Towards the elimination of paediatric tuberculosis in high-income, immigrant-receiving countries: a 25-year conventional and molecular epidemiological case study

The epidemiology of tuberculosis (TB) in high-income countries is increasingly dictated by immigration. The influence of this trend on paediatric TB and TB elimination are not well defined.We undertook a 25-year conventional and molecular epidemiologic study of paediatric TB in Alberta, one of four major immigrant-receiving provinces in Canada. All isolates ofMycobacterium tuberculosiswere DNA fingerprinted using standard methodology.Between 1990 and 2014, 176 children aged 0–14 years were diagnosed with TB. Foreign-born children or Canadian-born children of foreign-born parents accounted for an increasingly large proportion of total cases during the study period (from 32.1% to 89.5%). Of the 78 culture-positive cases, 35 (44.9%) had a putative source case identified by conventional epidemiology, with 34 (97.1%) having a concordant molecular profile. Of the remaining 43 culture-positive cases, molecular profiling identified spatially and temporally related sources in six cases (14.0%). These six children, along with four other children whose source cases were discovered through reverse-contact tracing, had a high morbidity and mortality.The increasing burden of paediatric TB in both foreign-born children and Canadian-born children of foreign-born parents calls for more timely diagnosis of source cases and more targeted screening for latent TB infection.

Download Full-text

Local Transmission Plays no Important Role in the Occurrence of MDR-TB In Immigrants to Canada: A Molecular Epidemiologic Study of Clustering and Contact Tracing

The Journal of Infectious Diseases ◽

10.1093/infdis/jiab045 ◽

2021 ◽

Author(s):

Richard Long ◽

Angela Lau ◽

Mary Lou Egedahl ◽

Catherine Paulsen ◽

Courtney Heffernan ◽

...

Keyword(s):

Epidemiologic Study ◽

Multidrug Resistant ◽

Contact Tracing ◽

Resistance Pattern ◽

Country Of Birth ◽

Foreign Born ◽

Drug Resistance Pattern ◽

Mdr Tb ◽

Recent Immigration ◽

Local Transmission

Abstract Background Multidrug-resistant tuberculosis (MDR-TB) is increasing among migrants in Canada. To what extent this increase is attributable to local transmission, recent immigration, or changed proportion of MDR-TB in immigrants’ country of birth, is unknown. Methods We performed a retrospective cohort study in a Canadian province with substantially increased immigration between 1982-2001 and 2002-2019. The proportion of MDR-TB among migrants arriving from high MDR-TB burden (HMDR-TB) countries during these two periods was used to estimate the proportion of cases due to immigration versus change in proportion in country of birth. Epidemiologic, spatio-temporal, and drug resistance pattern data were used to confirm local transmission. Results Fifty-two of 3,514 (1.48%) foreign-born culture-positive TB patients had MDR-TB; 8 (0.6%) in 1982-2001, 44 (2.0%) in 2002-2019. Between time periods, the proportion of MDR-TB among migrants with TB from HMDR-TB countries increased from 1.11% to 3.62%, p=0.003; 31.6% attributable to recent immigration, 68.4% to a higher proportion of MDR-TB in cases arrived from HMDR-TB countries. No cases of MDR-TB were attributable to local transmission. Conclusion In stark contrast to HMDR-TB countries, local transmission plays no important role in the occurrence of MDR-TB in Canada. Overseas investments to improve TB programming in HMDR-TB countries are urgently needed.

Download Full-text

Expected background rates of latent TB infection in London inner city schools: lessons from a TB contact investigation exercise in a secondary school

Epidemiology and Infection ◽

10.1017/s0950268818002327 ◽

2018 ◽

Vol 146 (16) ◽

pp. 2102-2106 ◽

Cited By ~ 1

Author(s):

S. Anaraki ◽

A.J. Bell ◽

S. Perkins ◽

S. Murphy ◽

S. Dart ◽

...

Keyword(s):

Contact Tracing ◽

London Borough ◽

Contact Group ◽

Contact Investigation ◽

High Prevalence ◽

Cohort Study Design ◽

Latent Tb ◽

Group 2 ◽

Latent Tb Infection ◽

Group 1

AbstractFollowing an extensive contact tracing exercise at a school in a London borough with one of highest tuberculosis (TB) rates in England, we estimated the background prevalence of latent TB infection to be significantly less than the widely accepted 10%. We screened 271 pupils aged 14–15 years in two groups: 96 pupils in group 1 had significant exposure (>8 h/week in the same room) to a case of infectious TB and 175 in group 2 who had minimal exposure. In group 1, 26% were diagnosed with latent or active TB, compared to 6.3% in group 2. Risk factors for TB infection (e.g. previous exposure or link to high-prevalence communities) were analysed using a cohort study design. In the univariable analysis only being in contact group 1 was statistically significantly associated with being a case (OR 5.25, 95%, P < 0.001). In the multivariable model contact group 1 remained significantly associated with being a case (adjusted OR 4.40, P = 0.001). We concluded that the 6.3% yield of TB infection in contact group 2 is either similar to or higher than the background prevalence rate of latent TB infection (LTBI) in this high TB prevalence London borough. Other parts of England with lower TB prevalence are likely to have even lower LTBI rates.

Download Full-text

SYSTEMATIC REVIEW OF URINARY TRACT INFECTION CAUSED BY ACINETOBACTER SPECIES AMONG HOSPITALISED PATIENTS

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703693 ◽

2013 ◽

Vol 03 (04) ◽

pp. 007-009

Author(s):

Sanjeev H. ◽

Swathi N. ◽

Asha Pai ◽

Rekha R. ◽

Vimal K. ◽

...

Keyword(s):

Urinary Tract ◽

Hospitalized Patients ◽

High Morbidity ◽

Acinetobacter Species ◽

Strict Adherence ◽

Disseminated Infection ◽

Hospitalised Patients ◽

Hospital Infection Control ◽

Tract Infections ◽

Culture Positive

Abstract Introduction:Acinetobacter species have emerged as important nosocomial pathogens and have been known to cause different kinds of opportunistic infections. Acinetobacter species cause a wide variety of illness in debilitated and hospitalized patients especially in intensive care units (ICU). Because of frequent resistance to aminoglycoside's, fluoroquinolone's, ureidopenicillin's and third generation cephalosporin's, carbapenem are important agents in managing Acinetobacter infections. Material and Methods: A systematic retrospective analysis was performed on culture positive urinary tract infections among hospitalized patients between January 2010-December 2012. Significant isolates of Acinetobacter species were included in the study and was further analyzed for antimicrobial susceptibility, associated risk factors, underlying debility and co-morbid conditions. Results:Among the 2240 culture positive samples, Acinetobacter species was isolated from 46 patients with UTI. Tigecyline was found to be the antibiotic with highest susceptibility (91%) followed by Imipenem(69.5%), Meropenem (67.3%) and Gatilfoxacin (63%). The six patients who expired had disseminated infection with highly resistant strains of Acinetobacter species. Mechanical ventilation was the predominant risk factor for severe and disseminated infection. Conclusion:Acinetobacter infections are associated with high morbidity and mortality. Multidrug resistant Acinetobacter are common in hospitals, especially in ICU's. A feasible hospital antibiotic policy and strict adherence to it, rigorous surveillance and good hospital infection control programme is needed to control the increasing incidence of highly resistant Acinetobacter infections.

Download Full-text

METABOLIC SYNDROME AND LATE-LIFE DEPRESSION AMONG MEXICAN AMERICANS: THE ROLE OF NATIVITY

Innovation in Aging ◽

10.1093/geroni/igz038.1168 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S320-S320

Author(s):

Weihui Zhang

Keyword(s):

Metabolic Syndrome ◽

Sex Education ◽

Psychological Health ◽

Mexican Americans ◽

Random Effect ◽

Epidemiologic Study ◽

Self Report ◽

Foreign Born ◽

Late Life Depression

Abstract Metabolic syndrome (MS) has been reported to predict depression. However, studies evaluating if there are differences by nativity status among Mexican Americans are scarce. This study aims to examine the association between metabolic syndrome and depression among Mexican-American older adults. We also evaluated the role of nativity, sociodemographic and health risk factors. We use three waves (2006-2013) from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE; N=1,542, mean age =83.45 in 2006). MS was defined according to the National Cholesterol Education Programme (NCEP-ATP III) using abdominal obesity, use of antihypertensive medication, and insulin. Depression was ascertained by self-report of a CES-D score greater than 16. We applied random-effect logistic regression models which accounted for inter-individual correlation and adjusted for age, sex, education, smoking, alcohol use, physical performance, and self-esteem. We also tested for interaction between MS and nativity. Approximately 30% of foreign-born and 22% of US-born reported depression. The prevalence of MS was higher in the Foreign-born when compare to the US-born (5.89% vs. 5.35%). In the total sample, MS was associated with a higher risk of depression (OR=4.34, p=0.007). Foreign-born Mexican Americans were more likely to have depression (OR=1.70, p=0.002) when compared to US-born; however, foreign-born with MS reported lower depression (OR=0.26, p=0.052) after adjusting for potential confounders. Our finding adds to the concept of “metabolic depression,” and further highlights the importance of evaluating nativity to explain the differences in physical and psychological health among a sample of the Hispanic population at old age.

Download Full-text

Multidrug-Resistant Tuberculosis in Alberta and British Columbia, 1989 to 1998

Canadian Respiratory Journal ◽

10.1155/1999/456395 ◽

1999 ◽

Vol 6 (2) ◽

pp. 155-160 ◽

Cited By ~ 11

Author(s):

Ahmed Hersi ◽

Kevin Elwood ◽

Robert Cowie ◽

Dennis Kunimoto ◽

Richard Long

Keyword(s):

British Columbia ◽

Multidrug Resistant ◽

Drug Resistant ◽

Foreign Born ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb ◽

Resistant Strains ◽

Drug Resistant Strains ◽

Culture Positive

OBJECTIVE: To describe the extent of the problem of multidrug-resistant tuberculosis (MDR-TB) in Alberta and British Columbia from 1989 to 1998.DESIGN: A retrospective, population-based descriptive study of all notified MDR-TB cases in the context of all notified TB cases, all notified culture-positive TB cases and all notified drug-resistant TB cases.SETTING: Provinces of Alberta and British Columbia, and their TB registries.PATIENTS: All people with TB reported to the TB registries of Alberta and British Columbia between January 1, 1989 and June 30, 1998.MAIN OUTCOME MEASURES: Drug susceptibility testing was performed in all cases of culture-positive TB. Demographic, clinical and laboratory data on all cases of MDR-TB were recorded.RESULTS: Of 4606 notified cases of TB, 3553 (77.1%) were culture positive. Of these, 365 (10.3%) were drug resistant; of the drug-resistant cases, 24 (6.6%) were MDR. Most MDR-TB patients were foreign-born; of the four Canadian-born patients, two were infected while travelling abroad. Although foreign-born patients were significantly more likely to harbour drug-resistant strains, 14.3% versus 4.8%, respectively (P<0.001), among those who were harbouring a drug-resistant strain, the proportion of Canadian-born versus foreign-born patients with an MDR strain was the same (6.7% versus 6.6%, respectively). From 1994 to 1998 versus 1989 to 1993, the proportion of all drug-resistant strains that were MDR was greater (9.0% versus 4.3%, respectively), but the difference was not statistically significant. Isolates from 16 of the 24 MDR-TB cases had been archived. Each of these was fingerprinted and found to be unique. Most MDR-TB cases (88%) were respiratory. Of those tested for human immunodeficiency virus (n=17), only one was seropositive. MDR-TB was ‘acquired’ in 67% and ‘primary’ in 33% of cases. Eight (33%) of the MDR-TB cases received curative courses of treatment, six (25%) are still being treated, and the remainder have either died (five, 21%), transferred out (four, 17%) or become ‘chronic’ (one, 4%). No secondary case of MDR-TB has been identified in Alberta and British Columbia.CONCLUSIONS: Most MDR-TB in Alberta and British Columbia is imported. The proportion of all drug-resistant cases that are MDR appears to be increasing, but not because of disease acquired from recent contact with MDR-TB in Canada.

Download Full-text

A Survey of Latent Tuberculosis Infection Among Laboratory Healthcare Workers in New York City

Infection Control and Hospital Epidemiology ◽

10.1086/502140 ◽

2003 ◽

Vol 24 (11) ◽

pp. 801-806 ◽

Cited By ~ 11

Author(s):

Elizabeth Garber ◽

Pablo San Gabriel ◽

Lauren Lambert ◽

Lisa Saiman

Keyword(s):

Risk Factors ◽

New York ◽

New York City ◽

York City ◽

Latent Tuberculosis ◽

Skin Tests ◽

First Year ◽

Foreign Born ◽

History Of ◽

Latent Tb Infection

AbstractObjective:To determine the prevalence of positive tuberculin skin tests (TSTs), incidence of TST conversion, risk factors for positive TSTs, and history of active TB among HCWs in microbiology laboratories in New York City.Design:Two-year survey from May 1999 to June 2001.Setting:Nineteen microbiology laboratories.Results:During the first year, interviews were conducted with 345 laboratory HCWs (mean, 18 HCWs per site; range, 2 to 51) to assess the prevalence of positive TSTs, but 3 (1%) could not recall their result and were excluded from further analyses. The mean age of the remaining 342 HCWs was 48 years; 68% (n = 233) were female, 54% (n = 183) received bacille Calmette-Guérin (BCG) vaccination, and 71% (n = 244) were foreign born. The prevalence of a positive TST was 57% (n = 196), but only 20% (n = 39) of the HCWs received isoniazid. The incidence of TST conversion in the second year of the study was 1% (1 of 108). Multivariate analysis identified age (odds ratio [OR] per year, 1.05; 95% confidence interval [CI95], 1.02–1.08), foreign birth (OR, 3.80; CI95, 1.98–7.28), BCG immunization (OR, 4.89; CI95, 2.72–8.80), and employment in a mycobacteriology laboratory (OR, 2.14; CI95, 1.25–3.68) as risk factors for a positive TST. Only one HCW had been treated for active TB.Conclusions:The prevalence of positive TSTs was high among laboratory HCWs, but the TST conversion rate was low. Higher rates of treatment for latent TB infection are desirable.

Download Full-text

Mechanical ventilator support and prone positioning in COVID-19 related pneumonia

Clinical Critical Care ◽

10.54205/ccc.v29i.251359 ◽

2021 ◽

Author(s):

Rungsun Bhurayanontachai

Keyword(s):

Respiratory Symptoms ◽

Epidemiologic Study ◽

Multiple Organ ◽

Positive Pressure ◽

High Morbidity ◽

Mechanical Ventilator ◽

Prone Positioning ◽

Ventilator Support ◽

Global Pandemic ◽

The Common

COVID-19 is currently a global pandemic that cause high morbidity and mortality, particularly in the critical cases. The common presentation is among the common respiratory symptoms and could be deteriorated to multiple organ failure. From the previous epidemiologic study, approximate 15% of cases developed pneumonia and 5% required intensive care admission. The optimal respiratory care including oxygen support are the key for hypoxic respiratory failure from severe COVID-19. Several devices have been practically suggested for respiratory symptoms included high flow nasal cannula (HFNC), non-invasive positive pressure ventilator (NIV) via either common facial mask or helmet. However, some patients did not improve with those devices, that become more respiratory distress and eventually required intubation and mechanical ventilator support. In this brief review, the author will pay attention on the mechanical ventilator support and prone positioning for COVID-19 pneumonia.

Download Full-text

Tetanus: A Rare Complication of Black Tar Heroin Use

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab613 ◽

2021 ◽

Author(s):

Elisa Pichlinski ◽

Emily Hoff ◽

Lindsey Claire Epperson ◽

Elizabeth Morley ◽

James Dazhe Cao ◽

...

Keyword(s):

Harm Reduction ◽

Rare Complication ◽

High Income ◽

Morbidity And Mortality ◽

High Morbidity ◽

Heroin Use ◽

Tetanus Vaccination ◽

Vaccination Campaigns

Abstract Tetanus is associated with high morbidity and mortality, though rarely encountered in high-income countries. We present a case of tetanus in an unvaccinated patient secondary to black tar heroin use that highlights the importance of consideration of tetanus in appropriate clinical contexts, harm reduction interventions and universal tetanus vaccination campaigns.

Download Full-text

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

10.1101/204461 ◽

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.

Download Full-text

Impact of travelling to high incidence countries on tuberculosis diagnostic delays among migrants: a retrospective study.

10.21203/rs.3.rs-123660/v1 ◽

2020 ◽

Author(s):

Loïc KASSEGNE ◽

Philippe FRAISSE

Keyword(s):

Retrospective Study ◽

Diagnostic Delay ◽

High Income ◽

Diagnosis Delay ◽

Foreign Born ◽

Tuberculosis Prevention ◽

Vulnerable Patients ◽

High Incidence ◽

Diagnostic Delays

Abstract Background Most tuberculosis (TB) cases in high-income countries occur in foreign-born people, most of them coming from high incidence countries. However, migrants return more or less frequently to their birth countries. The aim of the study was to estimate the influence of travelling to high incidence countries on the diagnosis delay of tuberculosis in France. Methods a monocentric retrospective study of 224 consecutive cases followed at the Bas-Rhin Tuberculosis Prevention Centre. Results 59.3% of cases were born abroad. Migrants who did not develop TB soon after arrival and, who travelled since then to high incidence countries, had a mean diagnosis delay, since their last trip, comparable to median diagnostic delay among immigrants who did not travel since their arrival (3.2 vs 4.4 years, p = 0.42). Diagnostic delays are shorter among those reporting an exposition to TB during their journey (1.5 years vs 3.7 years, p = 0.2). Conclusion These results suggest a targeted information on the risk of TB and LTBI among those persons and screening for tuberculosis and LTBI, in certain cases, including vulnerable patients (dialysis, under immunosuppressant drugs including anti-TNF, HIV).

Download Full-text