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1.
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
2.
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
3.
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
4.
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
5.
BMC Health Serv Res ; 19(1): 147, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30841929

RESUMO

BACKGROUND: Many countries are facing overlapping epidemics of tuberculosis (TB) and diabetes mellitus (DM). Diabetes increases the overall risk of developing Tuberculosis (TB) and contributes to adverse treatment outcomes. Active screening for both diseases can reduce TB transmission and prevent the development of complications of DM. We investigated bi-directional TB-DM screening in Karachi, Pakistan, a country that ranks fifth among high TB burden countries, and has the seventh highest country burden for DM. METHODS: Between February to November 2014, community-based screeners identified presumptive TB and DM through verbal screening at private health clinics. Individuals with presumptive TB were referred for a chest X-ray and Xpert MTB/RIF. Presumptive DM cases had random blood glucose (RBS) tested. All individuals with bacteriologically positive TB were referred for diabetes testing (RBS). All pre-diabetics and diabetics were referred for a chest X-ray and Xpert MTB/RIF test. The primary outcomes of this study were uptake of TB and DM testing. RESULTS: A total of 450,385 individuals were screened, of whom 18,109 had presumptive DM and 90,137 had presumptive TB. 14,550 of these individuals were presumptive for both DM and TB. The uptake of DM testing among those with presumptive diabetes was 26.1% while the uptake of TB testing among presumptive TB cases was 5.9%. Despite efforts to promote bi-directional screening of TB and DM, the uptake of TB testing among pre-diabetes and diabetes cases was only 4.7%, while the uptake of DM testing among MTB positive cases was 21.8%. CONCLUSION: While a high yield for TB was identified among pre-diabetics and diabetics along with a high yield of DM among individuals diagnosed with TB, there was a low uptake of TB testing amongst presumptive TB patients who were recorded as pre-diabetic or diabetic. Bi-directional screening for TB and DM which includes the integration of TB diagnostics, DM screening and TB-DM treatment within existing health care programs will need to address the operational challenges identified before implementing this as a strategy in public health programs.


Assuntos
Diabetes Mellitus/diagnóstico , Programas de Rastreamento , Setor Privado , Tuberculose/diagnóstico , Adulto , Idoso , Comorbidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Paquistão/epidemiologia , Setor Privado/economia , Setor Privado/organização & administração , Tuberculose/transmissão , Adulto Jovem
6.
BMC Infect Dis ; 19(1): 244, 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30866840

RESUMO

BACKGROUND: In current epidemiology of tuberculosis (TB), heterogeneity in infectiousness among TB patients is a challenge, which is not well studied. We aimed to quantify this heterogeneity and the presence of "super-spreading" events that can assist in designing optimal public health interventions. METHODS: TB epidemiologic investigation data notified between 1 January 2005 and 31 December 2015 from Victoria, Australia were used to quantify TB patients' heterogeneity in infectiousness and super-spreading events. We fitted a negative binomial offspring distribution (NBD) for the number of secondary infections and secondary active TB disease each TB patient produced. The dispersion parameter, k, of the NBD measures the level of heterogeneity, where low values of k (e.g. k < 1) indicate over-dispersion. Super-spreading was defined as patients causing as many or more secondary infections as the 99th centile of an equivalent homogeneous distribution. Contact infection was determined based on a tuberculin skin test (TST) result of ≥10 mm. A NBD model was fitted to identify index characteristics that were associated with the number of contacts infected and risk ratios (RRs) were used to quantify the strength of this association. RESULTS: There were 4190 (2312 pulmonary and 1878 extrapulmonary) index TB patients and 18,030 contacts. A total of 15,522 contacts were tested with TST, of whom 3213 had a result of ≥10 mm. The dispersion parameter, k for secondary infections was estimated at 0.16 (95%CI 0.14-0.17) and there were 414 (9.9%) super-spreading events. From the 3213 secondary infections, 2415 (75.2%) were due to super-spreading events. There were 226 contacts who developed active TB disease and a higher level of heterogeneity was found for this outcome than for secondary infection, with k estimated at 0.036 (95%CI 0.025-0.046). In regression analyses, we found that infectiousness was greater among index patients found by clinical presentation and those with bacteriological confirmation. CONCLUSION: TB transmission is highly over dispersed and super-spreading events are responsible for a substantial majority of secondary infections. Heterogeneity of transmission and super-spreading are critical issues to consider in the design of interventions and models of TB transmission dynamics.


Assuntos
Mycobacterium tuberculosis , Tuberculose , Busca de Comunicante , Humanos , Estudos Retrospectivos , Tuberculose/epidemiologia , Tuberculose/transmissão , Vitória/epidemiologia
7.
Int J Mycobacteriol ; 8(1): 60-69, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30860181

RESUMO

Background: The transmission of tuberculosis may affect the incidence rate of the disease in Poland. Genetic methods are of assistance in tracing the infection transmission, identifying its sources, determining the risk groups, and focusing on the preventive actions. Objectives: The objectives of this study lie in an assessment of tuberculosis transmission by genetic methods with the assistance of the standard epidemiologic interview. Methods: The genome DNA of 275 Mycobacterium tuberculosis (Mtb) strains from tuberculosis patients, inhabitants of the city of Krakow, was subjected to a genetic analysis via the spoligotyping method and the IS6110-Mtb1-Mtb2 polymerase chain reaction (PCR) method. If the DNA profiles were identical in both of the PCRs, they were considered identical and classified within one molecular family. Results: Among 275 strains, 104 genetic patterns (spoligotypes) were identified. Two hundred and three strains were divided into 66 molecular families (clusters) and analyzed with the IS6110- Mtb1-Mtb2 PCR method. Eighteen clusters were separated. In the Mtb1-Mtb2 clusters, 21 patients were in the risk groups (the homeless, prisoners, and nursing home residents). We did not confirm any direct or temporary contacts between the patients constituting the Mtb1-Mtb2 clusters (apart from the risk groups). However, the patients in these clusters often lived in the same parts of Krakow. Conclusions: The standard epidemiologic interview in tuberculosis patients should be combined with genetic methods. Active transmission of tuberculosis occurs largely among the individuals maintaining probably periodic contacts. The patients who are in the risk groups may play an important role in the transmission of tuberculosis.


Assuntos
Transmissão de Doença Infecciosa , Epidemiologia Molecular , Tipagem Molecular , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/genética , Tuberculose/epidemiologia , Tuberculose/transmissão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Análise por Conglomerados , Busca de Comunicante , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Polônia/epidemiologia , Adulto Jovem
8.
BMC Infect Dis ; 19(1): 154, 2019 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-30760211

RESUMO

BACKGROUND: TB outbreaks in educational institutions can result in significant transmission and pose a considerable threat to TB control. Investigation using traditional microbiological and epidemiological tools can lead to imprecise screening strategies due to difficulties characterising complex transmission networks. Application of whole genome sequencing (WGS) and social network analysis can provide additional information that may facilitate rapid directed public health action. We report the utility of these methods in combination with traditional approaches for the first time to investigate a TB outbreak in an educational setting. METHODS: Latent tuberculosis infection (LTBI) cases were screenees with a positive T-SPOT®.TB test. Active TB cases were defined through laboratory confirmation of M. tuberculosis on culture or through clinical or radiological findings consistent with infection. Epidemiological data were collected from institutional records and screenees. Samples were cultured and analysed using traditional M. tuberculosis typing and WGS. We undertook multivariable multinomial regression and social network analysis to identify exposures associated with case status and risk communities. RESULTS: We identified 189 LTBI cases (13.7% positivity rate) and nine active TB cases from 1377 persons screened. The LTBI positivity rate was 39.1% (99/253) among persons who shared a course with an infectious case (odds ratio 7.3, 95% confidence interval [CI] 5.2 to 10.3). The community structure analysis divided the students into five communities based on connectivity, as opposed to the 11 shared courses. Social network analysis identified that the community including the suspected index case was at significantly elevated risk of active disease (odds ratio 7.5, 95% CI 1.3 to 44.0) and contained eight persons who were lost to follow-up. Five sputum samples underwent WGS, four had zero single nucleotide polymorphism (SNP) differences and one had a single SNP difference. CONCLUSION: This study demonstrates the public health impact an undiagnosed case of active TB disease can have in an educational setting within a low incidence area. Social network analysis and whole genome sequencing provided greater insight to evolution of the transmission network and identification of communities of risk. These tools provide further information over traditional epidemiological and microbiological approaches to direct public health action in this setting.


Assuntos
Mycobacterium tuberculosis/genética , Rede Social , Tuberculose/transmissão , Sequenciamento Completo do Genoma/métodos , Adulto , Estudos de Coortes , Surtos de Doenças , Feminino , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Tuberculose Latente/transmissão , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/patogenicidade , Razão de Chances , Polimorfismo de Nucleotídeo Único , Saúde Pública , Instituições Acadêmicas , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Reino Unido
9.
BMC Public Health ; 19(1): 219, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30791954

RESUMO

BACKGROUND: We used data released by the government to analyze the epidemiological distribution of pulmonary tuberculosis in mainland China from 2004 to 2015, in order to provide a deeper understanding of trends in the epidemiology of pulmonary tuberculosis in China and a theoretical basis to assess the effectiveness of government interventions and develop more targeted prevention and control strategies. METHODS: A discrete dynamic model was designed based on the epidemiological characteristics of pulmonary tuberculosis and fitted to data published by the government to estimate changes in indicators such as adequate contact rate, prevalence of non-treated pulmonary tuberculosis (abbreviated as prevalence), and infection rate. Finally, we performed sensitivity analyses of the effects of parameters on the population infection rate. RESULTS: The epidemiological features of pulmonary tuberculosis in China include a pattern of seasonal fluctuations, with the highest rates of infection in autumn and winter. The adequate contact rate has increased slightly from an average of 0.12/month in 2010 to an average of 0.21/month in 2015. The prevalence in the population has continued to decrease from 3.4% in early 2004 to 1.7% in late 2015. The Mycobacterium tuberculosis (M. tuberculosis) infection rate in the population decreased gradually from 42.3% at the beginning of 2004 to 36.7% at the end of 2015. The actual number of new infections gradually decreased from 1,300,000/year in 2010 to 1,100,000/year in 2015. The actual number of new patients each year has been relatively stable since 2010 and remains at approximately 2,600,000/year. CONCLUSIONS: The population prevalence and the M. tuberculosis infection rate have decreased year by year since 2004, indicating that the tuberculosis epidemic in China has been effectively controlled. However, pulmonary tuberculosis has become increasingly contagious since 2010. China should focus on the prevention and control of pulmonary tuberculosis during autumn and winter.


Assuntos
Epidemias , Estações do Ano , Tuberculose Pulmonar/epidemiologia , China/epidemiologia , Testes Diagnósticos de Rotina , Feminino , Governo , Humanos , Masculino , Modelos Biológicos , Mycobacterium tuberculosis , Prevalência , Tuberculose/epidemiologia , Tuberculose/microbiologia , Tuberculose/transmissão , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/transmissão
10.
Emerg Infect Dis ; 25(3): 507-514, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30789134

RESUMO

Systematic molecular/genomic epidemiology studies for tuberculosis surveillance cannot be implemented in many countries. We selected Panama as a model for an alternative strategy. Mycobacterial interspersed repetitive unit-variable-number tandem-repeat (MIRU-VNTR) analysis revealed a high proportion (50%) of Mycobacterium tuberculosis isolates included in 6 clusters (A-F) in 2 provinces (Panama and Colon). Cluster A corresponded to the Beijing sublineage. Whole-genome sequencing (WGS) differentiated clusters due to active recent transmission, with low single-nucleotide polymorphism-based diversity (cluster C), from clusters involving long-term prevalent strains with higher diversity (clusters A, B). Prospective application in Panama of 3 tailored strain-specific PCRs targeting marker single-nucleotide polymorphisms identified from WGS data revealed that 31.4% of incident cases involved strains A-C and that the Beijing strain was highly represented and restricted mainly to Colon. Rational integration of MIRU-VNTR, WGS, and tailored strain-specific PCRs could be a new model for tuberculosis surveillance in countries without molecular/genomic epidemiology programs.


Assuntos
Modelos Teóricos , Mycobacterium tuberculosis , Tuberculose/epidemiologia , Tuberculose/transmissão , Humanos , Repetições Minissatélites , Epidemiologia Molecular , Tipagem Molecular , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Filogenia , Polimorfismo de Nucleotídeo Único , Vigilância da População , Tuberculose/genética , Tuberculose/microbiologia , Sequenciamento Completo do Genoma
11.
J Hosp Infect ; 102(1): 116-119, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30629999

RESUMO

This paper reports a case of nosocomial transmission of Mycobacterium tuberculosis by brief casual contact. Routine variable number tandem repeat typing in Yamagata Prefecture, Japan found that M. tuberculosis clinical isolates from two patients showed indistinguishable genotypes. The patients had an epidemiological relationship of sharing a waiting room in a hospital on the same day. As comparative genomics detected only two single nucleotide variants between the isolates, it was concluded that recent tuberculosis transmission occurred in the waiting room. These results indicate that the physical separation of infectious tuberculosis patients is an essential control measure for preventing unpredictable nosocomial transmission by casual contact.


Assuntos
Transmissão de Doença Infecciosa , Genômica , Tipagem Molecular , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/transmissão , Idoso de 80 Anos ou mais , Feminino , Genótipo , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Repetições Minissatélites , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/genética , Isolamento de Pacientes , Polimorfismo de Nucleotídeo Único
12.
Mol Biol Evol ; 36(3): 587-603, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30690464

RESUMO

Whole-genome sequencing (WGS) is increasingly used to aid the understanding of pathogen transmission. A first step in analyzing WGS data is usually to define "transmission clusters," sets of cases that are potentially linked by direct transmission. This is often done by including two cases in the same cluster if they are separated by fewer single-nucleotide polymorphisms (SNPs) than a specified threshold. However, there is little agreement as to what an appropriate threshold should be. We propose a probabilistic alternative, suggesting that the key inferential target for transmission clusters is the number of transmissions separating cases. We characterize this by combining the number of SNP differences and the length of time over which those differences have accumulated, using information about case timing, molecular clock, and transmission processes. Our framework has the advantage of allowing for variable mutation rates across the genome and can incorporate other epidemiological data. We use two tuberculosis studies to illustrate the impact of our approach: with British Columbia data by using spatial divisions; with Republic of Moldova data by incorporating antibiotic resistance. Simulation results indicate that our transmission-based method is better in identifying direct transmissions than a SNP threshold, with dissimilarity between clusterings of on average 0.27 bits compared with 0.37 bits for the SNP-threshold method and 0.84 bits for randomly permuted data. These results show that it is likely to outperform the SNP-threshold method where clock rates are variable and sample collection times are spread out. We implement the method in the R package transcluster.


Assuntos
Transmissão de Doença Infecciosa , Mycobacterium tuberculosis/genética , Tuberculose/transmissão , Sequenciamento Completo do Exoma , Surtos de Doenças , Humanos , Polimorfismo de Nucleotídeo Único
13.
BMC Infect Dis ; 19(1): 26, 2019 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-30616539

RESUMO

BACKGROUND: Transmission patterns in high tuberculosis incidence areas in England are poorly understood but need elucidating to focus contact tracing. We study transmission within and between age, ethnic and immigrant groups using molecular data from the high incidence West Midlands region. METHODS: Isolates from culture-confirmed tuberculosis cases during 2007-2011 were typed using 24-locus Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeats (MIRU-VNTR). We estimated the proportion of disease attributable to recent transmission, calculated the proportion of isolates matching those from the two preceding years ("retrospectively clustered"), and identified risk factors for retrospective clustering using multivariate analyses. We calculated the ratio (RCR) between the observed and expected proportion clustered retrospectively within or between age, ethnic and immigrant groups. RESULTS: Of the 2159 available genotypes (79% of culture-confirmed cases), 34% were attributed to recent transmission. The percentage retrospectively clustered decreased from 50 to 24% for 0-14 and ≥ 65 year olds respectively (p = 0.01) and was significantly lower for immigrants than the UK-born. Higher than expected clustering occurred within 15-24 year olds (RCR: 1.4 (95% CI: 1.1-1.8)), several ethnic groups, and between UK-born or long-term immigrants with the UK-born (RCR: 1.8 (95% CI: 1.1-2.4) and 1.6 (95% CI: 1.2-1.9) respectively). CONCLUSIONS: This study is the first to consider "who clusters with whom" in a high incidence area in England, laying the foundation for future whole-genome sequencing work. The higher than expected clustering seen here suggests that preferential mixing between some age, ethnic and immigrant groups occurs; prioritising contact tracing to groups with which cases are most likely to cluster retrospectively could improve TB control.


Assuntos
Mycobacterium tuberculosis/genética , Tuberculose/epidemiologia , Tuberculose/transmissão , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Análise por Conglomerados , Emigrantes e Imigrantes , Inglaterra/epidemiologia , Inglaterra/etnologia , Grupos Étnicos , Feminino , Genótipo , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Repetições Minissatélites , Epidemiologia Molecular , Análise Multivariada , Mycobacterium tuberculosis/isolamento & purificação , Fatores de Risco , Tuberculose/microbiologia
14.
Rev. panam. salud pública ; 43: e16, 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-978883

RESUMO

RESUMO Objetivo Estimar a prevalência de tuberculose entre a população privada de liberdade. Métodos Realizou-se uma revisão sistemática com metanálise. Foram selecionados estudos publicados de janeiro de 1997 a dezembro de 2016 nas bases de dados MEDLINE (via PubMed), SciELO e LILACS. O termos de busca foram ("tuberculosis"[MeSH] OR "tuberculosis"[TIAB]) AND ("prisons"[MeSH] OR "prisons"[TIAB]); ou ("tuberculose" [DeCS] OU "tuberculose" [palavras] E "prisões" [DeCS] OU "prisões" [palavras]). O desfecho primário foi a prevalência de tuberculose com intervalo de confiança de 95% (IC95%). Na metanálise, as variáveis associadas com as taxas de prevalência de tuberculose na população privada de liberdade na análise univariada (P ≤ 0,20) foram incluídas no modelo final multivariado. Resultados Com base nos 29 estudos incluídos na metanálise, 2 163 presos foram identificados com tuberculose. A prevalência combinada de tuberculose entre os prisioneiros foi de 2% (IC95%: 0,02 a 0,02). A prevalência de tuberculose entre prisioneiros em países com prevalência de 0 a 24 por 100 mil habitantes na população geral ficou abaixo de 1% (IC95% = 0,00 a 0,00). Nos países com prevalência de tuberculose de 25 a 99/100 mil, a estimativa foi de 3% (IC95% = 0,02 a 0,04); e nos países com prevalência ≥ 300/100 mil, a estimativa foi de 8% (IC95% = 0,05 a 0,11). Conclusão O presente estudo reafirma a alta magnitude da tuberculose entre a população privada de liberdade no contexto mundial. Os resultados mostram ainda uma ligação entre a prevalência de tuberculose na população geral e a prevalência da doença dentro dos presídios.


ABSTRACT Objective To estimate the prevalence of tuberculosis among incarcerated populations. Method A systematic review with meta-analysis was performed. The MEDLINE/PubMed, SciELO, and LILACS databases were searched for articles published from January 1997 to December 2016. The following search terms were used: ("tuberculosis"[MeSH] OR "tuberculosis"[TIAB]) AND ("prisons"[MeSH] OR "prisons"[TIAB]); or ("tuberculose" [DeCS] OU "tuberculose" [palavras] E "prisões" [DeCS] OU "prisões" [palavras]). The primary outcome was the prevalence of tuberculosis with 95% confidence interval (95%CI). In the metanalysis, variables associated with tuberculosis prevalence in incarcerated populations in the univariate analysis (P ≤ 0,20) were included in the final multivariate model. Results Based on the 29 studies included in the metanalysis, 2,163 prisoners with tuberculosis were identified. The combined prevalence of tuberculosis among prisoners was 2% (95%CI: 0.02-0.02). The prevalence among prisoners from countries with tuberculosis prevalence of 0-24 per 100,000 general population was below 1% (95%CI = 0.00-0.00). In countries with overall tuberculosis prevalence of 25-99/100,000, the estimate among prisoners was 3% (95%CI = 0.02-0.04); and in countries with overall prevalence ≥ 300/100 thousand, the estimated prevalence among prisoners was 8% (95%CI = 0.05-0.11). Conclusion The present results support the notion of a high prevalence of tuberculosis among incarcerated populations worldwide. The results also show a link between the prevalence of tuberculosis in the general and the prevalence of tuberculosis in prisons.


RESUMEN Objetivo Estimar la prevalencia de tuberculosis en la población privada de libertad. Métodos Se realizó una revisión sistemática con metanálisis. Se seleccionaron estudios publicados desde enero de 1997 hasta diciembre del 2016 en las bases de datos MEDLINE/PubMed, SciELO y LILACS. Los términos de búsqueda fueron ("tuberculosis"[MeSH] OR "tuberculosis"[TIAB]) AND ("prisons"[MeSH] OR "prisons"[TIAB]); o ("tuberculose" [DeCS] OU "tuberculose" [palavras] E "prisões" [DeCS] OU "prisões" [palavras]). El resultado principal fue la prevalencia de tuberculosis con un intervalo de confianza de 95% (IC95%). En el metanálisis, las variables asociadas con la prevalencia de la tuberculosis en la población privada de libertad en el análisis univariado (P ≤ 0,20) se incluyeron en el modelo final multivariado. Resultados Con base en los 29 estudios incluidos en el metanálisis, se detectaron 2 163 presos con tuberculosis. La prevalencia combinada de tuberculosis en los presos fue de 2% (IC95%: 0,02-0,02). La prevalencia de tuberculosis en presos de los países con prevalencia de 0 a 24 por 100.000 habitantes en la población general fue inferior a 1% (IC95% = 0,00-0,00). En los países con una prevalencia de tuberculosis de 25 a 99 por 100.000, la estimación fue de 3% (IC95% = 0,02-0,04); y en los países con prevalencia ≥ 300 por 100.000, de 8% (IC95% = 0,05-0,11). Conclusión El presente estudio reafirma la alta prevalencia de la tuberculosis en la población privada de libertad en el contexto mundial. Los resultados muestran además una conexión entre la prevalencia de la tuberculosis en la población general y la observada dentro de los presidios.


Assuntos
Prisões , Tuberculose/transmissão , Prevalência , Metanálise
15.
BMC Health Serv Res ; 18(1): 954, 2018 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-30541533

RESUMO

BACKGROUND: Strategies to identify and treat undiagnosed prevalent cases that have not sought diagnostic services on their own, are necessary to treat TB in patients earlier and interrupt transmission. Late presentation for medical services of symptomatic patients require special efforts to detect early and notify TB in high risk populations. An intervention that combined quality improvement with facility-led active case finding (QI-ACF) was implemented in 10 districts of Northern Uganda with the highest TB burden to improve case notification among populations at highest risk of TB. METHODS: Using QI-ACF intervention approach in 48 facilities, we; 1) targeted key vulnerable populations, 2) engaged district and facility teams in TB systems strengthening, 3) conducted systematic screening and diagnosis in vulnerable groups (people living with HIV, fishing communities, and prisoners), and 4) trained health workers on national x-ray diagnosis guidelines for smear-negative patients. Facility-led QI-ACF meant that health care providers identified the target population, mobilized and massively screened suspects, and addressed gaps in documentation. Chest X-ray diagnosis was promoted for smear-negative TB among those suspects whose sputum examination was negative. The effect of the intervention on case notification was then assessed separately over the post intervention period. RESULTS: Over all TB case notification in the intervention districts increased from 171 to 223 per 100,000 population between the baseline months of October-December 2016 and end line month of April-June 2017. TB patient contacts had the majority of TB positive cases identified during active case finding (40, 6.1%). Fishing communities had the highest TB positivity rate at 6.8%. Prisoners accounted for the lowest number of TB positive cases at 34 (2.3%). CONCLUSION: Targeting should be applied at all levels of TB intervention to improve yield: targeting districts and facilities with the lowest rates of case notification and targeting index patient contacts, HIV clients, and fishing communities. Screening tools are useful to guide health workers to identify presumptive cases. Efforts to improve availability of x-ray for TB diagnosis contributed to almost half of the new cases identified. Having all HIV patients who were eligible for viral load provide sputum for TB screening proved easy to implement.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Notificação de Doenças , Transmissão de Doença Infecciosa/prevenção & controle , Melhoria de Qualidade , Tuberculose/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/virologia , Busca de Comunicante , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/virologia , Pessoal de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Pulmão/diagnóstico por imagem , Programas de Rastreamento , Radiografia Torácica , Escarro/virologia , Tuberculose/epidemiologia , Tuberculose/transmissão , Uganda/epidemiologia , Carga Viral
16.
Artigo em Inglês | MEDLINE | ID: mdl-30544676

RESUMO

The aim of this paper is to evaluate the link between the history of exposure to tuberculosis (TB) in the household and diagnosed TB cases at school, and to compare the detection rate of active TB among household contacts and classroom contacts of adolescent TB cases with the rates among contacts of healthy controls. From November 2016 to December 2017, a prospective matched case-control study was conducted using passively identified index adolescent student cases from the TB surveillance system and healthy controls (matched by county, school type, sex, age and ethnicity). Contacts in households and classrooms of index cases and of controls were investigated. Matched tabulation of 117 case-control pairs revealed exposure to TB in the household as a strong risk factor (odds ratio (OR) = 21.0, 95% confidence interval (CI): 3.4, 868.6). Forty-five (case detection rate 0.69%) and two (case detection rate 0.03%) new active TB cases were detected among 6512 and 6480 classroom contacts of the index cases and controls, respectively. Having an index case in the classroom significantly increased the risk of classmates contracting active TB (OR = 22.5, 95% CI: 5.9, 191.4). Our findings suggested that previous exposure to TB in the household could lead a child to catch TB at school, then spread TB to classmates.


Assuntos
Busca de Comunicante , Tuberculose/transmissão , Adolescente , Estudos de Casos e Controles , Criança , China , Família , Feminino , Humanos , Masculino , Estudos Prospectivos , Instituições Acadêmicas , Estudantes , Adulto Jovem
17.
BMC Infect Dis ; 18(1): 660, 2018 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-30547759

RESUMO

BACKGROUND: Contact tracing for tuberculosis (TB) is a recommended measure to improve the case detection rate; however, actual implementation in Myanmar is limited and low detection rates have been reported. Household contacts of a known index TB case are at high risk of infection, thus a more strategic action for contact tracing is required to achieve the goal of the World Health Organization End TB Strategy. This study aimed to assess TB case detection rates among household contacts by an integrated approach and identify risk factors for TB. METHODS: A cross-sectional study was conducted in Mandalay City, Myanmar. Household contacts of index TB cases who had been receiving treatment for at least 3 months were prospectively investigated by an integrated approach which included modification of screening methods and active facilitation of screening investigations as follows. Initial chest x-ray (CXR) was performed for all contacts at the responsible facilities followed by sputum specimen collection for those aged ≥15 years and gene Xpert MTB/RIF examination. Transportation of all household contacts to health facilities and transportation of sputum samples for smear and gene Xpert MTB/RIF examination at centers were arranged by the research team to ensure that all household contacts received all investigations. Risk factors for TB among household contacts were identified by multiple logistic regression models. RESULTS: Of 174 household contacts, 115 were ≥ 15 years and 59 were < 15 years. The percentage of TB cases detected among the household contacts was 13.8%. There were 14 (12.2%) positive TB cases among the 115 contacts aged ≥15 years while 10 (16.9%) of those aged < 15 years had clinical signs and symptoms of TB with an abnormal CXR. Risk factors among household contacts for TB were being a caretaker of an index case, active and passive smoking, and drinking alcohol. CONCLUSIONS: The integrated approach of TB contact tracing by special arrangement for CXR, sputum and gene Xpert MTB/RIF examination yielded a high TB detection rate in a high TB prevalence area. Logistic and financial administration is needed to strengthen contact tracing. Further research on high-risk household contacts should be considered for increasing TB detection rates.


Assuntos
Características da Família , Tuberculose , Adolescente , Adulto , Criança , Busca de Comunicante , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Tuberculose/transmissão , Adulto Jovem
18.
BMC Infect Dis ; 18(1): 494, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30285633

RESUMO

BACKGROUND: The depletion of CD4 cell is the underlying reason for TB hyper-susceptibility among people with HIV. Consequently, the trend of TB dynamics is usually hidden by the HIV outbreak. METHODS: Here, we aim to evaluate the trend of TB dynamics quantitatively by a simple mathematical model using the known prevalence of hyper-susceptible individuals in the population. In order to estimate the parameters governing transmission we fit this model in a maximum likelihood framework to both reported TB cases and data from samples tested with Interferon Gamma Assay from Ho Chi Minh City - a city with high TB transmission and strong synchronization between HIV/AIDS and TB dynamics. RESULTS: Our results show that TB transmission in HCMC has been declining among people without HIV; we estimate a 18% (95% CI: 9-25%) decline in the transmission parameter between 1996 and 2015. Furthermore, we show that co-infected patients have limited contribution to the transmission process. For hyper-susceptible individuals, our model suggests that the risk of a new active TB infection occurring is significantly higher than the risk of relapsed active TB, while this is not the case for people without hyper-susceptibility. CONCLUSIONS: The increase of TB notifications in Ho Chi Minh City from 1996 to 2008 is evitable when, as occurred, the number of hyper-susceptible individuals increased faster than the decrease of TB transmission rate. The sharp decrease in TB notifications observed in this city from 2008 to 2015 is the combined result of the decrease of TB transmission rate and the decrease of hyper-susceptible individuals in the population. For hyper-susceptible individuals, we propose that the reason for the reduced relapsed active TB risk is HIV treatment delay. According to HIV treatment guidelines issued by Vietnam's Ministry of Health, hyper-susceptible individuals usually have to wait until their CD4 cell count falls under 350 cells/µl to start ART. Once patients begin ART, they will remain on ART for the rest of their life and thus have greater protection against relapses of TB. We therefore hypothesize that the delay in using ART imposes considerable TB burden on HCMC despite the declining transmission process.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Tuberculose/epidemiologia , Contagem de Linfócito CD4 , Cidades/epidemiologia , Coinfecção/epidemiologia , Surtos de Doenças , Infecções por HIV/epidemiologia , Humanos , Modelos Teóricos , Prevalência , Tuberculose/transmissão , Vietnã/epidemiologia
19.
Prev Vet Med ; 158: 1-17, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30220382

RESUMO

Mycobacterium tuberculosis complex is the cause of tuberculosis (TB) in humans and other animals. Specifically, Mycobacterium bovis (M. bovis) and Mycobacterium tuberculosis (M. tuberculosis) are highly pathogenic mycobacteria that may infect different animal species and are the sources of TB in humans. The objective of this paper was to review the epidemiology of M. bovis and M. tuberculosis in animals. The review also highlighted the transmission dynamics of M. bovis and M. tuberculosis in humans and animals and control challenges of zoonotic TB in Ethiopia. The literature review focused on scientific peer-reviewed articles from studies exclusively conducted in Ethiopia that were published from 1998 to 2017. Husbandry system, breed and herd size have significant role in the epidemiology of bovine tuberculosis (BTB) in Ethiopia. The information presented reveals that different strains of M. bovis are widely distributed in domestic animals predominantly in the Ethiopian cattle and the main strain was found to be SB1176. In addition, the isolation of M. tuberculosis from domestic animals in different settings signifies the circulation of the agent between humans and animals in Ethiopia. The life styles of the Ethiopian communities, close contact with domestic animals and/or the habit of consuming raw animal products, are suggested as the main factors for transmission of M. bovis and M. tuberculosis between human and animal which may have impact on the TB control program in human. In Ethiopia, a human TB control program has been widely implemented, however, the role of animal in the transmission of the causative agent has been neglected which could be one of the challenges for an effective control program. This warrants the need for incorporating animal TB control programs using "One Health" approach for effective TB control for both human and animal.


Assuntos
Gado , Mycobacterium bovis/fisiologia , Mycobacterium tuberculosis/fisiologia , Tuberculose/veterinária , Zoonoses/epidemiologia , Animais , Bovinos , Etiópia/epidemiologia , Humanos , Tuberculose/epidemiologia , Tuberculose/transmissão , Tuberculose Bovina/epidemiologia , Tuberculose Bovina/transmissão , Zoonoses/transmissão
20.
Ann Agric Environ Med ; 25(3): 409-410, 2018 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-30260200

RESUMO

Since 2009, Poland has been recognized as a country officially free of bovine tuberculosis (BTB). However, new outbreaks are each year quoted. In many countries it has been shown that badgers (Meles meles) are a vector of Mycobacterium bovis/caprae (M.bovis/caprae) and a source of bovine tuberculosis for many domestical species, mainly for cattle. The aim of the presented study was to determine, for the first time in Poland, the occurrence of tuberculosis in badgers in areas where the disease occurs in cattle. Tissue samples were examined by classical microbiology methods, mycobacteria growth indicator tube (MGIT), and real time PCR. A total of 155 samples from 31 badgers were examined. In any case Mycobacterium bovis/caprae infection has not been diagnosed. This indicates that badgers probably are not a vector of bovine tuberculosis in Poland.


Assuntos
Reservatórios de Doenças/veterinária , Mustelidae/microbiologia , Mycobacterium bovis/fisiologia , Tuberculose/veterinária , Animais , Animais Selvagens/microbiologia , Bovinos , Reservatórios de Doenças/microbiologia , Mycobacterium bovis/genética , Mycobacterium bovis/crescimento & desenvolvimento , Mycobacterium bovis/isolamento & purificação , Polônia/epidemiologia , Tuberculose/microbiologia , Tuberculose/transmissão , Tuberculose Bovina/epidemiologia , Tuberculose Bovina/microbiologia , Tuberculose Bovina/transmissão
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