High Incidence of Active Tuberculosis in Asylum Seekers from Eritrea and Somalia in the First 5 Years after Arrival in the Netherlands.

Three quarters of tuberculosis (TB) patients in the Netherlands are foreign-born; 26% are from Eritrea or Somalia. We analyzed TB incidence rates in asylum seekers from Eritrea and Somalia in the first 5 years after arrival in the Netherlands (2013-2017) and performed survival analysis with Cox proportional hazards regression to analyze the effect of age and sex on the risk for TB. TB incidence remained high 5 years after arrival in asylum seekers from Eritrea (309 cases/100,000 person-years) and Somalia (81 cases/100,000 person-years). Age >18 years was associated with a higher risk for TB in asylum seekers from Eritrea (3.4 times higher) and Somalia (3.7 times higher), and male sex was associated with a 1.6 times higher risk for TB in asylum seekers from Eritrea. Screening and treating asylum seekers from high-incidence areas for latent TB infection upon arrival would further reduce TB incidence in the Netherlands.

Policy and practice of programmatic management of latent tuberculosis infection in The Netherlands.

Latent tuberculosis infection (LTBI) screening and preventive treatment is one of the components of the World Health Organization (WHO) End TB strategy, and particularly relevant for low tuberculosis (TB) incidence countries, i.e. less than 100 TB cases per million population. The Netherlands is such a low-incidence country with traditionally a strong emphasis on programmatic management of LTBI, e.g. examining contacts of infectious TB patients by the public health services. Increasingly, curative services are involved in LTBI management of clinical risk groups. The country recently adopted a five-year strategic national plan recommending LTBI screening of high-risk migrants populations. A monitoring and evaluation system is already in place to measure programme performance and guide policy. Research on LTBI screening of migrants is on-going and results should inform future decisions in scaling-up this intervention. Several challenges remain for programmatic LTBI management, such as securing financial resources and the right professional cadre for implementation; availability of screening tests and drugs; collecting additional data for monitoring and evaluation, in line with the WHO indicators for LTBI programmatic management; developing cultural-sensitive and client-centred education for migrants; reducing patient costs for LTBI screening and preventive treatment; and assessing cost-effectiveness and impact on TB epidemiology.

Risk of developing tuberculosis disease among persons diagnosed with latent tuberculosis infection in the Netherlands.

Diagnosis and preventive treatment of latent tuberculosis infection (LTBI) among high-risk groups is recommended to achieve tuberculosis (TB) elimination in low-incidence countries.We studied TB incidence rates among those notified with LTBI in the Netherlands from 2005 to 2013 and analysed associated risk factors. We stratified analyses by target group for screening, and by initiation and completion of preventive treatment.The incidence for those completing, stopping and not receiving preventive treatment was 187, 436 and 355 per 100 000 person-years for contacts of TB patients, respectively, and 63, 96 and 110 per 100 000 person-years for other target groups. The rate ratio for TB development among contacts compared to other target groups was 3.1 (95% CI 2.0-4.9). In both groups, incidence was highest in the first year after diagnosis. Independent factors associated with progression to TB among contacts were age <5 years and stopping preventive treatment within 28 days compared to those not receiving preventive treatment. Among other target groups, being foreign born was the only risk factor associated with the risk of developing TB.We conclude that the epidemiological impact of preventive treatment is highest in contacts of TB patients and limited in other target groups for LTBI management in the Netherlands.

Monitoring latent tuberculosis infection diagnosis and management in the Netherlands.

Targeted diagnosis and treatment of latent tuberculosis (TB) infection (LTBI) among persons with a high risk of exposure to TB or of developing TB when infected has been performed and monitored routinely in the Netherlands since 1993. We describe trends in target groups, diagnostic methods and treatment regimens, and explore determinants for treatment initiation, treatment completion and adverse events.In total, 37 729 persons were registered with LTBI from 1993 to 2013, of whom 28 931 (77%) started preventive treatment; 82% of those completed preventive treatment and 8% stopped preventive treatment due to adverse events. Two-thirds of the notified cases were detected through contact investigation.Increasing numbers of persons with immunosuppressive disorders, elderly persons and foreign-born persons were notified in recent years, due to policy changes and the introduction of the interferon-γ release assay. Children (96%) and the immunosuppressed (95%) were more likely to start preventive treatment. Children (93%) were also more likely to complete preventive treatment, as were persons treated with rifampicin or rifampicin/isoniazid regimens (91% and 92%, respectively). The latter groups were also 40% less likely to stop preventive treatment due to adverse events.Under these operational conditions, the estimated risk reduction on incident TB in the target population for LTBI management is 40-60%.

The epidemiology of childhood tuberculosis in the Netherlands: still room for prevention.

BACKGROUND: The occurrence of tuberculosis (TB) among children has long been neglected as a public health concern. However, any child with TB is a sentinel event indicating recent transmission. Vaccination, early case finding and treatment of those latently infected with TB can prevent cases, severe morbidity and unnecessary death. METHOD: The objective of the study was to describe the occurrence of TB events among children in the Netherlands which may be avoided through preventive measures. For this purpose we performed a trend analysis of routine Dutch TB and LTBI (surveillance data in 1993-2012 and a descriptive analysis of children with TB and with LTBI diagnosed in 2005-2012). RESULTS: Overall childhood TB incidence has declined over the last two decades from 3.6 in 1993 to 1.9 per 100,000 children in 2012. The decline was stronger among Dutch-born children compared to foreign-born children. In 2005-2012 64% of childhood TB cases were detected through active case finding. Foreign-born children with TB were less likely to be detected through active case finding, when not detected through post-entry TB screening. Childhood TB diagnosis was culture confirmed in 68% of passively detected cases and 12% of actively detected cases. Of 1,049 children with LTBI started on preventive treatment in 2005-2012, 90% completed treatment. In 37% of all childhood TB cases there was at least one 'missed opportunity' for prevention. Thirty nine percent of child TB patients eligible for BCG were not vaccinated. CONCLUSION: Children with TB in the Netherlands are generally detected at an early stage and treatment completion rates are high. However, more TB cases among children can be prevented through enhancing TB case finding and screening and preventive treatment of latent TB infection among migrant children, and improving the coverage of BCG vaccination among eligible risk groups.

A comparative examination of tuberculosis immigration medical screening programs from selected countries with high immigration and low tuberculosis incidence rates.

BACKGROUND: Tuberculosis (TB) in migrants is an ongoing challenge in several low TB incidence countries since a large proportion of TB in these countries occurs in migrants from high incidence countries. To meet these challenges, several countries utilize TB screening programs. The programs attempt to identify and treat those with active and/or infectious stages of the disease. In addition, screening is used to identify and manage those with latent or inactive disease after arrival. Between nations, considerable variation exists in the methods used in migration-associated TB screening. The present study aimed to compare the TB immigration medical examination requirements in selected countries of high immigration and low TB incidence rates. METHODS: Descriptive study of immigration TB screening programs. RESULTS: 16 out of 18 eligible countries responded to the written standardized survey and phone interview. Comparisons in specific areas of TB immigration screening programs included authorities responsible for TB screening, the primary objectives of the TB screening program, the yield of detection of active TB disease, screening details and aspects of follow up for inactive pulmonary TB. No two countries had the same approach to TB screening among migrants. Important differences, common practices, common problems, evidence or lack of evidence for program specifics were noted. CONCLUSIONS: In spite of common goals, there is great diversity in the processes and practices designed to mitigate the impact of migration-associated TB among nations that screen migrants for the disease. The long-term goal in decreasing migration-related introduction of TB from high to low incidence countries remains diminishing the prevalence of the disease in those high incidence locations. In the meantime, existing or planned migration screening programs for TB can be made more efficient and evidenced based. Cooperation among countries doing research in the areas outlined in this study should facilitate the development of improved screening programs.

Early nutritional supplementation immediately after diagnosis of infectious disease improves body weight in psychogeriatric nursing home residents.

BACKGROUND AND AIMS: Many elderly people with Alzheimer's disease experience weight loss. Illness and inadequate regain after a period of illness are considered as contributory causes of progressive weight loss in psychogeriatric patients. We studied whether early use of a liquid nutrition supplement immediately after onset of acute illness from infection can prevent weight loss in elderly psychogeriatric nursing home residents. METHODS: Randomised controlled trial of 5 weeks after the onset of illness. Thirty-four psychogeriatric nursing home residents (aged > or =65 yrs) completed the study period. A liquid nutrition supplement (200 ml) once daily immediately after diagnosis of infection or standard treatment (enriched food after referral to a dietician) were provided. Body weight, mid-upper arm circumference, calf circumference, triceps skin fold thickness, dietary energy intake, and need for care were measured. RESULTS: Weight change during the study period was significantly different between the standard (-0.4 kg) and supplement (+0.8 kg) groups (p = 0.040). No significant differences were observed in changes of mid-upper arm circumference, triceps skin fold thickness, calf circumference or energy intake between groups. CONCLUSIONS: Early provision of a liquid nutrition supplement immediately after onset of acute illness from infection leads to weight gain in elderly psychogeriatric nursing home residents.

Body weight changes in elderly psychogeriatric nursing home residents.

OBJECTIVE: This study was undertaken to identify predictors of body weight change in nursing home patients with possible to severe dementia. METHODS: For 24 weeks, 108 elderly residents of a nursing home were followed. Body weight was measured every 2 weeks. Other anthropometric characteristics, dietary intake, food behavior restrictions, psychological characteristics, medical status, and use of medicines were measured at baseline. Dietary intake was measured with a combined 3-day food record and by observations during the hot meals. Food behavior restrictions were measured following the classification of Berkhout. Dependency was measured by a questionnaire (Care Index Geriatrics), which measures restrictions in cognitive, physical, and social functioning. A generalized linear mixed effects model was used to investigate weight changes over time. The model was adjusted for age and sex. RESULTS: During the follow-up period, 26% of the participants lost and 22% gained at least 2 kg of body weight. Dependency (beta = -0.11, 95% confidence interval [CI] = -0.21, -0.01) and decreased appetite (beta = -2.17, 95% CI = -4.32, -0.01) were significantly associated with body weight loss, whereas body mass index (beta = 2.25, 95% CI = 1.98, 2.51) and intake of fat (beta = 0.07, 95% CI = 0.01, 0.15) were predictors of weight gain. CONCLUSION: Dependency, body mass index, intake of fat, and decreased appetite are significant predictors of body weight changes.