Seasonal dynamics of tuberculosis epidemics and implications for multidrug-resistant infection risk assessment

2013 ◽  
Vol 142 (2) ◽  
pp. 358-370 ◽  
Author(s):  
Y.-J. LIN ◽  
C.-M. LIAO
Keyword(s):  
Seasonal Dynamics ◽  
Multidrug Resistant ◽  
Infection Risk ◽  
Assessment Model ◽  
Relative Fitness ◽  
Tropical Regions ◽  
Resistant Infection ◽  
Control Programmes ◽  
Mdr Tb ◽  
The Impact

SUMMARYUnderstanding how seasonality shapes the dynamics of tuberculosis (TB) is essential in determining risks of transmission and drug resistance in (sub)tropical regions. We developed a relative fitness-based multidrug-resistant (MDR) TB model incorporated with seasonality and a probabilistic assessment model to assess infection risk in Taiwan regions. The model accurately captures the seasonal transmission and population dynamics of TB incidence during 2006–2008 and MDR TB in high TB burden areas during 2006–2010 in Taiwan. There is ∼3% probability of having exceeded 50% of the population infected attributed to MDR TB. Our model not only provides insight into the understanding of the interactions between seasonal dynamics of TB and environmental factors but is also capable of predicting the seasonal patterns of TB incidence associated with MDR TB infection risk. A better understanding of the mechanisms of TB seasonality will be critical in predicting the impact of public control programmes.

scholarly journals Epidemiology of HIV-negative Rifampicin Resistance /Multidrug-Resistant Extrapulmonary Tuberculosis: 5 Years-experience From a National Tuberculosis Clinical Research Center in China

2021 ◽  
Author(s):  
Jun Ma ◽  
Lin Fan ◽  
Hongcheng Liu ◽  
Wenting Li ◽  
Wenwen Sun
Keyword(s):  
Early Stage ◽  
Extrapulmonary Tuberculosis ◽  
Multidrug Resistant ◽  
Rifampicin Resistance ◽  
Anatomical Site ◽  
Successful Treatment Outcome ◽  
National Tuberculosis ◽  
Control Programmes ◽  
Mdr Tb ◽  
Positive Rate

Abstract Background: China is a region with a high global burden of Rifampicin Resistance ／Multidrug-Resistant tuberculosis (RR/MDR-TB) and low HIV incidence. Our aim was to assess the epidemiological and clinical characteristics of RR/MDR-extrapulmonary tuberculosis (EPTB) over the past five years in China to inform national TB control programmes.Methods: We investigated the epidemiological and clinical datas of all MDR/RR-EPTB cases in a TB specialized hospitals in China over a five-year period and compared cases with a cohort of MDR/RR-PTB patients over the same period.Results: Of the 1,700 RR/MDR-TB patients enrolled, 17.76% were EPTB. The incidence of RR／MDR-EPTB were increasing.The most common anatomical site was pleura/chest wall (20.20%). Compared with RR／MDR-Pulmonary tuberculosis (PTB），RR/MDR-EPTB were were predominately female (50.66%, P< 0.01) 、more prone to delay (P<0.01) in RR/ MDR-EPTB detection with the median time of 145（14 ,341）days since first visit、more less likely to develop diabetes (22.85 %, P<0.01) 、more likely to be newly diagnosed ( 56.95%, P<0.01) 、lower successful treatment outcome（69.56%，p <0.01）、more dependent on Xpert (93.71%) for resistance detection、lower culture positive rate (56.95% , P< 0.01). RR/ MDR-EPTB also showed a significantly higher rate of pre-XDR/XDR (32.45%, P <0.01) . Conclusion: RR/MDR-EPTB is different from RR-MDR/PTB in both epidemiology and clinical. Clinicians should recommend Xpert in early stage and use fluoroquinolones cautiously in cases suspected TB.

scholarly journals Assessing the impacts of short-course multidrug-resistant tuberculosis treatment in the Southeast Asia Region using a mathematical modeling approach

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248846
Author(s):  
Win Min Han ◽  
Wiriya Mahikul ◽  
Thomas Pouplin ◽  
Saranath Lawpoolsri ◽  
Lisa J. White ◽  
...  
Keyword(s):  
Southeast Asia ◽  
Treatment Initiation ◽  
Multidrug Resistant ◽  
Treatment Regimens ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Short Course ◽  
Mdr Tb ◽  
The Impact

This study aimed to predict the impacts of shorter duration treatment regimens for multidrug-resistant tuberculosis (MDR-TB) on both MDR-TB percentage among new cases and overall MDR-TB cases in the WHO Southeast Asia Region. A deterministic compartmental model was constructed to describe both the transmission of TB and the MDR-TB situation in the Southeast Asia region. The population-level impacts of short-course treatment regimens were compared with the impacts of conventional regimens. Multi-way analysis was used to evaluate the impact by varying programmatic factors (eligibility for short-course MDR-TB treatment, treatment initiation, and drug susceptibility test (DST) coverage). The model predicted that overall TB incidence will be reduced from 246 (95% credible intervals (CrI), 221–275) per 100,000 population in 2020 to 239 (95% CrI, 215–267) per 100,000 population in 2035, with a modest reduction of 2.8% (95% CrI, 2.7%–2.9%). Despite the slight reduction in overall TB infections, the model predicted that the MDR-TB percentage among newly notified TB infections will remain steady, with 2.4% (95% CrI, 2.1–2.9) in 2020 and 2.5% (95% CrI, 2.3–3.1) in 2035, using conventional MDR-TB treatment. With the introduction of short-course regimens to treat MDR-TB, the development of resistance can be slowed by 38.6% (95% confidence intervals (CI), 35.9–41.3) reduction in MDR-TB case number, and 37.6% (95% CI, 34.9–40.3) reduction in MDR-TB percentage among new TB infections over the 30-year period compared with the baseline using the standard treatment regimen. The multi-way analysis showed eligibility for short-course treatment and treatment initiation greatly influenced the impacts of short-course treatment regimens on reductions in MDR-TB cases and percentage resistance among new infections. Policies which promote the expansion of short-course regimens and early MDR-TB treatment initiation should be considered along with other interventions to tackle antimicrobial resistance in the region.

scholarly journals P569 The role of multidrug-resistant infections in IBD patients undergoing surgery

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S480-S480
Author(s):  
F Colombo ◽  
G M B Lamperti ◽  
S Antinori ◽  
M Corbellino ◽  
G Maconi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nutritional Status ◽  
Antibiotic Therapy ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Tertiary Care Centre ◽  
Bowel Diseases ◽  
Resistant Infection ◽  
Few Data ◽  
The Impact

Abstract Background Inflammatory bowel diseases (IBD) patients are particularly vulnerable to an increased incidence of infections, due to both innate characteristics and prolonged pharmacological therapies as steroids, biologics and antibiotics. Very few data are available in the literature about multidrug-resistant (MDR) infections and previous studies have not taken into account the impact of the surgical treatment on infections. We focused on the identification of risk factors for the development of MDR infections in IBD patients undergoing surgical procedures, we investigated the involved microorganisms, and finally, we proceeded to a costs/complications analysis of the treatment. Methods 472 consecutive, unselected IBD patients (285 Crohn’s disease and 187 ulcerative colitis) undergoing surgery from 2016 to 2018 in our Tertiary Care Centre were divided into three groups: MDR infections, antibiotics sensitive infections (no-MDR) and no infections. Results In 37 CD patients nutritional status (p &lt; 0.0008), preoperative biologics (p &lt; 0.008) and antibiotic therapy (p &lt; 0.001), duration of surgical procedure (p &lt; 0.0001) and preoperative hospitalisation length (p &lt; 0.0001) were risks factors for MDR infection development. In 14 UC patients multidrug-resistant infection was related to age at surgery (p &lt; 0.003), disease duration (p &lt; 0.008), inflammatory/nutritional status (p &lt; 0.04), preoperative antibiotic therapy (p &lt; 0.04), and suture leakage (p &lt; 0,01). In the MDR CD group Gram + cocci (54%) were the most implicated pathogens, with a prevalence of 19% of Enterococcus faecium; while in MDR UC patients Gram – bacilli (59%) were the most involved pathogens, with prevalence of Escherichia coli ESBL+ (47%). The antibiotic therapy cost for the CD group was higher in MDR (3249 €) and no-MDR (924 €) groups vs. non-infected patients (41€). In UC we found higher cost only in the MDR group (1408€ vs. 33€). Conclusion Preoperative risk factors involved in the development of MDR infections in IBD patients undergoing surgery were identified. Some factors, such as nutritional status or preoperative antibiotic therapy, were found to be common between CD and UC patients, while some others were found to be specific for UC or CD. Some of these elements appear to be non-modifiable, while some others are part of the multidisciplinary approach, for which further studies are needed to improve the preoperative ‘patient optimisation’ in order to reduce surgical complications.

scholarly journals Impact of multidrug-resistant tuberculosis and its medications on adverse maternal and perinatal outcomes: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e034821 ◽  
Author(s):  
Kefyalew Addis Alene ◽  
Akilew Awoke Adane ◽  
Alemken Jegnie
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Perinatal Outcomes ◽  
Public Health Problem ◽  
Multidrug Resistant ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Impact

IntroductionMultidrug-resistant tuberculosis (MDR-TB) is a common public health problem affecting pregnant women. However, the impact of MDR-TB and its medication on pregnancy and perinatal outcomes has been poorly understood and inconsistently reported. Therefore, using the available literature, we aim to determine whether MDR-TB and its medications during pregnancy impact maternal and perinatal outcomes.Methods and analysisThis systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches will be conducted in PubMed, Scopus and Web of Science on 10 February 2020 for studies that reported adverse maternal and perinatal outcomes due to MDR-TB and/or its medication. The search will be performed without language and time restrictions. Adverse birth outcomes include miscarriage or abortion, stillbirth, preterm birth, low birth weight, small and large for gestational age, and neonatal death. Two independent reviewers will screen search records, extract data and assess the quality of the studies. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the methodological quality of the included studies. In addition to a narrative synthesis, a random-effects meta-analysis will be conducted when sufficient data are available. I2 statistics will be used to assess the heterogeneity between studies.Ethics and disseminationAs it will be a systematic review and meta-analysis based on previously published evidence, there will be no requirement for ethical approval. Findings will be published in a peer-reviewed journal and will be presented at various conferences.

scholarly journals Evolutionary trajectories and transmission dynamics of multidrug-resistant Mycobacterium tuberculosis in Tibet, China

2021 ◽  
Author(s):  
Qi Jiang ◽  
Hai-can Liu ◽  
Qing-yun Liu ◽  
Jody E. Phelan ◽  
Li Shi ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Phylogenetic Trees ◽  
Multidrug Resistant ◽  
Rifampicin Resistance ◽  
Whole Genome Sequencing Data ◽  
High Burden ◽  
Increased Risk ◽  
Mdr Tb ◽  
Resistant Strains ◽  
The Impact

ABSTRACTObjectiveTibet has the highest prevalence of both tuberculosis disease and multidrug-resistant tuberculosis (MDR-TB) in China. The circulated Mycobacterium tuberculosis strains from Tibet were sequenced to investigate the underlying drivers for the high burden of MDR-TB.MethodsUsing whole-genome sequencing data of 576 M. tuberculosis strains isolated from consecutive patients in Tibet, we mapped resistance-conferring mutations onto phylogenetic trees to determine their evolution and spread. The impact of drug resistance on bacterial population growth was assessed with a Bayesian (Skyline Plot) analysis. Multivariable logistic regression was used to identify risk factors for the development of rifampicin resistance.ResultsOf the 576 isolates, 284 (49.3%), 280 (48.6%), and 236 (41.0%) were, respectively, genetically resistant to isoniazid, rifampicin, or both (MDR-TB). Among the isoniazid- and rifampicin-resistant strains, the proportions in phylogenetically-inferred clusters were 77.8% (221/284) and 62.1% (174/280), respectively. Nearly half (47.2%, 134/284) of the isoniazid-resistant strains were in six major clades, which contained between 8 and 58 strains with katG S315T, katG S315N, or fabG1 promoter −15 C>T resistance mutations. These major clades exponentially expanded after emerging with isoniazid resistance and stabilized before evolving into MDR-TB twenty years later. Isoniazid-resistant isolates showed an increased risk of accumulating rifampicin resistance compared to isoniazid-susceptible strains, with an adjusted odds ratio of 3.81 (95% confidence interval 2.47-5.95).ConclusionHistorical expansion of isoniazid-resistant strains and their increased likelihood of acquiring rifampicin resistance both contributed to the high burden of MDR-TB in Tibet, highlighting the need to detect INH-resistant strains promptly and to control their transmission.

scholarly journals The relative fitness of drug-resistant Mycobacterium tuberculosis : a modelling study of household transmission in Peru

2018 ◽  
Vol 15 (143) ◽  
pp. 20180025 ◽  
Author(s):  
Gwenan M. Knight ◽  
Mirko Zimic ◽  
Sebastian Funk ◽  
Robert H. Gilman ◽  
Jon S. Friedland ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Credible Interval ◽  
Relative Fitness ◽  
Drug Resistant ◽  
Household Transmission ◽  
Prevalence Estimates ◽  
Control Programmes ◽  
Mdr Tb ◽  
Large Prospective Cohort Study

The relative fitness of drug-resistant versus susceptible bacteria in an environment dictates resistance prevalence. Estimates for the relative fitness of resistant Mycobacterium tuberculosis ( Mtb ) strains are highly heterogeneous and mostly derived from in vitro experiments. Measuring fitness in the field allows us to determine how the environment influences the spread of resistance. We designed a household structured, stochastic mathematical model to estimate the fitness costs associated with multidrug resistance (MDR) carriage in Mtb in Lima, Peru during 2010–2013. By fitting the model to data from a large prospective cohort study of TB disease in household contacts, we estimated the fitness, relative to susceptible strains with a fitness of 1, of MDR- Mtb to be 0.32 (95% credible interval: 0.15–0.62) or 0.38 (0.24–0.61), if only transmission or progression to disease, respectively, was affected. The relative fitness of MDR- Mtb increased to 0.56 (0.42–0.72) when the fitness cost influenced both transmission and progression to disease equally. We found the average relative fitness of MDR- Mtb circulating within households in Lima, Peru during 2010–2013 to be significantly lower than concurrent susceptible Mtb . If these fitness levels do not change, then existing TB control programmes are likely to keep MDR-TB prevalence at current levels in Lima, Peru.

Nanomedicine as a Newly Emerging Approach Against Multidrug-Resistant Tuberculosis (MDR-TB)

2017 ◽  
pp. 50-73
Author(s):  
Muthupandian Saravanan ◽  
Kebret Duche ◽  
Tsehaye Asmelash ◽  
Araya Gebreyesus ◽  
Anima Nanda ◽  
...  
Keyword(s):  
Large Scale ◽  
Current Knowledge ◽  
Low Cost ◽  
Multidrug Resistant ◽  
Current Treatment ◽  
Diagnostic Assays ◽  
Resistant Tuberculosis ◽  
Mdr Tb ◽  
Potential Applications ◽  
The Impact

Emergence of MDR-TB is highly associated with morbidity and mortality and it needs high concerns about the possibility of a future TB epidemic as limited therapeutic options are available. The current treatment against TB needs daily administration for at least 6 months. That in turn leads to the development and spread of drug-resistant TB. Plenty of work has been done in nanomedicine that provides hope to encounter TB effectively. In the developing world the development of nanoparticle-based aerosol vaccines for tuberculosis has potential applications using on a large scale at relatively low cost, and particularly attractive for use. This book review examines the current TB diagnostic assays and treatment by nanotechnologies and highlight recent advances in Anti-TB Drug (ATD) delivery systems and anti-TB drug encapsulation. It also discusses the impact of the nanoparticles as an emerging treatment against MDR-TB and discusses the current knowledge and potential nanomedicine to improve MDR-TB therapy.

scholarly journals Projecting the impact of variable MDR-TB transmission efficiency on long-term epidemic trends in South Africa and Vietnam

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Phillip P. Salvatore ◽  
Emily A. Kendall ◽  
Dena Seabrook ◽  
Jessie Brown ◽  
George H. Durham ◽  
...  
Keyword(s):  
South Africa ◽  
Population Level ◽  
Multidrug Resistant ◽  
Transmission Efficiency ◽  
Transmission Potential ◽  
Frequency Of Contact ◽  
Mdr Tb ◽  
Relative Transmission ◽  
Lower Transmission ◽  
The Impact

AbstractWhether multidrug-resistant tuberculosis (MDR-TB) is less transmissible than drug-susceptible (DS-)TB on a population level is uncertain. Even in the absence of a genetic fitness cost, the transmission potential of individuals with MDR-TB may vary by infectiousness, frequency of contact, or duration of disease. We used a compartmental model to project the progression of MDR-TB epidemics in South Africa and Vietnam under alternative assumptions about the relative transmission efficiency of MDR-TB. Specifically, we considered three scenarios: consistently lower transmission efficiency for MDR-TB than for DS-TB; equal transmission efficiency; and an initial deficit in the transmission efficiency of MDR-TB that closes over time. We calibrated these scenarios with data from drug resistance surveys and projected epidemic trends to 2040. The incidence of MDR-TB was projected to expand in most scenarios, but the degree of expansion depended greatly on the future transmission efficiency of MDR-TB. For example, by 2040, we projected absolute MDR-TB incidence to account for 5% (IQR: 4–9%) of incident TB in South Africa and 14% (IQR: 9–26%) in Vietnam assuming consistently lower MDR-TB transmission efficiency, versus 15% (IQR: 8–27%)and 41% (IQR: 23–62%), respectively, assuming shrinking transmission efficiency deficits. Given future uncertainty, specific responses to halt MDR-TB transmission should be prioritized.

scholarly journals The relative fitness of drug resistant Mycobacterium tuberculosis: a modelling study of household transmission in Peru

2017 ◽  
Author(s):  
Gwenan M. Knight ◽  
Mirko Zimic ◽  
Sebastian Funk ◽  
Robert H. Gilman ◽  
Jon S. Friedland ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Credible Interval ◽  
Relative Fitness ◽  
Multi Drug Resistance ◽  
Drug Resistant ◽  
Household Transmission ◽  
Control Programmes ◽  
Mdr Tb ◽  
Large Prospective Cohort Study

AbstractThe relative fitness of drug resistant versus susceptible bacteria in an environment dictates resistance prevalence. Estimates for the relative fitness of resistant Mycobacterium tuberculosis (Mtb) strains are highly heterogeneous and mostly derived from in-vitro experiments. Measuring fitness in the field allows us to determine how the environment influences resistance spread.We designed a household structured, stochastic mathematical model to estimate the fitness costs associated with multi-drug resistance (MDR) carriage in Mtb in Lima, Peru between 2010-2013. By fitting the model to data from a large prospective cohort study of TB disease in household contacts we estimated the fitness, relative to susceptible strains with a fitness of 1, of MDR-Mtb to be 0.33 (95% credible interval: 0.17-0.54) or 0.39 (0.26-0.58), if only transmission or progression to disease, respectively, was affected. The relative fitness of MDR-Mtb increased to 0.57 (0.43-0.73) when the fitness cost influenced both transmission and progression to disease equally.We found the average relative fitness of MDR-Mtb circulating within households in Lima, Peru between 2010-2013 to be significantly lower than concurrent susceptible-Mtb. If these fitness levels do not change, then existing TB control programmes are likely to keep MDR-TB prevalence at current levels in Lima, Peru.

scholarly journals Controlling risk of SARS-CoV-2 infection in essential workers of enclosed food manufacturing facilities

2021 ◽  
Author(s):  
Julia Silva Sobolik ◽  
Elizabeth Sajewski ◽  
Lee-Ann Jaykus ◽  
D. Kane Cooper ◽  
Ben A. Lopman ◽  
...  
Keyword(s):  
Risk Reduction ◽  
Close Contact ◽  
Infection Risk ◽  
Assessment Model ◽  
Relative Reduction ◽  
Food Manufacturing ◽  
Surface Disinfection ◽  
Reduction Strategies ◽  
Risk Reduction Strategies ◽  
The Impact

The SARS-CoV-2 global pandemic poses significant health risks to workers who are essential to maintaining the food supply chain. Using a quantitative risk assessment model, this study characterized the impact of risk reduction strategies for controlling SARS-CoV-2 transmission (droplet, aerosol, fomite-mediated) among front-line workers in a representative enclosed food manufacturing facility. We simulated: 1) individual and cumulative SARS-CoV-2 infection risks from close contact (droplet and aerosols at 1-3m), aerosol, and fomite-mediated exposures to a susceptible worker following exposure to an infected worker during an 8h-shift; and 2) the relative reduction in SARS-CoV-2 infection risk attributed to infection control interventions (physical distancing, mask use, ventilation, surface disinfection, hand hygiene). Without mitigation measures, the SARS-CoV-2 infection risk was largest for close contact (droplet and aerosol) at 1m (0.96, 95%CI: 0.67-1.0). In comparison, risk associated with fomite (0.26, 95%CI: 0.10-0.56) or aerosol exposure alone (0.05, 95%CI: 0.01-0.13) at 1m distance was substantially lower (73-95%). At 1m, droplet transmission predominated over aerosol and fomite-mediated transmission, however, this changed by 3m, with aerosols comprising the majority of the exposure dose. Increasing physical distancing reduced risk by 84% (1 to 2m) and 91% (1 to 3m). Universal mask use reduced infection risk by 52-88%, depending on mask type. Increasing ventilation (from 0.1 to 2-8 air changes/hour) resulted in risk reductions of 14-54% (1m) and 55-85% (2m). Combining these strategies, together with handwashing and surface disinfection, resulted in <1% infection risk. Current industry SARS-CoV-2 risk reduction strategies, particularly when bundled, provide significant protection to essential food workers.

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