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1.
PLoS One ; 15(4): e0231372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32324750

RESUMO

BACKGROUND: Rwanda conducted a national tuberculosis (TB) prevalence survey to determine the magnitude of TB in the country and determine to what extent the national surveillance system captures all TB cases. In addition we measured the patient diagnostic rate, comparing the measured TB burden data with the routine surveillance data to gain insight into how well key population groups are being detected. METHODS: A national representative nationwide cross-sectional survey was conducted in 73 clusters in 2012 whereby all enrolled participants (residents aged 15 years and above) were systematically screened for TB by symptoms and chest X-ray (CXR). Those with either clinical symptoms (cough of any duration) and/or CXR abnormalities suggestive of TB disease were requested to provide two sputum samples (one spot and one morning) for smear examination and solid culture. RESULTS: Of the 45,058 eligible participants, 43,779 were enrolled in the survey. Participation rate was high at 95.7% with 99.8% of participants undergoing both screening procedures and 99.0% of those eligible for sputum examination submitting at least one sputum sample. Forty cases of prevalent mycobacterium tuberculosis (MTB) and 16 mycobacteria other than tuberculosis (MOTT) cases were detected during the survey. Chest x-ray as screening tool had 3 and 5 times greater predictive odds for smear positive and bacteriological confirmed TB than symptom screening alone respectively. A TB prevalence of 74.1 (95% CI 48.3-99.3) per 100,000 adult population for smear positive TB and 119.3 (95% CI 78.8-159.9) per 100,000 adult population for bacteriological confirmed MTB was estimated for Rwanda. CONCLUSIONS: The survey findings indicated a lower TB prevalence than previously estimated by WHO providing key lessons for national TB control, calling for more sensitive screening and diagnostic tools and a focus on key populations. Use of chest x-ray as screening tool was introduced to improve the diagnostic yield of TB.


Assuntos
Tuberculose/diagnóstico , Adolescente , Adulto , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium/isolamento & purificação , Mycobacterium tuberculosis/isolamento & purificação , Prevalência , Ruanda/epidemiologia , Escarro/microbiologia , Tuberculose/diagnóstico por imagem , Tuberculose/epidemiologia , Adulto Jovem
2.
Int J Infect Dis ; 87: 119-125, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31357057

RESUMO

OBJECTIVE: To determine the prevalence of resistance to rifampicin alone; rifampicin and isoniazid, and second-line anti-TB drugs among sputum smear-positive tuberculosis patients in Zimbabwe. DESIGN: A health facility-based cross-sectional survey. RESULTS: In total, 1114 (87.6%) new and 158 (12.4%) retreatment TB patients were enrolled. MTB was confirmed by Xpert MTB/RIF among 1184 (93%) smear-positive sputum samples. There were 64 samples with Xpert MTB/RIF-determined rifampicin resistance. However, two were rifampicin susceptible on phenotypic drug susceptibility testing. The prevalence of RR-TB was [4.0% (95% CI, 2.9, 5.4%), n=42/1043) and 14.2% (95% CI, 8.9, 21.1%; n=20/141) among new and retreatment patients, respectively. The prevalence of MDR-TB was 2.0% (95% CI, 1.3, 3.1%) and 6.4% (95% CI, 2.4, 10.3%) among new and retreatment TB patients, respectively. Risk factors for RR-TB included prior TB treatment, self-reported HIV infection, travel outside Zimbabwe for ≥one month (univariate), and age <15 years. Having at least a secondary education was protective against RR-TB. CONCLUSION: The prevalence of MDR-TB in Zimbabwe has remained stable since the 1994 subnational survey. However, the prevalence of rifampicin mono-resistance was double that of MDR-TB.


Assuntos
Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Adolescente , Adulto , Idoso , Antibacterianos/farmacologia , Criança , Estudos Transversais , Farmacorresistência Bacteriana , Feminino , Instalações de Saúde , Humanos , Isoniazida/farmacologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mycobacterium tuberculosis/genética , Prevalência , Rifampina/farmacologia , Fatores de Risco , Sensibilidade e Especificidade , Escarro/microbiologia , Inquéritos e Questionários , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto Jovem , Zimbábue/epidemiologia
3.
PLoS One ; 11(1): e0146392, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26771588

RESUMO

BACKGROUND: Tuberculosis in Zambia is a major public health problem, however the country does not have reliable baseline data on the TB prevalence for impact measurement; therefore it was among the priority countries identified by the World Health Organization to conduct a national TB prevalence survey. OBJECTIVE: To estimate the prevalence of tuberculosis among the adult Zambian population aged 15 years and above, in 2013-2014. METHODS: A cross-sectional population-based survey was conducted in 66 clusters across all the 10 provinces of Zambia. Eligible participants aged 15 years and above were screened for TB symptoms, had a chest x-ray (CXR) performed and were offered an HIV test. Participants with TB symptoms and/or CXR abnormality underwent an in-depth interview and submitted one spot- and one morning sputum sample for smear microscopy and liquid culture. Digital data collection methods were used throughout the process. RESULTS: Of the 98,458 individuals who were enumerated, 54,830 (55.7%) were eligible to participate, and 46,099 (84.1%) participated. Of those who participated, 45,633/46,099 (99%) were screened by both symptom assessment and chest x-ray, while 466/46,099 (1.01%) were screened by interview only. 6,708 (14.6%) were eligible to submit sputum and 6,154/6,708 (91.7%) of them submitted at least one specimen for examination. MTB cases identified were 265/6,123 (4.3%). The estimated national adult prevalence of smear, culture and bacteriologically confirmed TB was 319/100,000 (232-406/100,000); 568/100,000 (440-697/100,000); and 638/100,000 (502-774/100,000) population, respectively. The risk of having TB was five times higher in the HIV positive than HIV negative individuals. The TB prevalence for all forms was estimated to be 455 /100,000 population for all age groups. CONCLUSION: The prevalence of tuberculosis in Zambia was higher than previously estimated. Innovative approaches are required to accelerate the control of TB.


Assuntos
Tuberculose/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem , Zâmbia/epidemiologia
4.
J Epidemiol Community Health ; 70(6): 556-60, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26700301

RESUMO

BACKGROUND: Knowledge of the HIV status in patients with tuberculosis (TB) and vice versa is crucial for proper individual patient management, while knowledge of the prevalence of co-infection guides preventive and therapeutic strategies. The aim of the study was to assess if national disease databases on TB and HIV are adequate sources to provide this information. METHODS: A two way capture-recapture analysis to assess the completeness of the registers, and to obtain the prevalence of TB-HIV co-infection in the Netherlands in the years 2002-2012. RESULTS: HIV testing was performed in less than 50% of the patients with TB. Of the 932 TB-HIV infected patients, just 293 (31.4%) were registered in both registers. Under-reporting of TB-HIV co-infection ranged from 50% to 70% in the national TB register, and from 31% to 37% in the HIV database. Prevalence of TB-HIV co-infection in the Netherlands in 2012 was 7.1% (95% CI 6.0% to 8.3%), which was more than double of the prevalence estimated from the national TB database. CONCLUSIONS: TB-HIV co-infection is markedly under-reported in national disease databases. There is an urgent need for improved registration and preferably a routine data exchange between the two surveillance systems.


Assuntos
Coinfecção/epidemiologia , Notificação de Doenças/estatística & dados numéricos , Infecções por HIV/epidemiologia , Informática em Saúde Pública/estatística & dados numéricos , Tuberculose/epidemiologia , Adolescente , Adulto , Notificação de Doenças/normas , Feminino , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Vigilância da População , Prevalência , Informática em Saúde Pública/normas , Sistema de Registros
5.
Am J Epidemiol ; 174(2): 243-51, 2011 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-21606233

RESUMO

Molecular epidemiologic studies may use genotypic clustering of isolates as an indicator of recent transmission. It has been shown that missing cases lead to underestimating clustering, and modelling studies suggested that they may also lead to underestimating odds ratios for clustering. Using a national, comprehensive database from the Netherlands covering 15 years between 1993 and 2007 and including over 12,000 patients and their isolates, the authors determined the effects of sampling at random, in time, and by geographic area. As expected, sampling reduced the observed clustering percentages. However, sampling did not reduce the observed odds ratios for clustering. The main explanations for this discrepancy with model outcomes were that a substantial proportion of clustered cases were found in large clusters and that risk factors for clustering tended to be-among clustered cases-also risk factors for large clusters. The authors conclude that, in settings where risk factors for clustering may be interpreted as risk factors for recent transmission, these risk factors are also associated with larger cluster sizes. As a result, odds ratios would show limited sampling bias.


Assuntos
Epidemiologia Molecular , Amostragem , Tuberculose/epidemiologia , Adolescente , Adulto , Criança , Análise por Conglomerados , Feminino , Humanos , Masculino , Razão de Chances , Fatores de Risco
6.
Int J Epidemiol ; 40(4): 964-70, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21441552

RESUMO

BACKGROUND: There is limited information on the distribution of incubation periods of tuberculosis (TB). METHODS: In The Netherlands, patients whose Mycobacterium tuberculosis isolates have identical DNA fingerprints in the period 1993-2007 were interviewed to identify epidemiological links between cases. We determined the incubation period distribution in secondary cases. Survival analysis techniques were used to include secondary cases not yet symptomatic at diagnosis with weighting to adjust for lower capture probabilities of couples with longer time intervals between their diagnoses. In order to deal with missing data, we used multiple imputations. RESULTS: We identified 1095 epidemiologically linked secondary cases, attributed to 688 source cases with pulmonary TB. Of those developing disease within 15 years, the Kaplan-Meier probability to fall ill within 1 year was 45%, within 2 years 62% and within 5 years 83%. The incubation time was shorter in secondary cases who were men, young, those with extra-pulmonary TB and those not reporting previous TB or previous preventive therapy. CONCLUSIONS: Molecular epidemiological analysis has allowed a more precise description of the incubation period of TB than was possible in previous studies, including the identification of risk factors for shorter incubation periods.


Assuntos
Período de Incubação de Doenças Infecciosas , Tuberculose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Mycobacterium tuberculosis/genética , Países Baixos/epidemiologia , Sistema de Registros , Fatores de Risco , Análise de Sobrevida , Adulto Jovem
7.
Eur J Public Health ; 19(4): 424-7, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19357241

RESUMO

BACKGROUND: The incidence of tuberculosis (TB) in The Netherlands has been declining for many years. For the purpose of planning future TB-control activities we estimated the number of TB patients in The Netherlands up to 2030. METHODS: Statistical modelling for 5-year age groups up to 2030 distinguishing among Dutch TB patients infected by a Dutch source (survival model), non-Dutch patients (projection of the proportion of culture-positive patients among first generation immigrants) and Dutch patients infected by a non-Dutch source (fixed relation with the number of non-Dutch patients). RESULTS: The number of TB patients is expected to decline to 877 in 2030. After 2010 declines may slow due to an increase in non-Dutch TB patients. This increase cancels out the decrease of Dutch TB patients infected by a Dutch source. In 2030, 85% of all TB patients are expected to be non-Dutch. In the four largest counties and the rest of The Netherlands, this will be 89 and 76%, respectively. CONCLUSION: The decrease in TB incidence observed over many years may stall from 2010 onwards because of an estimated increase in non-Dutch TB patients. Given their disproportionate burden, future TB-control activities should prioritize the health of first-generation immigrants. Enhanced TB control in the countries of origin and new diagnostic tests to identify those at high risk of developing active TB could help in reducing further the TB incidence in the Netherlands. Future TB-control efforts must be organized in a flexible way to be able to incorporate changing epidemiological situations.


Assuntos
Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Previsões , Humanos , Tábuas de Vida , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Tuberculose/etnologia , Adulto Jovem
8.
Clin Infect Dis ; 47(9): 1135-42, 2008 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-18823268

RESUMO

BACKGROUND: Sputum smear microscopy is commonly used for diagnosing tuberculosis (TB). Although patients with sputum smear-negative TB are less infectious than patients with smear-positive TB, they also contribute to TB transmission. The objective of this study was to determine the proportion of TB transmission events caused by patients with smear-negative pulmonary TB in The Netherlands. METHODS: All patients in The Netherlands with culture-confirmed TB during the period 1996-2004 were included in this study. Patients with identical DNA fingerprints in Mycobacterium tuberculosis isolates from sputum samples were clustered. The first patients in a cluster were considered to be the index patients; all other patients were considered to have secondary cases. In addition, we examined transmission from sources by conventional contact tracing. RESULTS: We analyzed 394 clusters with a total of 1285 patients. On the basis of molecular linkage only, 12.6% of the secondary cases were attributable to transmission from a patient with smear-negative TB. The relative transmission rate among patients with smear-negative TB, compared with patients with smear-positive TB, was 0.24 (95% confidence interval, 0.20-0.30). Secondary cases in clusters with an index patient with smear-negative TB more frequently had smear-negative status (odds ratio, 1.86; 95% confidence interval, 1.18-2.93), compared with secondary cases in clusters with an index patient with smear-positive TB. Conventional contact tracing revealed that 26 (6.2%) of the 417 sources, as identified by the Municipal Health Services, had smear-negative TB. CONCLUSIONS: In The Netherlands, patients with smear-negative, culture-positive TB are responsible for 13% of TB transmission. Countries that have ample resources should expand their TB-control efforts to include prevention of transmission from patients with smear-negative, culture-positive pulmonary TB.


Assuntos
Tuberculose Pulmonar/transmissão , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Análise por Conglomerados , Estudos de Coortes , Busca de Comunicante , Impressões Digitais de DNA , DNA Bacteriano/genética , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Países Baixos/epidemiologia , Polimorfismo de Fragmento de Restrição , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia
9.
Emerg Infect Dis ; 13(5): 776-8, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17553264

RESUMO

In the Netherlands during 1993-2001, multidrug-resistant tuberculosis among newly diagnosed patients was more frequent in those with HIV coinfection (5/308, 1.6%) than in those with no HIV infection (39/646, 0.6%; adjusted odds ratio 3.43, p=0.015). Four of the 5 patients coinfected with multidrug-resistant tuberculosis and HIV were foreign-born. DNA fingerprint analysis suggested that transmission had occurred outside the Netherlands.


Assuntos
Emigrantes e Imigrantes , Infecções por HIV/complicações , Sistema de Registros , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto , Antituberculosos , Impressões Digitais de DNA , Feminino , Humanos , Masculino , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/genética , Países Baixos/epidemiologia , Prevalência , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/transmissão
10.
AIDS ; 20(6): 915-21, 2006 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-16549977

RESUMO

OBJECTIVE: To assess the impact of the HIV epidemic on tuberculosis transmission in Tanzania by estimating the trend in annual risk of tuberculosis infection (ARTI) over the period 1983-2003. DESIGN: Tuberculin survey among school children aged 6-14 years, randomly selected by cluster sampling. METHODS: Primary outcome was the ARTI among children without a BCG vaccination scar. To obtain time trends, data were reanalysed from three previous surveys carried out at intervals of 5 years since 1983, using identical methods and definitions. RESULTS: Of 96,226 children included in the analysis (74% of those enrolled), 10,239 (11%) had no BCG scar. The ARTI was 0.68% (95% confidence interval 0.55-0.81). Despite a doubling of notification rates of smear-positive tuberculosis since 1983, this represents an average annual decline since the first survey of 2.7% (P < 0.001). The declining trend in ARTI was observed in 17 of 20 regions, with no association between this trend and region-specific prevalence of HIV infection among patients with tuberculosis (P = 0.575). A similar decline in ARTI was observed among children with a BCG scar and for various ways of estimating the prevalence of tuberculosis infection from the distribution of skin test reactions. CONCLUSION: Despite substantial increases in tuberculosis incidence, the overall population-level effect of the HIV epidemic on tuberculosis transmission in Tanzania has been limited. This suggests that in the presence of a strong control programme, the HIV epidemic has limited impact on tuberculosis transmission.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/transmissão , Tuberculose/epidemiologia , Tuberculose/transmissão , Adolescente , Criança , Países em Desenvolvimento , Surtos de Doenças , Feminino , Infecções por HIV/epidemiologia , Inquéritos Epidemiológicos , Humanos , Masculino , Prevalência , Tanzânia/epidemiologia , Teste Tuberculínico
11.
Clin Infect Dis ; 39(4): 488-96, 2004 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-15356811

RESUMO

BACKGROUND: Severe liver injury has been attributed to preventive treatment of latent tuberculosis infection with a 2-month course of rifampin-pyrazinamide. METHODS: A retrospective cohort study in The Netherlands compared the hepatotoxicity of preventive treatment with rifampin-pyrazinamide with that of preventive treatment with isoniazid, and also with that of treatment for active tuberculosis containing at least isoniazid, rifampin, and pyrazinamide. RESULTS: Preventive treatment with rifampin-pyrazinamide caused severe hepatotoxicity more often than did preventive treatment with isoniazid (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.26-5.39; P=.012), especially in patients <25 years old. It also caused severe hepatotoxicity more often than triple- or quadruple-drug tuberculosis treatment (OR, 2.61; 95% CI, 1.21-5.59; P=.016), especially if the pyrazinamide dose was > or =30 mg/kg. Preventive treatment with rifampin-pyrazinamide was more hepatotoxic even when the advised pyrazinamide dose of up to 20 mg/kg for preventive treatment was compared with the pyrazinamide dose of 30 mg/kg for tuberculosis treatment. CONCLUSIONS: Preventive treatment with rifampin-pyrazinamide causes severe hepatotoxicity more often than does preventive treatment with isoniazid or curative treatment for tuberculosis.


Assuntos
Antibacterianos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Quimioterapia Combinada/efeitos adversos , Isoniazida/efeitos adversos , Pirazinamida/efeitos adversos , Rifampina/efeitos adversos , Tuberculose/tratamento farmacológico , Tuberculose/prevenção & controle , Adolescente , Adulto , Antibióticos Antituberculose/efeitos adversos , Antibióticos Antituberculose/uso terapêutico , Estudos de Coortes , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Isoniazida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Prospectivos , Pirazinamida/uso terapêutico , Estudos Retrospectivos , Rifampina/uso terapêutico , Resultado do Tratamento
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