scholarly journals Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives

2018 ◽  
Vol 52 (1) ◽  
pp. 1800591 ◽  
Author(s):  
Claudia C. Dobler ◽  
Greg J. Fox ◽  
Paul Douglas ◽  
Kerri A. Viney ◽  
Faiz Ahmad Khan ◽  
...  
Keyword(s):  
Foreign Born ◽  
Screening Practices ◽  
Migrant Populations ◽  
Long Duration ◽  
Increased Risk ◽  
High Incidence ◽  
Latent Tb ◽  
Low Incidence ◽  
Latent Tb Infection

In most settings with a low incidence of tuberculosis (TB), foreign-born people make up the majority of TB cases, but the distribution of the TB risk among different migrant populations is often poorly quantified. In addition, screening practices for TB disease and latent TB infection (LTBI) vary widely. Addressing the risk of TB in international migrants is an essential component of TB prevention and care efforts in low-incidence countries, and strategies to systematically screen for, diagnose, treat and prevent TB among this group contribute to national and global TB elimination goals.This review provides an overview and critical assessment of TB screening practices that are focused on migrants and visitors from high to low TB incidence countries, including pre-migration screening and post-migration follow-up of those deemed to be at an increased risk of developing TB. We focus mainly on migrants who enter the destination countryviaapplication for a long-stay visa, as well as asylum seekers and refugees, but briefly consider issues related to short-term visitors and those with long-duration multiple-entry visas. Issues related to the screening of children and screening for LTBI are also explored.

scholarly journals Estimating the prevalence of latent tuberculosis in a low-incidence setting: Australia

2018 ◽  
Vol 52 (6) ◽  
pp. 1801218 ◽  
Author(s):  
Katie Dorothy Dale ◽  
James McCracken Trauer ◽  
Pete J. Dodd ◽  
Rein M.G.J. Houben ◽  
Justin Timothy Denholm
Keyword(s):  
Census Data ◽  
Health Planning ◽  
Latent Tuberculosis ◽  
Absolute Number ◽  
Migrant Populations ◽  
High Incidence ◽  
Ltbi Prevalence ◽  
Australian Census ◽  
Latent Tb ◽  
Low Incidence

Migration is a key driver of tuberculosis (TB) in many low-incidence settings, with the majority of TB cases attributed to reactivation of latent TB (LTBI) acquired overseas. A greater understanding of LTBI risk in heterogeneous migrant populations would aid health planning. We aimed to estimate the LTBI prevalence and distribution among locally born and overseas-born Australians.Annual risks of TB infection estimates were applied to population cohorts (by country of birth, year of arrival and age) in Australian census data in 2006, 2011 and 2016.Both the absolute number and proportion of Australian residents with LTBI increased from 4.6% (interquartile range (IQR) 4.2–5.2%) in 2006 to 5.1% (IQR 4.7–5.5%) in 2016, due to the increasing proportion of the population born overseas (23.8% in 2006 to 28.3% in 2016). Of all residents estimated to have LTBI in 2016; 93.2% were overseas born, 21.6% were aged <35 years and 34.4% had migrated to Australia since 2007.The overall prevalence of LTBI in Australia is low. Some residents, particularly migrants from high-incidence settings, may have considerably higher risk of LTBI, and these findings allow for tailored public health interventions to reduce the risk and impact of future TB disease.

scholarly journals Universal screening for latent and active tuberculosis (TB) in asylum seeking children, Bochum and Hamburg, Germany, September 2015 to November 2016

2018 ◽  
Vol 23 (12) ◽  
Author(s):  
Maya Mueller-Hermelink ◽  
Robin Kobbe ◽  
Benedikt Methling ◽  
Cornelius Rau ◽  
Ulf Schulze-Sturm ◽  
...  
Keyword(s):  
Travel Time ◽  
Interferon Gamma Release Assay ◽  
Foreign Born ◽  
Screening Strategies ◽  
Ltbi Prevalence ◽  
Risk Of Progression ◽  
Release Assay ◽  
Latent Tb ◽  
Low Incidence ◽  
Latent Tb Infection

Background In Germany, the incidence of tuberculosis (TB) in children has been on the rise since 2009. High numbers of foreign-born asylum seekers have contributed considerably to the disease burden. Therefore, effective screening strategies for latent TB infection (LTBI) and active TB in asylum seeking children are needed. Aim: Our aim was to investigate the prevalence of LTBI and active TB in asylum seeking children up to 15 years of age in two geographic regions in Germany. Methods: Screening for TB was performed in children in asylum seeker reception centres by tuberculin skin test (TST) or interferon gamma release assay (IGRA). Children with positive results were evaluated for active TB. Additionally, country of origin, sex, travel time, TB symptoms, TB contact and Bacille Calmette-Guérin (BCG) vaccination status were registered. Results: Of 968 screened children 66 (6.8%) had TB infection (58 LTBI, 8 active TB). LTBI prevalence was similar in children from high (Afghanistan) and low (Syria) incidence countries (8.7% vs 6.4%). There were no differences regarding sex, age or travel time between infected and non-infected children. Children under the age of 6 years were at higher risk of progression to active TB (19% vs 2% respectively, p=0,07). Most children (7/8) with active TB were asymptomatic at the time of diagnosis. None of the children had been knowingly exposed to TB. Conclusions: Asylum seeking children from high and low incidence countries are both at risk of developing LTBI or active TB. Universal TB screening for all asylum seeking children should be considered.

Respiratory Complications in Outpatient Endoscopy with Endoscopist-Directed Sedation

2014 ◽  
Vol 23 (3) ◽  
pp. 255-259 ◽  
Author(s):  
Kilian Friedrich ◽  
Sabine G. Scholl ◽  
Sebastian Beck ◽  
Daniel Gotthardt ◽  
Wolfgang Stremmel ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Respiratory Infection ◽  
Endoscopic Procedure ◽  
Shortness Of Breath ◽  
Respiratory Complications ◽  
Endoscopic Procedures ◽  
Increased Risk ◽  
High Incidence ◽  
Respiratory Complaints

Background & Aims: Respiratory complications represent an important adverse event of endoscopic procedures. We screened for respiratory complications after endoscopic procedures using a questionnaire and followed-up patients suggestive of respiratory infection.Method: In this prospective observational, multicenter study performed in Outpatient practices of gastroenterology we investigated 15,690 patients by questionnaires administered 24 hours after the endoscopic procedure.Results: 832 of the 15,690 patients stated at least one respiratory symptom after the endoscopic procedure: 829 patients reported coughing (5.28%), 23 fever (0.15%) and 116 shortness of breath (SOB, 0.74%); 130 of the 832 patients showed at least two concomitant respiratory symptoms (107 coughing + SOB, 17 coughing + fever, 6 coughing + coexisting fever + SOB) and 126 patients were followed-up to assess their respiratory complaints. Twenty-nine patients (follow-up: 22.31%, whole sample: 0.18%) reported signs of clinically evident respiratory infection and 15 patients (follow-up: 11.54%; whole sample: 0.1%) received therefore antibiotic treatment. Coughing or vomiting during the endoscopic procedure resulted in a 156.12-fold increased risk of respiratory complications (95% CI: 67.44 - 361.40) and 520.87-fold increased risk of requiring antibiotic treatment (95% CI: 178.01 - 1524.05). All patients of the follow-up sample who coughed or vomited during endoscopy developed clinically evident signs of respiratory infection and required antibiotic treatment while this occurred in a significantly lower proportion of patients without these symptoms (17.1% and 5.1%, respectively).Conclusions: We demonstrated that respiratory complications following endoscopic sedation are of comparably high incidence and we identified major predictors of aspiration pneumonia which could influence future surveillance strategies after endoscopic procedures.

Recurrence of First Afebrile Unprovoked Seizure and Parental Consanguinity: A Hospital-Based Study

2020 ◽  
Vol 35 (10) ◽  
pp. 643-648
Author(s):  
Miral A. Al Momani ◽  
Basima Almomani ◽  
Salar Bani Hani ◽  
Andrew Lux
Keyword(s):  
University Hospital ◽  
Unprovoked Seizure ◽  
Recurrent Attack ◽  
Parental Consanguinity ◽  
Pediatric Clinic ◽  
Increased Risk ◽  
High Incidence ◽  
History Of

Purpose: The aim of the current study was to determine the incidence, clinical characteristics, and risk factors associated with the recurrence of first unprovoked seizure in children. Methods: A retrospective, observational study was conducted at King Abdullah University Hospital in Jordan. Children aged from 1 month to 16 years old who attended the hospital between January 2013 to December 2017 were evaluated on the basis of medical records, from the first visit and for a 1-year follow-up period. Results: During the study period, a total of 290 cases with first unprovoked seizure were included. The incidence of first unprovoked seizure was 441 cases per 100 000 patient visits to the pediatric clinic. More than half of the cases developed a second attack (55.3%). Children with parental consanguinity were almost 3 times more likely to develop a second attack of seizure compared to those without parental consanguinity (odds ratio [OR] = 2.785, 95% confidence interval [CI] = 1.216-6.378, P = .015) and patients who had a history of focal type of seizure were almost twice as likely to develop seizure recurrence (OR = 1.798, 95% CI = 1.013-3.193, P = .045). Conclusions: The current results showed a high incidence of first unprovoked seizure among children in Jordan. Parental consanguinity and focal seizure were associated with the increased risk of recurrent attack. This finding highlights the need for public education regarding the outcomes of parental consanguinity to improve the patient’s quality of life.

scholarly journals Antirelapse effect of pretransplant exposure to rabbit antithymocyte globulin

2019 ◽  
Vol 3 (9) ◽  
pp. 1394-1405 ◽  
Author(s):  
Rosy Dabas ◽  
Kareem Jamani ◽  
Shahbal B. Kangarloo ◽  
Poonam Dharmani-Khan ◽  
Tyler S. Williamson ◽  
...  
Keyword(s):  
T Cells ◽  
Antithymocyte Globulin ◽  
Hematopoietic Cell Transplantation ◽  
Mononuclear Cells ◽  
Negative Impact ◽  
Area Under The Curve ◽  
Increased Risk ◽  
High Incidence ◽  
Rabbit Antithymocyte Globulin ◽  
Low Incidence

AbstractIt remains unknown why rabbit antithymocyte globulin (ATG; Thymoglobulin) has not affected relapse after hematopoietic cell transplantation (HCT) in randomized studies. We hypothesized that high pre-HCT ATG area under the curve (AUC) would be associated with a low incidence of relapse, whereas high post-HCT AUC would be associated with a high incidence of relapse. We measured serum levels of ATG capable of binding to mononuclear cells (MNCs), lymphocytes, T cells, CD4 T cells, or CD33 cells. We estimated pre- and post-HCT AUCs in 152 adult recipients of myeloablative conditioning and blood stem cells. High pre-HCT AUCs of MNC- and CD33 cell–binding ATG were associated with a low incidence of relapse and high relapse-free survival (RFS). There was a trend toward an association of high post-HCT AUC of lymphocyte-binding ATG with a high incidence of relapse and low RFS. High pre-HCT AUCs were also associated with faster engraftment and had no impact on graft-versus-host disease (GVHD) or fatal infections. High post-HCT AUCs were associated with a low risk of GVHD, seemed associated with an increased risk of fatal infections, and had no impact on engraftment. In conclusion, pre-HCT AUC seems to have a positive, whereas post-HCT AUC seems to have a negative, impact on relapse.

Monitoring of Kindreds With Hereditary Predisposition for Cutaneous Melanoma and Dysplastic Nevus Syndrome: Results of a Swedish Preventive Program

2007 ◽  
Vol 25 (19) ◽  
pp. 2819-2824 ◽  
Author(s):  
Johan Hansson ◽  
Mia Bergenmar ◽  
Per-Åke Hofer ◽  
Göran Lundell ◽  
Eva Månsson-Brahme ◽  
...  
Keyword(s):  
Cutaneous Melanoma ◽  
Skin Lesions ◽  
Preventive Program ◽  
Swedish Population ◽  
Dysplastic Nevus ◽  
Dysplastic Nevus Syndrome ◽  
Increased Risk ◽  
Low Incidence ◽  
Vertical Growth Phase

Purpose To evaluate a program initiated in 1987 by the Swedish Melanoma Study Group aiming to provide preventive surveillance to kindreds with hereditary cutaneous melanoma and dysplastic nevus syndrome. Patients and Methods Overall, 2,080 individuals belonging to 280 melanoma families were followed for 14 years between 1987 and 2001 at 12 participating centers. Data were registered in a central database. Results Among 1,912 skin lesions excised during follow-up, 41 melanomas were removed in 32 individuals. Of these, 15 (37%) were in situ melanomas and 26 (63%) invasive melanomas. The median tumor thickness of invasive melanomas was 0.5 mm. Ulceration was absent in 24 of 26 invasive melanomas (92%) and 12 (46%) lacked vertical growth phase. Compared with melanomas in the general Swedish population, the melanomas identified in these kindreds during follow-up had better prognostic characteristics. All melanomas except one were diagnosed in families with two or more first-degree relatives with melanoma. Diagnosis of melanoma occurred in three of eight kindreds with germline CDKN2A mutations, supporting that families with such mutations are at increased risk for melanoma development. Of the 32 individuals who developed melanoma during follow-up, 21 (66%) had had at least one previously diagnosed melanoma. Conclusion This study shows that a coordinated program aimed at detecting and offering skin surveillance in kindreds with hereditary cutaneous melanoma results in a low incidence of melanomas during the follow-up period and that the tumors that do arise have favorable prognostic characteristics.

scholarly journals Diabetes mellitus is associated with increased prevalence of latent tuberculosis infection: Results from the National Health and Nutrition Examination Survey

2017 ◽  
Author(s):  
Marissa M. Barron ◽  
Kate M. Shaw ◽  
Kai McKeever Bullard ◽  
Mohammed K. Ali ◽  
Matthew J. Magee
Keyword(s):  
Survey Data ◽  
National Health ◽  
Smoking Status ◽  
The United States ◽  
Nutrition Examination Survey ◽  
Foreign Born ◽  
Health And Nutrition ◽  
Diabetes Status ◽  
Latent Tb ◽  
Latent Tb Infection

ABSTRACTAimsWe aimed to determine the association between prediabetes and diabetes with latent TB using National Health and Nutrition Examination Survey data.MethodsWe performed a cross-sectional analysis of 2011-2012 National Health and Nutrition Examination Survey data. Participants ≥20 years were eligible. Diabetes was defined by glycated hemoglobin (HbA1c) as no diabetes (≤5.6% [38 mmol/mol]), prediabetes (5.7-6.4% [3946mmol/mol]), and diabetes (≥6.5% [48 mmol/mol]) combined with self-reported diabetes. Latent TB infection was defined by the QuantiFERON®-TB Gold In Tube (QFT-GIT) test. Adjusted odds ratios (aOR) of latent TB infection by diabetes status were calculated using logistic regression and accounted for the stratified probability sample.ResultsDiabetes and QFT-GIT measurements were available for 4,958 (89.2%) included participants. Prevalence of diabetes was 11.4% (95%CI 9.8-13.0%) and 22.1% (95%CI 20.523.8%) had prediabetes. Prevalence of latent TB infection was 5.9% (95%CI 4.9-7.0%). After adjusting for age, sex, smoking status, history of active TB, and foreign born status, the odds of latent TB infection were greater among adults with diabetes (aOR 1.90, 95%CI 1.15-3.14) compared to those without diabetes. The odds of latent TB in adults with prediabetes (aOR 1.15, 95%CI 0.90-1.47) was similar to those without diabetes.ConclusionsDiabetes is associated with latent TB infection among adults in the United States, even after adjusting for confounding factors. Given diabetes increases the risk of active TB, patients with co-prevalent diabetes and latent TB may be targeted for latent TB treatment.

scholarly journals Effects of Programmatic Interventions to Improve the Management of Latent Tuberculosis: A Follow Up Study Up to Five Months After Implementation.

2020 ◽  
Author(s):  
Mercedes Yanes-Lane ◽  
Anete Trajman ◽  
Mayara Lisboa Bastos ◽  
Olivia Oxlade ◽  
Chantal Valiquette ◽  
...  
Keyword(s):  
Health Care Workers ◽  
Intervention Trial ◽  
Household Contacts ◽  
Follow Up Study ◽  
Infection Treatment ◽  
Care Workers ◽  
Cascade Of Care ◽  
Latent Tb ◽  
Latent Tb Infection

Abstract BACKGROUND: Less than 19% of those needing tuberculosis (TB) preventive treatment complete it, due to losses in several steps of the cascade of care for latent TB infection. A cluster randomized trial of a programmatic public health intervention to improve management of latent TB infection in household contacts was conducted in Rio de Janeiro. Interventions included contact registry, initial and in-service training, and a TB booklet. We conducted a follow-up study starting one month after the conclusion of this trial, to measure the effect of interventions implemented, and to identify remaining barriers and facilitators to latent TB infection treatment, from different perspectives.METHODS: In two health clinics in Rio de Janeiro, that received the interventions in the intervention trial, data for the latent TB infection cascade of care for household contacts was collected over a five-month period. The number of household contacts initiating treatment per 100 TB index-patients was compared with cascade data obtained before and during the intervention trial. Semi-structured open-ended questionnaires were administered to healthcare workers, household contacts and TB index-patients regarding knowledge and perceptions about TB and study interventions. RESULTS: In this follow-up study, 184 household contacts per 100 TB index-patients were identified which was 65 fewer per 100 TB index-patients, (95% CI -115, -15) but the number of household contacts starting latent TB infection treatment was sustained (difference 2, 95% CI -8,5). A total of 31 TB index-patients, 22 household contacts and 19 health care workers were interviewed. Among TB index-patients, 61% said all their household contacts had been tested for latent TB infection. All health care workers said it was very important to test household contacts, and 95% mentioned that possessing correct knowledge on the benefits of latent TB infection treatment was the main facilitator to enable them to recommend this treatment.CONCLUSION: In this follow-up study, we observed a persistent effect of interventions to strengthen the latent TB infection cascade of care, on increasing the number of household contacts starting latent TB infection treatment.

scholarly journals Risk Factors for Tuberculosis and Effect of Preventive Therapy Among Close Contacts of Persons With Infectious Tuberculosis

2019 ◽  
Vol 70 (8) ◽  
pp. 1562-1572 ◽  
Author(s):  
Mary R Reichler ◽  
Awal Khan ◽  
Timothy R Sterling ◽  
Hui Zhao ◽  
Bin Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skin Test ◽  
Index Patient ◽  
Preventive Therapy ◽  
Patient Contact ◽  
Foreign Born ◽  
Ltbi Treatment ◽  
Increased Risk ◽  
Latent Tb Infection ◽  
Close Contacts

Abstract Background Close contacts of persons with pulmonary tuberculosis (TB) have high rates of TB disease. Methods We prospectively enrolled TB patients and their close contacts at 9 US/Canadian sites. TB patients and contacts were interviewed to identify index patient, contact, and exposure risk factors for TB. Contacts were evaluated for latent TB infection (LTBI) and TB, and the effectiveness of LTBI treatment for preventing contact TB was examined. Results Among 4490 close contacts, multivariable risk factors for TB were age ≤5 years, US/Canadian birth, human immunodeficiency virus infection, skin test induration ≥10 mm, shared bedroom with an index patient, exposure to more than 1 index patient, and index patient weight loss (P &lt; .05 for each). Of 1406 skin test–positive contacts, TB developed in 49 (9.8%) of 446 who did not initiate treatment, 8 (1.8%) of 443 who received partial treatment, and 1 (0.2%) of 517 who completed treatment (1951, 290, and 31 cases/100 000 person-years, respectively; P &lt; .001). TB was diagnosed in 4.2% of US/Canadian-born compared with 2.3% of foreign-born contacts (P = .002), and TB rates for US/Canadian-born and foreign-born contacts who did not initiate treatment were 3592 and 811 per 100 000 person-years, respectively (P &lt; .001). Conclusions Treatment for LTBI was highly effective in preventing TB among close contacts of infectious TB patients. Several index patient, contact, and exposure characteristics associated with increased risk of contact TB were identified. These findings help inform contact investigation, LTBI treatment, and other public health prevention efforts.

Sign in / Sign up

Export Citation Format

Share Document