Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.211
Filtrar
3.
Lancet Glob Health ; 8(9): e1223-e1233, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32827484

RESUMO

BACKGROUND: In settings of high tuberculosis incidence, previously treated individuals remain at high risk of recurrent tuberculosis and contribute substantially to overall disease burden. Whether tuberculosis case finding and preventive interventions among previously treated people are cost-effective has not been established. We aimed to estimate costs and health benefits of annual post-treatment follow-up examinations and secondary preventive therapy for tuberculosis in a tuberculosis-endemic setting. METHODS: We developed a transmission-dynamic mathematical model and calibrated it to data from two high-incidence communities of approximately 40 000 people in suburban Cape Town, South Africa. We used the model to estimate overall cost and disability-adjusted life-years (DALYs) associated with annual follow-up examinations and secondary isoniazid preventive therapy (IPT), alone and in combination, among individuals completing tuberculosis treatment. We investigated scenarios under which these interventions were restricted to the first year after treatment completion, or extended indefinitely. For each intervention scenario, we projected health system costs and DALYs averted with respect to the current status quo of tuberculosis control. All estimates represent mean values derived from 1000 epidemic trajectories simulated over a 10-year period (2019-28), with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values. FINDINGS: We estimated that a single follow-up examination at the end of the first year after treatment completion combined with 12 months of secondary IPT would avert 2472 DALYs (95% UI -888 to 7801) over a 10-year period and is expected to be cost-saving compared with current control efforts. Sustained annual follow-up and continuous secondary IPT beyond the first year after treatment would avert an additional 1179 DALYs (-1769 to 4377) over 10 years at an expected additional cost of US$18·2 per DALY averted. Strategies of follow-up without secondary IPT were dominated (ie, expected to result in lower health impact at higher costs) by strategies that included secondary IPT. INTERPRETATION: In this high-incidence setting, post-treatment follow-up and secondary preventive therapy can accelerate declines in tuberculosis incidence and potentially save resources for tuberculosis control. Empirical trials to assess the feasibility of these interventions in settings most severely affected by tuberculosis are needed. FUNDING: National Institutes of Health, Günther Labes Foundation, Oskar Helene Heim Foundation.


Assuntos
Assistência ao Convalescente/economia , Prevenção Secundária/economia , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Análise Custo-Benefício , Humanos , Incidência , Modelos Teóricos , África do Sul/epidemiologia
6.
Ig Sanita Pubbl ; 76(1): 59-66, 2020.
Artigo em Italiano | MEDLINE | ID: mdl-32668448

RESUMO

Tuberculosis (TB) is an infectious and contagious disease caused by Mycobacterium tuberculosis, commonly called Koch's bacillus. TB is spread by air and is present all over the world. Not everyone who become infected develop the disease; the immune system can cope with the infection and the bacterium can remain dormant for years. Despite advances in therapy and prevention, TB remains one of the top 10 causes of death worldwide. Over 9 million new cases and over 1 million deaths occur each year. Since 1921 BCG has been the only authorized vaccine. More than ten experimental vaccines are currently in different stages of development. Depending on the type, they are divided into vaccines consisting of: live attenuated, inactivated mycobacteria and subunits. According to their purpose they can be divided in: vaccines aimed at preventing infection, vaccines aimed at preventing disease, vaccines aimed at preventing recurrence and therapeutic vaccines. Hopefully, these numerous attempts to develop new vaccination approaches will lead to obtain products with greater immunogenicity and efficacy.


Assuntos
Mycobacterium tuberculosis/imunologia , Vacinas contra a Tuberculose/imunologia , Tuberculose/prevenção & controle , Humanos , Tuberculose/diagnóstico , Vacinação
7.
Lancet Glob Health ; 8(9): e1132-e1141, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32673577

RESUMO

BACKGROUND: COVID-19 has the potential to cause substantial disruptions to health services, due to cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions to services for HIV, tuberculosis, and malaria in low-income and middle-income countries with high burdens of these diseases could lead to additional loss of life over the next 5 years. METHODS: Assuming a basic reproduction number of 3·0, we constructed four scenarios for possible responses to the COVID-19 pandemic: no action, mitigation for 6 months, suppression for 2 months, or suppression for 1 year. We used established transmission models of HIV, tuberculosis, and malaria to estimate the additional impact on health that could be caused in selected settings, either due to COVID-19 interventions limiting activities, or due to the high demand on the health system due to the COVID-19 pandemic. FINDINGS: In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemic. The greatest impact on HIV was estimated to be from interruption to antiretroviral therapy, which could occur during a period of high health system demand. For tuberculosis, the greatest impact would be from reductions in timely diagnosis and treatment of new cases, which could result from any prolonged period of COVID-19 suppression interventions. The greatest impact on malaria burden could be as a result of interruption of planned net campaigns. These disruptions could lead to a loss of life-years over 5 years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics. INTERPRETATION: Maintaining the most critical prevention activities and health-care services for HIV, tuberculosis, and malaria could substantially reduce the overall impact of the COVID-19 pandemic. FUNDING: Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development, and Medical Research Council.


Assuntos
Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento , Infecções por HIV/prevenção & controle , Acesso aos Serviços de Saúde , Malária/prevenção & controle , Pandemias , Pneumonia Viral/epidemiologia , Tuberculose/prevenção & controle , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Humanos , Malária/epidemiologia , Malária/mortalidade , Modelos Teóricos , Tuberculose/epidemiologia , Tuberculose/mortalidade
11.
Rev Chilena Infectol ; 37(1): 51-63, 2020 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-32730401

RESUMO

Tuberculosis in the neonatal stage has a high morbidity and mortality, is difficult to diagnose and involves the mother-child binomial and their environment. The particular characteristics of the immune system in pregnant women and the newborn, impact the clinical presentation of this disease. Its diagnosis is complex and the establishment of treatment must be timely and cannot be postponed. Relevant aspects for the diagnosis and management of the newborn exposes to the tuberculosis are covered.


Assuntos
Complicações Infecciosas na Gravidez , Tuberculose , Criança , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/prevenção & controle , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/prevenção & controle
15.
PLoS Negl Trop Dis ; 14(6): e0008069, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32498074

RESUMO

Africa is the second most populous continent and has perennial health challenges. Of the estimated 181 million school aged children in sub-Saharan Africa (SSA), nearly half suffer from ascariasis, trichuriasis, or a combination of these infections. Coupled with these is the problem of tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb) infection, which is a leading cause of death in the region. Compared to the effect of the human immunodeficiency virus on the development of TB, the effect of chronic helminth infections is a neglected area of research, yet helminth infections are as ubiquitous as they are varied and may potentially have profound effects upon host immunity, particularly as it relates to TB infection, diagnosis, and vaccination. Protection against active TB is known to require a clearly delineated T-helper type 1 (Th1) response, while helminths induce a strong opposing Th2 and immune-regulatory host response. This Review highlights the potential challenges of helminth-TB co-infection in Africa and the need for further research.


Assuntos
Ascaríase/epidemiologia , Coinfecção/epidemiologia , Tricuríase/epidemiologia , Vacinas contra a Tuberculose/imunologia , Tuberculose/complicações , Tuberculose/epidemiologia , Adolescente , África/epidemiologia , Ascaríase/complicações , Ascaríase/imunologia , Criança , Pré-Escolar , Coinfecção/imunologia , Coinfecção/prevenção & controle , Feminino , Humanos , Lactente , Masculino , Prevalência , Células Th1/imunologia , Células Th2/imunologia , Tricuríase/complicações , Tricuríase/imunologia , Tuberculose/imunologia , Tuberculose/prevenção & controle , Vacinas contra a Tuberculose/administração & dosagem
16.
Stud Health Technol Inform ; 270: 848-852, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570502

RESUMO

Online digital tools are considered an innovative method to promote HIV, hepatitis and STIs prevention, testing and treatment services, overcoming individual and social barriers, especially for younger people and other, possibly hard-to-reach, target population groups. In this paper, we introduce INTEGRATE RiskRadar, a web and mobile application developed in the scope of the EU-supported INTEGRATE Joint Action (JA), that aims to enhance the integration of combination prevention, testing and linkage to care for HIV, hepatitis, STIs and tuberculosis by providing integrated information and digital tools regarding all four diseases to population groups at increased risk, aiming to eliminate the individual and social barriers to effective adoption of prevention practices, testing and linkage to care, and thus reduce the incidence and burden of these diseases in the European Region.


Assuntos
Infecções por HIV , Hepatite , Doenças Sexualmente Transmissíveis , Tuberculose , Europa (Continente) , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Hepatite/diagnóstico , Hepatite/prevenção & controle , Humanos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/prevenção & controle , Software , Tuberculose/diagnóstico , Tuberculose/prevenção & controle
17.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(6): 856-860, 2020 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-32564549

RESUMO

Objective: To analyse the epidemic features and programs of control on tuberculosis (TB) in China from 1990 to 2017 to provide references and evidence on prevention and control of the disease. Methods: We used data from the Global Burden of Disease Study 2017 to analyse the trends of incident and death cases of TB in China from 1990 to 2017. Results: In 2017, there were an estimated 831.0 thousand (age-standardized incidence: 54.18 per 100 000 population) incident cases and 39.3 thousand (age-standardised mortality: 2.17 per 100 000 population) deaths of TB in the country. The incident cases and deaths of TB decreased by 51.05% and 76.24% compared with the numbers in 1990, respectively. The average annual declining rates on incident cases and deaths of TB were 2.61% and 5.18%, respectively, from 1990 to 2017. The number of incident cases of TB decreased from 833.6 thousand in 2016 to 831.0 thousand in 2017 (decreased by 0.31%). The number of deaths of TB decreased from 40.7 thousand in 2016 to 39.3 thousand in 2017 (decreased by 3.44%). The number of incident cases and deaths of drug-sensitive TB showed a declining trend from 1990 to 2017. However, the number of incident cases and deaths showed first increased and then decreased trends for both multidrug-resistant TB (MDRTB) and extensively drug-resistant TB (XDRTB) in the same period. The number of incident cases of XDRTB increased from 2 979 in 2016 to 3 018 in 2017, with an increasing rate by 1.32%. The number of deaths of XDRTB increased from 819 in 2016 to 829 in 2017, with an increase rate by 1.22%. Conclusions: China made substantial progress in reducing both the TB incidence and mortality from 1990 to 2017 but the rate of decline became slow in the later years. We noticed that the increase of TB caused by XDR-TB had been increasing which called for special attention.


Assuntos
Epidemias , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , China/epidemiologia , Epidemias/prevenção & controle , Humanos
18.
Acta Biomed ; 91(2): 207-213, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: covidwho-320998

RESUMO

Since the beginning of the COVID-19 epidemic, a possible explanation for the high heterogeneity of infection/mortality rates across involved countries was hinted in the prevalence of tuberculosis vaccination with Bacille Calmette-Guérin (BCG). A systematic review was therefore performed on May 2, 2020. A total of 13 articles were ultimately retrieved, 12 of them as preprint papers. All articles were ecological studies of low quality. Most of them did not include main confounding factors (i.e. demographic of the assessed countries, share of peo- ple residing in urban settings, etc.), and simply assessed the differences among incidence/mortality of COVID-19 with vaccination rates or by having vs. having not any vaccination policy for BCG. Even though all studies shared the very same information sources (i.e. international registries for BCG vaccination rates and open source data for COVID-19 epidemics), results were conflicting, with later studies apparently denying any true correlation between COVID-19 occurrence and BCG vaccination rates and/or policies. As a consequence, there is no sound evidence to recommend BCG vaccination for the prevention of COVID-19.


Assuntos
Vacina BCG/imunologia , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Mycobacterium bovis/imunologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/imunologia , Humanos , Pneumonia Viral/imunologia , Tuberculose/imunologia , Tuberculose/prevenção & controle
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA