Tuberculosis preventive treatment in newborns.

OBJECTIVE: To describe the reported cases of newborns subjected to tuberculosis preventive treatment (TPT) in the state of Paraná, Brazil, and to evaluate the safety and effectiveness in preventing the progression of TB disease in this population. METHOD: Observational, descriptive case series, with secondary data. The characteristics of the participants were analyzed from the information systems of preventive treatment of TB (of Paraná), between 2009 and 2016. To evaluate which children had developed tuberculosis later or died, we used the data from the information systems of TB (in Brazil), and mortality (in Paraná), covering the years 2009 to 2018. RESULTS: A total of 24 children underwent TPT with the age at treatment onset ranging from 0 to 87 days (median: 23 days). In 95.8 %, the exposure occurred at home, and in 33.3 % of cases, the mother was the source of the infection. A total of 20.8 % of the children tested positive for tuberculosis test at 3 months of age, 83.3 % completed treatment, and 2 experienced adverse events (gastrointestinal issues). No children developed TB or died during the minimum of a 2-year evaluation period through the official databases. CONCLUSIONS: In this case series, the adherence to the plan was high, with few adverse events and 100 % protection against infection.

Tuberculose no Paraná: uma análise da série histórica alicerçada na epidemiologia descritiva / Tuberculosis in Paraná: an analysis of the historical series based on descriptive epidemiology

O objetivo desse estudo foi analisar os casos notificados de tuberculose no Paraná, com base em série histórica determinada pelo período de 2010 a 2019, alicerçada pela epidemiologia descritiva. Trata-se de um estudo epidemiológico descritivo observacional do tipo levantamento, com dados oriundos do Sistema de Informação de Agravos de Notificação. Resultou na análise de 25.893 casos, com característica endêmica, não cíclica ou sazonal, com prevalência na Regional de Saúde de Paranaguá, entre adultos, sexo masculino, cor/raça preta seguida da indígena, em pessoas com escolaridade baixa e associadas ao etilismo e tabagismo como risco. Predominaram notificações de casos novos, seguido pela recidiva decorrentes da tuberculose pulmonar. A cura prevaleceu seguido por abandono de tratamento. Por ser uma doença secular no Brasil, com etiologia multifatorial, são necessários investimentos além do acesso à saúde, em ações intersetoriais no âmbito da justiça social atreladas principalmente a educação, alimentação, renda e habitação.

The objective of this study was to analyze the reported cases of tuberculosis in Paraná, based on a historical series determined for the period from 2010 to 2019, on descriptive epidemiology basis. This is a descriptive observational epidemiological study of the survey type, with data from the Notifiable Diseases Information System. It resulted in the analysis of 25,893 cases, with endemic, non-cyclical or seasonal characteristics, with prevalence in the Health Area of Paranaguá, among male, black and indigenous adults, with low education, and associated with risk of alcoholism and smoking. Reports of new cases predominated, followed by recurrence of pulmonary tuberculosis. The cure prevailed, followed by treatment abandonment. As it is a secular disease in Brazil, with multifactorial etiology, investments not only for access to health but also in intersectoral actions, within the scope of social justice, mainly linked to education, food, income, and housing are required.

El objetivo fue analizar casos notificados de tuberculosis en Paraná, Brasil a partir de una serie histórica para el período de 2010 a 2019, con base en la epidemiología descriptiva. Se trata de un estudio epidemiológico observacional descriptivo del tipo encuesta, con datos del Sistema de Información de Enfermedades de Declaración Obligatoria. Resultó en el análisis de 25.893 casos, con características endémicas, no cíclicas o estacionales, prevalencia en la Regional de Salud de Paranaguá, entre adultos del sexo masculino, color/raza negra e indígenas, en personas con baja escolaridad y que están asociados al uso abusivo de alcohol y tabaco. Predominaron casos nuevos por tuberculosis pulmonar. Predominó la curación seguida del abandono del ratamiento. Por tratarse de una enfermedad secular en Brasil, con una etiología multifactorial, se necesitan inversiones además del acceso a la salud, en acciones intersectoriales en el ámbito de la justicia social, principalmente vinculadas a la educación, la alimentación, la renta y la vivienda.

Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries.

Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality-over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant negative impact on case detection and treatment outcomes. Child and adolescent TB working groups can address country-specific challenges to close the policy-practice gaps by developing and supporting decentral ized models of care, strengthening clinical and laboratory diagnosis, including of multidrug-resistant TB, providing recommended options for treatment of disease and infection, and forging strong collaborations across relevant health sectors.

Challenges faced by health workers in the use of the directly observed treatment (DOT) for tuberculosis.

Tuberculosis is a worldwide public health problem, which, even with available treatment, continues to cause deaths worldwide. One of the obstacles to control the disease is the multifactorial difficulty of patients to adhere to treatment, in addition to the difficulty of health workers in circumventing barriers to implement strategies such as the directly observed treatment (DOT). The aim of this study is to analyze the performance and challenges faced by health workers in the use of DOT in tuberculosis. This is a descriptive, quali-quantitative study using data from interviews with primary-care professionals working in nine municipalities of Parana State, Brazil. The professionals answered a questionnaire containing four closed questions about DOT and an open question related to their professional opinion about the strategy. Quantitative data were entered into a spreadsheet and statistically propagated. Qualitative data were treated from the transcription of statements, subsequently submitted to content analysis. Of the 387 professionals interviewed, at least 58.9% had some knowledge about DOT. Among the main challenges faced by the professionals are: lack of user commitment to treatment (48.3%), users' difficulty in attending the basic health clinics (BHC) (31.4%), professionals' difficulty to reach the place where patients are treated (8.8 %), insufficient staff / lack of human resources (4.1%) and use of illicit drugs by patients (3.9%). Blaming the user and the lack of resources are the main highlights, in addition to issues such as the professionals' lack of access and knowledge that are highlighted by the difficulty of patients to adhere to the treatment of tuberculosis according to the participants' statements. The issues were raised by health workers manifestations involving adherence to treatment according to the DOT in the studied health region. It is possible, in this context, to observe the need for improvement in the knowledge of professionals with regard to the DOT, the importance of their bond with patients and families and the recognition of the part of responsibility that belongs to the health team on guaranteeing treatment.

Tuberculose em População Indígena Autodeclarada no Estado do Paraná / Tuberculosis in Self-declares Indigenous People in the State of Parana

Objetivo: Descrever o perfil epidemiológico e o percentual de cura da tuberculose (TB) na população indígena no Estado do Paraná. Metodologia: Trata-se de um estudo epidemiológico retrospectivo realizado a partir de 36.889 casos de tuberculose obtidos por meio do Sistema de Informação de Agravos de Notificação do Estado do Paraná, no período de 2001 a 2012. Foram selecionadas variáveis clínicas contemplando dados da população indígena notificada com tuberculose no Estado do Paraná, forma clínica da tuberculose, situação de encerramento e variáveis sociodemográficas (sexo, idade, escolaridade e zona de domicílio). Utilizou-se análise exploratória das variáveis por meio da distribuição de frequência absoluta e relativas. Resultados: Considerando a população total do estudo, 174 eram indígenas com predomínio de tuberculose na forma pulmonar (85%), apresentando coeficiente de incidência elevado principalmente no sexo masculino (58,6%), em residentes na zona rural (67,2%), sendo que, 72,4% obtiveram a cura. A faixa etária com idade entre 31-40 anos (20,1%) apresentou o maior número de casos notificados. Conclusão: A população que se declarou indígena apresentou características sociodemográficas similares à população geral com tuberculose, entretanto, evidenciou-se vulnerabilidade na população declarada indígena para incidência e cura da doença. (AU)

Objective: To describe the epidemiological profile and cure rate of tuberculosis (TB) in the indigenous population in the state of Paraná. Methodology: This is a retrospective epidemiological study based on 36.889 cases of tuberculosis obtained through the Paraná Notification of Injury Information System from 2001 to 2012. Clinical variables were selected contemplating data from the indigenous population reported with tuberculosis in the State of Paraná, clinical form of tuberculosis, closure and sociodemographic variables (sex, age, schooling and domicile area. An exploratory analysis of the data was used through the absolute and relative frequency distribution. Results: Considering the total population of the study, 174 were indigenous with a predominance of tuberculosis in the pulmonary form (85%), with a high incidence rate, mainly in males (58,6%), in rural residents (67,2%), being that 72,4% obtained a cure. The age group between 31-40 years (20,1%) had the highest number of reported cases. Conclusion: The population that declared themselves indigenous had sociodemographic characteristics similar to the general population with tuberculosis. However, it showed a vulnerability in the population declared indigenous for incidence and cure of the disease. (AU)

Epidemic of surgical-site infections by a single clone of rapidly growing mycobacteria in Brazil.

AIM: Our aim is to investigate if the clusters of postsurgical mycobacterial infections, reported between 2004 and 2008 in seven geographically distant states in Brazil, were caused by a single mycobacterial strain. MATERIALS & METHODS: Available information from 929 surgical patients was obtained from local health authorities. A total of 152 isolates from surgical patients were identified by PCR restriction enzyme analysis of the hsp65 gene (PRA-hsp65) and sequencing of the rpoB gene. Isolates were typed by pulsed-field gel electrophoresis (PFGE) using two restriction enzymes, DraI and AseI. A total of 15 isolates not related to surgical cases were analyzed for comparison. RESULTS: All isolates were identified as Mycobacterium abscessus ssp. massiliense. Isolates from surgical patients and one sputum isolate grouped in a single PFGE cluster, composed of two closely related patterns, with one band difference. A total of 14 other isolates unrelated to surgical cases showed distinctive PFGE patterns. CONCLUSION: A particular strain of M. abscessus ssp. massiliense was associated with a prolonged epidemic of postsurgical infections in seven Brazilian states, suggesting that this strain may be distributed in Brazilian territory and better adapted to cause surgical-site infections.