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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46804

RESUMO

Ministro da Saúde assume presidência do conselho da Stop TB, organização internacional que atua para eliminar a tuberculose. SUS ofertará nova formulação para o tratamento em crianças


Assuntos
Tuberculose , Qualidade de Vida , Tuberculose/prevenção & controle
2.
J Glob Health ; 9(1): 010423, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263546

RESUMO

Background: Tuberculosis (TB) is a major global health burden, which has been inadequately addressed. This study aims to analyze different patterns and gaps of care along the care cascade across countries and to develop a model to examine the relationship between performance of tuberculosis programmes in high and low burden countries along the tuberculosis care cascade and tuberculosis disease burden. Methods: We used the World Health Organization's Global TB Database for the year 2016 to construct tuberculosis care cascade consisting of four steps: incidence, diagnosed, treatment started and treatment completed. Based on the constructed care cascades, we analyzed the relationship between health system performance indicators and tuberculosis cascades performance: diagnosed rate, treatment started rate, and treatment completed rate. Results: There are wide differences in access to diagnosis and treatment between high-burden countries and non-high-burden countries. The largest gap was found between incidence and diagnosed rate, with 65% of diagnosed rate for high burden countries and 80% of diagnosed rate for non-high burden countries. We found variations in care performance among high-burden countries. We found a negative relationship between the population health indicators related to the mortality rate and TB care cascade performance. There was a positive relationship between immunization coverage rate and antenatal care indicators and TB care cascade performance. Conclusions: Well-functioning tuberculosis care cascades and effective health systems are important for the successful management of tuberculosis. While improving screening performance is essential for tuberculosis control especially for high-burden countries, resource should be allocated to improve health system performance, which is weak in high-burden countries. Performance of TB programmes across care cascade could be used as a useful tracer to measure performance of health systems.


Assuntos
Assistência à Saúde/organização & administração , Saúde Global/estatística & dados numéricos , Tuberculose/prevenção & controle , Bases de Dados como Assunto , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Incidência , Modelos Organizacionais , Avaliação de Programas e Projetos de Saúde , Tuberculose/epidemiologia , Organização Mundial da Saúde
3.
Epidemiol Health ; 41: e2019028, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31319659

RESUMO

OBJECTIVES: Tuberculosis (TB) is common in children with human immunodeficiency virus (HIV), but its effect on the survival of HIV-infected children is not well understood. Therefore, the aim of this study was to assess the incidence and predictors of active TB among HIV-positive children at Adama Referral Hospital and Medical College, Oromia, Ethiopia. METHODS: A retrospective study was conducted over 5 years using a checklist to gather data from 428 randomly selected pediatric patient charts. The checklist was adapted from the standardized antiretroviral therapy (ART) follow-up form currently used by the institution's ART clinic. Data were analyzed by bivariate and multivariable analysis using Cox regression proportional hazards models, as appropriate. Survival was calculated and compared using the Kaplan-Meier and log-rank tests. RESULTS: Of the 466 charts reviewed, 428 patient records were included in the analysis. A total of 67 new TB cases were observed during the follow-up period. Hence, the incidence rate in this cohort was found to be 6.03 per 100 child-years of observation. A baseline hemoglobin level <10 g/dL (adjusted hazard ratio [aHR], 7.04; 95% confidence interval [CI], 1.03 to 48.15), moderate wasting (aHR, 2.86; 95% CI, 1.02 to 7.99), and not receiving isoniazid preventive therapy (aHR, 8.23; 95% CI, 2.11 to 32.06) were among the independent predictors of TB occurrence. CONCLUSIONS: The incidence of TB was high, particularly in pre-ART patients receiving chronic care for HIV. Close followup of HIV-positive children is crucial to protect them against the development of TB. Initiating isoniazid preventive therapy, averting malnutrition, and managing anemia are also of significant importance.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Tuberculose/epidemiologia , Antirretrovirais/uso terapêutico , Antituberculosos/uso terapêutico , Criança , Pré-Escolar , Etiópia/epidemiologia , Feminino , Seguimentos , Infecções por HIV/tratamento farmacológico , Humanos , Incidência , Isoniazida/uso terapêutico , Masculino , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco , Tuberculose/prevenção & controle
4.
BMC Public Health ; 19(1): 796, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226971

RESUMO

BACKGROUND: This study assesses how tuberculosis (TB) screening is perceived by immigrants in Norway. Screening is mandatory for people arriving from high incidence countries. To attend screening, immigrants have to contact the health system after receiving an invitation by letter. The proportion of non-attenders is not known, and there are no sanctions for not attending. Generally, only persons who test positive receive test results. The study explores users' experiences, attitudes and motivations for attending or not attending TB screening, and perceived barriers and enablers. METHODS: We conducted six focus group discussions and three individual interviews with 34 people from 16 countries in Africa, Asia and Europe. Interviews were recorded and transcribed, and data was coded following a general inductive approach: All transcribed text data was closely read through, salient themes were identified and categories were created and labelled. The data was read through several times and the category system was subsequently revised. RESULTS: Most appreciated the opportunity to be tested for a severe disease and were generally positive towards the healthcare system. At the same time, many were uncomfortable with screening, particularly due to the fear and stigma attached to TB. All experienced practical problems related to language, information, and accessing facilities. Having to ask others for help made them feel dependent and vulnerable. Positive and negative attitudes simultaneously created ambivalence. Many wanted "structuring measures" like sanctions to help attendance. Many said that not receiving results left them feeling anxious. CONCLUSIONS: In order to adapt the system and improve trust and patient uptake, all aspects of the screening should be taken into account. Ambivalence towards screening probably has a negative impact on screening uptake and should be sought reduced. A combination of ambivalence and a wish for "structuring measures" leads the authors to conclude that mandatory screening is a reasonable measure. However, since mandatory screening negatively impacts patient autonomy, and because of fear, stigma and practical problems, the health system should empower users by improving communication and access to services. In addition, it is recommended that negative test results are also communicated to the users.


Assuntos
Atitude Frente a Saúde , Emigrantes e Imigrantes/psicologia , Programas de Rastreamento/psicologia , Tuberculose/prevenção & controle , Adulto , África/etnologia , Ásia/etnologia , Emigrantes e Imigrantes/estatística & dados numéricos , Europa (Continente)/etnologia , Feminino , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Masculino , Motivação , Noruega , Pesquisa Qualitativa
5.
Rev Bras Epidemiol ; 22: e190031, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038612

RESUMO

OBJECTIVE: To describe and evaluate the factors associated with actions for the control of tuberculosis (TB) in primary care (PC) in the five Brazilian macroregions. METHODS: This cross-sectional study was carried out with data from the second cycle of the National Program for Improving Access to and Quality of Primary Care. Theoutcome of the study was constructed based on a set of items that were considered essential for the treatment and control of tuberculosis in Primary Care Units (PCUs). Data were analyzed using the χ2 test and Poisson regression with robust variance. RESULTS: The national prevalence of the set of items to control tuberculosis was 17.22%. TheNortheast (11.18%) and North (12.15%) had the worst performance. The main results indicate association with this outcome for PCUs performing educational actions for TB (PR = 1.53; 95%CI 1.45 - 1.62), those performing HIV serology (PR = 1.68; 95%CI 1.11 - 2.54), those that have a reception room (PR = 1.61; 95%CI 1.46 - 1.79) and those performing continuing education activities (PR = 1.73; 95%CI 1.54 - 1.95). CONCLUSION: The results show a weakness in the structures and in the work process of PC in relation to the control of tuberculosis in all Brazilian regions.


Assuntos
Atenção Primária à Saúde/estatística & dados numéricos , Tuberculose/prevenção & controle , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Avaliação de Resultados (Cuidados de Saúde) , Distribuição de Poisson , Qualidade da Assistência à Saúde
7.
BMC Infect Dis ; 19(1): 405, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077133

RESUMO

BACKGROUND: Tuberculosis (TB) and HIV makeup a deadly synergy of infectious disease, and the combined effect is apparent in resource limited countries like Ethiopia. Previous studies have demonstrated inconsistent results about the protective effect of isoniazid preventive therapy (IPT) on active TB incidence among HIV positive patients receiving ART. Therefore, the aim of this meta-analysis was, first, to determine the protective effect of IPT on active tuberculosis incidence, and second, to assess the pooled incidence of active TB among HIV positive patients taking ART with and without IPT intervention in Ethiopia. METHODS: PubMed, Google scholar and Cochran library databases were searched from April 1 to 30, 2018. Two independent authors explored and assessed studies for eligibility, and extracted data based on predefined criteria. Studies that reported TB incidence among HIV positive patients taking ART in Ethiopia with and without IPT concomitant intervention, and with a clear stratified data on the incidence of TB based on the duration of IPT intervention were selected. A random effects model was used to estimate risk ratios and the pooled incident TB with the respective 95% confidence intervals. RESULTS: We identified 7 suitable studies in this analysis. Accordingly, IPT reduced the risk of TB incidence by 74%, risk ratio (RR) 0.26 (95% CI; 0.16-0.43%), compared to no IPT group. Moreover, IPT for 12 months reduced incident TB by 91% (RR: 0.09, 95% CI: 0.04 to 0.21), whereas 6 months IPT averted TB incidence by 63% (RR: 0.37, 95% CI: 0.26 to 0.52). The overall pooled incident TB among HIV infected patients receiving ART was 10.30% (95% CI; 7.57-13.02%). Specifically, incident TB among study cohorts with and without IPT was 3.79% (95% CI; 2.03-5.55%) and 16.32% (95% CI; 11.57-21.06%) respectively. CONCLUSION: IPT reduced the risk of incident TB among HIV positive patients receiving ART in Ethiopian settings. Moreover, the duration of IPT intervention has effect on its protective role. Thus, scaling up the isoniazid preventive therapy program and its strict compliance is necessary to avert HIV fueled tuberculosis. STUDY PROTOCOL REGISTRATION: CRD42018090804.


Assuntos
Terapia Antirretroviral de Alta Atividade , Antituberculosos/uso terapêutico , Infecções por HIV/complicações , Isoniazida/uso terapêutico , Tuberculose/prevenção & controle , Estudos de Coortes , Etiópia/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Recursos em Saúde , Humanos , Incidência , Razão de Chances , Cooperação do Paciente , Serviços Preventivos de Saúde , Tuberculose/epidemiologia
8.
Cochrane Database Syst Rev ; 4: CD012915, 2019 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-31038197

RESUMO

BACKGROUND: Tuberculosis causes more deaths than any other infectious disease globally. Bacillus Calmette-Guérin (BCG) is the only available vaccine, but protection is incomplete and variable. The modified Vaccinia Ankara virus expressing antigen 85A (MVA85A) is a viral vector vaccine produced to prevent tuberculosis. OBJECTIVES: To assess and summarize the effects of the MVA85A vaccine boosting BCG in humans. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); Embase (Ovid); and four other databases. We searched the WHO ICTRP and ClinicalTrials.gov. All searches were run up to 10 May 2018. SELECTION CRITERIA: We evaluated randomized controlled trials of MVA85A vaccine given with BCG in people regardless of age or HIV status. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the eligibility and risk of bias of trials, and extracted and analyzed data. The primary outcome was active tuberculosis disease. We summarized dichotomous outcomes using risk ratios (RR) and risk differences (RD), with 95% confidence intervals (CI). Where appropriate, we combined data in meta-analyses. Where meta-analysis was inappropriate, we summarized results narratively. MAIN RESULTS: The search identified six studies relating to four Phase 2 randomized controlled trials enrolling 3838 participants. Funding was by government bodies, charities, and philanthropic donors. Five studies included infants, one of them infants born to HIV-positive mothers. One study included adults living with HIV. All trials included authors from Oxford University who led the laboratory development of the vaccine. Participants received intradermal MVA85A after BCG in some studies, and before selective deferred BCG in HIV-exposed infants.The largest trial in 2797 African children was well conducted with low risk of bias for most parameters. Risk of bias was uncertain for selective reporting because there were no precise case definition endpoints for active tuberculosis published prior to the trial analysis.MVA85A added to BCG compared to BCG alone probably has no effect on the risk of developing microbiologically confirmed tuberculosis (RR 0.97, 95% CI 0.58 to 1.62; 3439 participants, 2 trials; moderate-certainty evidence), or the risk of starting on tuberculosis treatment (RR 1.10, 95% CI 0.92 to 1.33; 3687 participants, 3 trials; moderate-certainty evidence). MVA85A probably has no effect on the risk of developing latent tuberculosis (RR 1.01, 95% CI 0.85 to 1.21; 3831 participants, 4 trials; moderate-certainty evidence). Vaccinating people with MVA85A in addition to BCG did not cause life-threatening serious adverse effects (RD 0.00, 95% CI -0.00 to 0.00; 3692 participants, 3 trials; high-certainty evidence). Vaccination with MVA85A is probably associated with an increased risk of local skin adverse effects (3187 participants, 3 trials; moderate-certainty evidence), but not systemic adverse effect related to vaccination (144 participants, 1 trial; low-certainty evidence). This safety profile is consistent with Phase 1 studies which outlined a transient, superficial reaction local to the injection site and mild short-lived symptoms such as malaise and fever. AUTHORS' CONCLUSIONS: MVA85A delivered by intradermal injection in addition to BCG is safe but not effective in reducing the risk of developing tuberculosis.


Assuntos
Vacina BCG , Vacinas contra a Tuberculose , Tuberculose/prevenção & controle , Soropositividade para HIV/complicações , Soropositividade para HIV/imunologia , Humanos , Prevenção Primária , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Int J Nanomedicine ; 14: 3129-3143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31118627

RESUMO

Background: Bacillus Calmette-Guérin, the attenuated strain of Mycobacterium bovis, remains the only available vaccine against tuberculosis (TB). However, its ineffectiveness in adults against pulmonary TB and varied protective efficacy (0-80%) speak to an urgent need for the development of an improved and efficient TB vaccine. In this milieu, poly(lactic-co-glycolic acid) (PLGA), is a preferential candidate, due to such properties as biocompatibility, targeted delivery, sustained antigen release, and atoxic by-products. Methods: In this study, we formulated PLGA nanoparticles (NPs) encapsulating the bivalent H1 antigen, a fusion of Mycobacterium tuberculosis (Mtb) Ag85B and ESAT6 proteins, and investigated its role in immunomodulation and protection against Mtb challenge. Using the classical water-oil-water solvent-evaporation method, H1-NPs were prepared, with encapsulation efficiency of 86.1%±3.2%. These spherical NPs were ~244.4±32.6 nm in diameter, with a negatively charged surface (ζ-potential -4±0.6 mV). Results: Under physiological conditions, NPs degraded slowly and the encapsulated H1 antigen was released over a period of weeks. As a proof-of-concept vaccine candidate, H1 NPs were efficiently internalized by the THP-1 human macrophages. Six weeks after a single-dose vaccination, H1 NP-immunized C57BL/6J mice showed significant increase in the production of total serum IgG (P<0.0001) and its isotypes compared to H1 alone, IgG2a being the predominant one, followed by IgG1. Further, the cytokine-release profile of antigen-stimulated splenocyteculture supernatant indicated a strong TH1-biased immunoresponse in H1 NP-vaccinated mice, with ~6.03- and ~2.8-fold increase in IFNγ and TNFα cytokine levels, and ~twofold and 1.6 fold increase in IL4 and IL10 cytokines, respectively, compared to H1 alone-immunized mice. In protection studies, H1 NP-vaccinated mice displayed significant reductions in lung and spleen bacillary load (P<0.05) at 5-week post-Mtb H37Rv challenge and prolonged survival, with a mean survival time of 177 days, compared to H1 alone-vaccinated mice (mean survival time 80 days). Conclusion: Altogether, our findings highlight the significance of the H1-PLGA nanoformulation in terms of providing long-term protection in mice with a single dose.


Assuntos
Imunidade , Nanopartículas/química , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Proteínas Recombinantes de Fusão/metabolismo , Tuberculose/imunologia , Tuberculose/prevenção & controle , Animais , Citocinas/metabolismo , Relação Dose-Resposta Imunológica , Liberação Controlada de Fármacos , Endocitose , Epitopos , Feminino , Humanos , Imunidade Humoral , Imunização , Imunoglobulina G/metabolismo , Macrófagos/metabolismo , Camundongos Endogâmicos C57BL , Mycobacterium tuberculosis/imunologia , Nanopartículas/administração & dosagem , Nanopartículas/ultraestrutura , Baço/citologia , Baço/imunologia , Análise de Sobrevida , Células THP-1 , Células Th1/imunologia , Vacinas contra a Tuberculose/imunologia , Vacinação
10.
MMWR Morb Mortal Wkly Rep ; 68(19): 439-443, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31099768

RESUMO

The 2005 CDC guidelines for preventing Mycobacterium tuberculosis transmission in health care settings include recommendations for baseline tuberculosis (TB) screening of all U.S. health care personnel and annual testing for health care personnel working in medium-risk settings or settings with potential for ongoing transmission (1). Using evidence from a systematic review conducted by a National Tuberculosis Controllers Association (NTCA)-CDC work group, and following methods adapted from the Guide to Community Preventive Services (2,3), the 2005 CDC recommendations for testing U.S. health care personnel have been updated and now include 1) TB screening with an individual risk assessment and symptom evaluation at baseline (preplacement); 2) TB testing with an interferon-gamma release assay (IGRA) or a tuberculin skin test (TST) for persons without documented prior TB disease or latent TB infection (LTBI); 3) no routine serial TB testing at any interval after baseline in the absence of a known exposure or ongoing transmission; 4) encouragement of treatment for all health care personnel with untreated LTBI, unless treatment is contraindicated; 5) annual symptom screening for health care personnel with untreated LTBI; and 6) annual TB education of all health care personnel.


Assuntos
Pessoal de Saúde , Programas de Rastreamento , Mycobacterium tuberculosis , Tuberculose/prevenção & controle , Centers for Disease Control and Prevention (U.S.) , Humanos , Testes de Liberação de Interferon-gama , Tuberculose Latente/epidemiologia , Tuberculose Latente/prevenção & controle , Medição de Risco , Revisão Sistemática como Assunto , Teste Tuberculínico , Tuberculose/epidemiologia , Tuberculose/transmissão , Estados Unidos/epidemiologia
11.
BMC Infect Dis ; 19(1): 397, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072396

RESUMO

BACKGROUND: Tuberculosis (TB) is the ninth leading cause of death worldwide and the leading cause from a single infectious agent. Bacillus Calmette-Guerin (BCG) is the only licensed vaccine for TB, yet its efficacy remains debated with variations in vaccine sub-strains, policies, and practices observed across the world. Three BCG vaccination policies were implemented across adjoining regions in the South West of Ireland from 1972; neonatal vaccination (vaccinated Region-A), vaccination of children aged 10-12 years (vaccinated Region-B) and no vaccination (unvaccinated Region-C). The aim of this study is to examine the impact of different BCG vaccination policies on incidence of TB disease in the South of Ireland over a 13-year period. METHODS: Cases of active TB disease from 2003 to 2016 were identified through surveillance data. Residential addresses for each case were geocoded using the Google Maps API. Addresses were linked to 2011 census population data and to Local Health Offices BCG coverage data for study regions A-C. A steady-state population was assumed to calculate the 13-year incidence of TB disease. Using SatScan (v9.4.4), spatial clusters were identified at a small area level with the spatial scan statistic based on the discrete Poisson probability distribution. RESULTS: Of 621 TB disease cases identified, 510 could be linked to the study area based on the reported addresses. The median age was 42 years (range 4 months - 94 years), 65% male and 66% Irish born. The incidence of TB disease was higher in the unvaccinated population, region-C 132/100,000 (95% CI 116-150) versus vaccinated region-A 56/100,000 (95%CI 45-69) and region-B 44/100,000 (95%CI 29-63). A spatial cluster analysis identified a single high-risk cluster in region -C where the relative risk (vs. the areas outside of the cluster) was 4.94 (95% CI 4.03 to 5.96). CONCLUSION: Our study demonstrates significant regional variation in the incidence of TB in demographically similar populations based on BCG vaccination policy. This observation is particularly noteworthy in a country with low TB disease incidence such as Ireland. These findings strengthen existing data demonstrating efficacy of BCG vaccination for primary prevention of TB disease.


Assuntos
Vacina BCG/imunologia , Tuberculose/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Risco , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Vacinação , Adulto Jovem
12.
Top Antivir Med ; 27(1): 34-40, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31137001

RESUMO

The 2019 Conference on Retroviruses and Opportunistic Infections provided a considerable amount of new information on the progress in implementation of strategies to reduce morbidity and mortality from complications and coinfections that occur in people with HIV infection, and on the clinical management of these important problems. This review will address new insights into the prevention and treatment of tuberculosis, fungal infections, sexually transmitted infections, malignancies, and a range of metabolic complications and noncommunicable diseases.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Coinfecção/epidemiologia , Infecções por HIV/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Coinfecção/prevenção & controle , Humanos , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/tratamento farmacológico , Doenças Metabólicas/prevenção & controle , Micoses/diagnóstico , Micoses/tratamento farmacológico , Micoses/prevenção & controle , Neoplasias/diagnóstico , Neoplasias/tratamento farmacológico , Neoplasias/prevenção & controle , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/prevenção & controle
13.
BMC Infect Dis ; 19(1): 475, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138140

RESUMO

BACKGROUND: Fear of TB infection is rooted in historical and social memories of the disease, marked by stigma, segregation and exclusion. Healthcare workers (HCWs) face these same fears today, and even seek to hide their TB status when infected. This study sought to investigate factors associated with HCWs fears of acquiring TB while at work, including selected biographic characteristics, TB knowledge, infection control and perceptions that their colleagues stigmatise co-workers with TB/ presumed to have TB. METHODS: In the Free State Province, South Africa, a representative sample of 882 HCWs from eight hospitals completed self-administered questionnaires on issues related to fear of occupationally acquired TB, infection control, TB knowledge and workplace TB stigma. The data were analysed using descriptive statistics as well as binomial logistic regression. RESULTS: Most of the HCWs (67.2%) were concerned about contracting TB at work. Support staff were less likely to worry about acquiring TB than clinical staff (OR = 0.657, P = 0.041). Respondents who indicated that there were inadequate numbers of disposable respirators at work, were 1.6 times more likely to be afraid of contracting TB at work (P = 0.040). With every unit increase on the TB stigma scale, respondents were 1.1 times more likely to fear acquiring TB at work (P = 0.000). CONCLUSIONS: Being a professional clinical HCW, not having adequate disposable respirators available and seeing/perceiving co-workers stigmatise colleagues with (presumptive) TB were all significantly associated with the fear of occupationally-acquired TB. It is recommended that campaigns to destigmatise TB, as well as appropriate TB infection control education and measures, are necessary to alleviate HCWs fears of acquiring the disease in the workplace. Ultimately this should create a health-enabling working environment, where HCWs are not afraid to function and are free to seek treatment and support when necessary.


Assuntos
Pessoal de Saúde/psicologia , Exposição Ocupacional , Estigma Social , Tuberculose/psicologia , Tuberculose/transmissão , Adulto , Feminino , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Recursos Humanos em Hospital/psicologia , África do Sul , Inquéritos e Questionários , Tuberculose/prevenção & controle , Local de Trabalho
14.
J Forensic Leg Med ; 64: 42-44, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30974385

RESUMO

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB) that is most often transmitted by the inhalation of bacteria-containing aerosols. While there has been a decline in numbers of cases in certain countries, large population movements, the increasing emergence of drug-resistant strains and the association with human immunodeficiency virus (HIV) infection make it a disease that is increasingly seen in forensic practice. Mortuary staff are at risk of infection from penetrating sharp injuries, droplet inhalation, ingestion, direct inoculation, through skin breaks or through mucous membranes of the eyes, nose and mouth. While the health and safety measures outlined by agencies may vary slightly, the principles of handling infectious autopsy cases remain the same with awareness and education, immunisation and regular tuberculin testing of staff, pre-necropsy screening of decedents, use of personal protective equipment, and the implementation of safe sharps practices and measures to reduce aerosol formation.


Assuntos
Controle de Infecções/organização & administração , Práticas Mortuárias , Tuberculose/prevenção & controle , Tuberculose/transmissão , Vacina BCG , Humanos , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Doenças Profissionais/prevenção & controle , Roupa de Proteção , Dispositivos de Proteção Respiratória
15.
BMC Infect Dis ; 19(1): 346, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023260

RESUMO

BACKGROUND: Mozambican healthcare workers have high rates of latent and active tuberculosis, but occupational screening for tuberculosis is not routine in this setting. Furthermore, the specificity of tuberculin skin testing in this population compared with interferon gamma release assay testing has not been established. METHODS: This study was conducted among healthcare workers at Maputo Central Hospital, a public teaching quaternary care hospital in Mozambique. With a cross sectional study design, risk factors for tuberculosis were assessed using multivariable logistic regression. The care cascade is reported for participants who were prescribed six months of isoniazid preventive therapy for HIV or highly reactive testing for latent tuberculosis infection. The agreement of interferon-gamma release assay results with positive tuberculin skin testing was calculated. RESULTS: Of 690 screened healthcare workers, three (0.4%) had active tuberculosis and 426 (61.7%) had latent tuberculosis infection. Less education, age 35-49, longer hospital service, and work in the surgery department were associated with increased likelihood of being tuberculosis infected at baseline (p < 0.05). Sex, Bacillus Calmette-Guerin vaccination, HIV, outside tuberculosis contacts, and professional category were not. Three new cases of active tuberculosis developed during the follow-up period, two while on preventive therapy. Among 333 participants offered isoniazid preventive therapy, five stopped due to gastrointestinal side effects and 181 completed treatment. For HIV seropositive individuals, the agreement of interferon gamma release assay positivity with positive tuberculin skin testing was 50% among those with a quantitative skin test result of 5-10 mm, and among those with a skin test result ≥10 mm it was 87.5%. For HIV seronegative individuals, the agreement of interferon gamma release assay positivity with a tuberculin skin test result of 10-14 mm was 63.6%, and for those with a quantitative skin test result ≥15 mm it was 82.2%. CONCLUSIONS: There is a high prevalence of tuberculosis infected healthcare workers at Maputo Central Hospital. The surgery department was most heavily affected, suggesting occupational risk. Isoniazid preventive therapy initiation was high and just over half completed therapy. An interferon gamma release assay was useful to discern LTBI from false positives among those with lower quantitative tuberculin skin test results.


Assuntos
Pessoal de Saúde/estatística & dados numéricos , Tuberculose , Antituberculosos/uso terapêutico , Estudos Transversais , Hospitais , Humanos , Incidência , Moçambique/epidemiologia , Fatores de Risco , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
16.
Math Biosci Eng ; 16(3): 1150-1170, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30947413

RESUMO

A new tuberculosis model with fast and slow progression and media coverage is formulated and analyzed. The basic reproductive number R0 is derived, and the existence and stability of all the equilibria are discussed. The occurrences of forward and backward bifurcation are obtained by using center manifold theory. Numerical simulations are also given to support our theoretical results. Sensitivity analysis on a few parameters is also carried out. Our results show that media coverage can encourage people to take measures to avoid potential infections and control the spread of tuberculosis.


Assuntos
Controle de Doenças Transmissíveis , Meios de Comunicação de Massa , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Algoritmos , Número Básico de Reprodução , Comunicação , Simulação por Computador , Progressão da Doença , Intervalo Livre de Doença , Humanos , Modelos Biológicos , Sensibilidade e Especificidade , Software , Tuberculose/transmissão
17.
MMWR Morb Mortal Wkly Rep ; 68(11): 257, 2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30897076

RESUMO

World TB Day is observed each year on March 24. This observance provides an opportunity to raise awareness about tuberculosis (TB) and the measures needed to find, treat, and prevent this devastating disease.


Assuntos
Saúde Global/estatística & dados numéricos , Tuberculose/prevenção & controle , Aniversários e Eventos Especiais , Humanos , Tuberculose/epidemiologia , Estados Unidos/epidemiologia
18.
MMWR Morb Mortal Wkly Rep ; 68(11): 263-266, 2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30897077

RESUMO

Worldwide, tuberculosis (TB) is the leading cause of death from a single infectious disease agent (1) and the leading cause of death among persons living with human immunodeficiency virus (HIV) infection, accounting for approximately 40% of deaths in this population (2). The United Nations' (UN) Sustainable Development Goals (3) and the World Health Organization's (WHO's) End TB Strategy (4) have defined ambitious targets for 2020-2035, including a 35% reduction in the absolute number of TB deaths and a 20% reduction in TB incidence by 2020, compared with 2015 (4). Since 2000, WHO has produced annual TB estimates for all countries (1). Global and regional disease estimates were evaluated for 2017 to determine progress toward meeting targets. In 2017, an estimated 10 million incident cases of TB and 1.57 million TB deaths occurred, representing 1.8% and 3.9% declines, respectively, from 2016. Numbers of TB cases and disease incidence were highest in the WHO South-East Asia and Africa regions, and 9% of cases occurred among persons with HIV infection. Rifampicin-resistant (RR) or multidrug-resistant (MDR) (resistance to at least both isoniazid and rifampicin) TB occurred among 3.6% and 18% of new and previously treated TB cases, respectively (5.6% among all cases). Overall progress in global TB elimination was modest in 2017, consistent with that in recent years (1); intensified efforts to improve TB diagnosis, treatment, and prevention are required to meet global targets for 2020-2035.


Assuntos
Saúde Global/estatística & dados numéricos , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Metas , Humanos
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