional challenges included: the potential utility that WGS adds to a public health program, the risks associated with linking necessary epidemiological metadata to the genomic data, and challenges associated with jurisdictional capacity to implement the technology. CONCLUSIONS: Successful implementation of WGS is dependent on fostering relationships of trust between those working with genomics technology and those directly impacted by it, including clinicians. Building trust (a) between the public and the public health agencies and (b) within public health agencies themselves is critical due to the inherent complexity of WGS and its implementation for communicable disease control purposes.


Asunto(s)
Vigilancia de la Población , Confianza , Tuberculosis Pulmonar/prevención & control , Secuenciación Completa del Genoma/ética , Actitud del Personal de Salud , Humanos , Difusión de la Información/ética , Entrevistas como Asunto , Vigilancia de la Población/métodos , Tuberculosis Pulmonar/diagnóstico
12.
Indian J Public Health ; 63(2): 94-100, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31219056

RESUMEN

Background: Timely treatment of tuberculosis is imperative for its control. This can get delayed due to delay in care seeking, diagnosis or treatment initiation. Objectives: The study aims to find out the magnitude of delays in care seeking, diagnosis or treatment initiation, and understand the reasons behind these delays in Wardha district of Maharashtra, India. Methods: A mixed methods study was conducted among 275 patients selected from those enrolled under Revised National Tuberculosis Control Programme in 2014. We collected information regarding the duration of delays and generated a free list of reasons for delays in care seeking and diagnosis. The free list items were then subjected to pile sorting. Two-dimensional scaling and hierarchical clustering analysis were performed to identify the various domains of reasons for delays. Results: The median delay in initial care seeking and diagnosis was 10 days each, and that for treatment initiation was 2 days. The domains identified for delay in care seeking were negligence toward health, health conditions, facility-related issues, and household and social reasons. The domains identified for delay in diagnosis were system-related reasons; and patient-related reasons, each of them further having two subdomains. Conclusions: Interventions for reducing the knowledge gap and stigma, increasing the accessibility of services, active case finding; capacity building of providers, quality assured sputum microscopy, and communication skills will help reduce these delays.


Asunto(s)
Aceptación de la Atención de Salud/psicología , Tuberculosis Pulmonar/prevención & control , Diagnóstico Tardío/psicología , Diagnóstico Tardío/estadística & datos numéricos , Humanos , India/epidemiología , Aceptación de la Atención de Salud/estadística & datos numéricos , Factores de Tiempo , Tuberculosis Pulmonar/psicología
13.
Indian J Tuberc ; 66(2): 253-258, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31151493

RESUMEN

BACKGROUND: India accounts for 25% of global TB burden and majority of TB patients seek care from private practitioners. It becomes imperative to involve private practitioners with newer strategies to strengthen the Revised National Tuberculosis Control Program (RNTCP). A study was conducted to assess the knowledge, attitude and practices among private practitioners with regards to tuberculosis case detection and referral and to demonstrate the feasibility of utilizing existing medico-social worker of a medical college in sensitizing the private practitioners. METHODS: An intervention study was conducted during 2017. In an urban field practice area of a medical college, 34 allopathic private practitioners (PP) from six slums formed the study population. The RNTCP trained Medico social workers (MSW) of medical college provided repeated sensitization to private practitioners on case referrals. The data of KAP among private practitioners was collected. The output of repeated sensitization was measured by comparing the number of cases referred by Private Practitioners to DMC during the pre and post intervention period. RESULTS: Only 1 in 2 practitioners were aware about the duration of cough in presumptive TB cases. Nearly 44% of them were not aware about the first investigation of choice under RNTCP; 53% of the doctors did not know about the total number of sputum samples to be collected. After the sensitization of PPs by MSWs the number of presumptive pulmonary cases was increased by more than two folds. CONCLUSION: The strategy of utilizing the services of medico-social workers employed in a medical college to sensitize the private practitioners is feasible and has demonstrated the increase in number of presumptive TB case referrals to DMCs.


Asunto(s)
Competencia Clínica , Pautas de la Práctica en Medicina , Trabajadores Sociales , Tuberculosis Pulmonar/epidemiología , Adulto , Anciano , Femenino , Hospitales Universitarios , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Áreas de Pobreza , Práctica Privada , Tuberculosis Pulmonar/prevención & control , Población Urbana
14.
Indian J Tuberc ; 66(2): 266-267, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31151495

RESUMEN

National Strategic Plan for tuberculosis care and control, Nepal ( 2016-2021) envisions ambitious target of decreasing TB incidence by 20% by 2021.In achieving so it has to identify and manage 20,000 more cases by 2021 compared to 2015. Contribution of private sector which roughly accounts to 25% of all the burden of tuberculosis cases in Nepal will be vitally important along with effective public private partnership. In this review we discuss why blaming the private sector alone is not sufficient and much effective PPP collaboration needs to be done stepping on the positive results shown by the earlier collaboration.


Asunto(s)
Metas , Asociación entre el Sector Público-Privado , Tuberculosis Pulmonar/prevención & control , Humanos , Nepal
15.
Indian J Tuberc ; 66(2): 268-278, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31151496

RESUMEN

We synthesised the findings of intervention studies on Tuberculosis control (TC) in low- and middle-income countries with specific reference to India through a systematic review during the period 2000-2017 in order to identify the implementation gap. The research questions were framed using PICOS (population, intervention, comparison, outcomes and study design) framework and PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines were used for study selection. The search was mainly carried out in MEDLINE/PubMed, Web of Knowledge and Cochrane libraries. DOTS was found to be the most effective intervention program for control of Tuberculosis. Lack of utilization of the capacity of various level health staff, accessibility in utilizing health facilities and insufficient community involvement was identified as the major gaps for TC. In the case of India, each state has its own priority and applicability for different TC interventions. Most of the studies on implementation of the TC program supported the encouraging effect of the intervention in the control of Tuberculosis. The specific need of each country is clearly reflected in many of the selected studies. In order to establish the association of intervention and its implementation gaps on TB control, more rigorous evaluation methods are needed including meta-analysis. REGISTRATION: PROSPERO registration number: CRD42018070406.


Asunto(s)
Medicina Basada en la Evidencia , Área sin Atención Médica , Tuberculosis Pulmonar/prevención & control , Países en Desarrollo , Humanos , India
17.
Scand J Immunol ; 90(2): e12774, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31054193

RESUMEN

Tuberculosis (TB) remains one of a major health problem worldwide. Tuberculosis vaccine research has made an extraordinary progress over the past few years. However, there is still no replacement for the Bacillus Calmette-Guérin vaccine, the only TB vaccine licensed for human use. Therefore, the discovery and development of new TB vaccines remains a priority. This article discusses current strategies used to diversify TB vaccines and includes discussion of the status of efforts to improve protection against Mycobacterium tuberculosis (M tb) infection or TB disease by developing new and safe TB vaccines. This article also highlights the current research efforts in immune-enhancing approaches to improve vaccination efficacy. The development of more effective TB vaccines might have significant impact on global TB control.


Asunto(s)
Mycobacterium tuberculosis/inmunología , Vacunas contra la Tuberculosis/inmunología , Tuberculosis Pulmonar/prevención & control , Humanos , Tuberculosis Pulmonar/inmunología , Vacunación , Vacunas Atenuadas/inmunología
18.
Tuberculosis (Edinb) ; 116S: S114-S117, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31076321

RESUMEN

A vaccine that prevents transmission of infection is urgently needed in the fight against tuberculosis (TB). Results of clinical trials have been disappointing. Major problems include lack of biomarkers and understanding of the mechanisms of disease and protection. A more fundamental problem is that the scientific community seldom recognizes that primary and post-primary TB are distinct disease entities. Nearly all vaccine candidates have been designed and tested in models of primary TB, while transmission of infection is mediated by post-primary TB. Post-primary TB is seldom studied because no animal develop complete symptoms of the disease as it exists in humans. Nevertheless, mice, guinea pigs and rabbits all develop infections that at certain points appear to be models of human post-primary TB. Slowly progressive pulmonary TB in immunocompetent mice is an example. It is characterized by an alveolitis with infected foamy macrophages that have multiple characteristics of the human disease. We demonstrated that inclusion of an immune modulating agent, lactoferrin, with a BCG vaccine in this model induced a sustained reduction in lung pathology, but not numbers of organisms in tissue. Since the animals die of expanding pathology, this demonstrates the feasibility of using selected animal models for studies of vaccines against post-primary TB.


Asunto(s)
Adyuvantes Inmunológicos/farmacología , Vacuna BCG/farmacología , Lactoferrina/farmacología , Pulmón/microbiología , Mycobacterium tuberculosis/patogenicidad , Tuberculosis Pulmonar/prevención & control , Animales , Vacuna BCG/inmunología , Modelos Animales de Enfermedad , Interacciones Huésped-Patógeno , Humanos , Lactoferrina/inmunología , Pulmón/inmunología , Macrófagos Alveolares/inmunología , Macrófagos Alveolares/microbiología , Mycobacterium tuberculosis/inmunología , Tuberculosis Pulmonar/inmunología , Tuberculosis Pulmonar/microbiología , Tuberculosis Pulmonar/transmisión
19.
Enferm. glob ; 18(54): 285-293, abr. 2019. tab
Artículo en Español | IBECS | ID: ibc-183484

RESUMEN

La tuberculosis pulmonar (TB pulmonar) es una enfermedad infecciosa común en el mundo, incluso en Indonesia. Se transmite muy fácilmente a través de las salpicaduras de esputo. Fomenta el desarrollo de intervenciones para controlar la transmisión de la TB, como la educación sanitaria estructurada. El objetivo de este estudio fueron determinar el efecto de la intervención de educación sanitaria estructurada sobre el comportamiento preventivo de la tuberculosis pulmonar en la regencia de Bogor, Indonesia. Este estudio utilizó un diseño cuasiexperimental con diseño previo y posterior a la prueba, que involucró a 82 miembros adultos de la comunidad de edad que se dividieron en grupos de intervención y control. El muestreo aleatorio en varias etapas se utilizó para determinar el área de investigación, mientras que el sujeto de investigación se seleccionó mediante muestreo aleatorio simple. Los resultados mostraron que la educación estructurada afecta significativamente el conocimiento (valor de p = 0,000), la actitud (valor de p = 0,000) y la prevención de habilidades de transmisión de TB pulmonar (valor de p = 0,000). La salud estructurada podría aplicarse como una alternativa de intervención de enfermería comunitaria que se puede administrar a las personas en riesgo de TB pulmonar


Pulmonary Tuberculosis (pulmonary TB) is a common infectious disease in the world, including in Indonesia. It is very easily transmitted through sputum splashes. It encourages development of interventions in order to control the transmission of TB, such as structured health education. The aims of this study were to determine the effect of structured health education intervention on the prevention behavior of pulmonary TB in Bogor regency, Indonesia. This study used quasi-experimental design with pre- and post-test design, involving 82 adults age community member who were devided into intervention and control group. The study was conducted in districts with high TB prevalence selected by purposive sampling, while the research subject was selected using simple random sampling. The results showed that structured education significantly affects knowledge (p value = 0,000), attitude (p value = 0,000), and skill prevention of pulmonary TB transmission (p value = 0,000). Structured health could applied as an alternative choice of community nursing interventions that can be given to people at risk of pulmonary TB


Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Tuberculosis Pulmonar/prevención & control , Calidad de la Atención de Salud/organización & administración , Educación en Salud/organización & administración , Atención de Enfermería/métodos , Indonesia/epidemiología , Evaluación de Resultados de Acciones Preventivas , Mejoramiento de la Calidad/tendencias , Estudios de Casos y Controles
20.
Indian J Tuberc ; 66(1): 165-166, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30878062

RESUMEN

India has made great progress towards TB prevention and control with the adoption of the National Strategic Plan 2017-2025 with significantly greater allocated resources and high level political commitment. Aligning with the global End TB Strategy, India has announced the target of ending TB by 2025, five years ahead of the rest of the world. The End TB strategy is comprised of a multi-pronged approach incorporating patient-centered care and prevention, bold policies and supportive systems, and intensified research and innovation. In the past decade, India has made great strides towards ending TB, but the challenges, especially in a high burden setting, are great, and achieving our ambitious targets and goals will require partnering with all stakeholders including civil society and the community.


Asunto(s)
Programas Nacionales de Salud , Tuberculosis Pulmonar/prevención & control , Investigación Biomédica , Implementación de Plan de Salud , Humanos , India , Atención Dirigida al Paciente , Asignación de Recursos
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