Epidemiology and clinical characteristics of childhood TB identified using active and passive case finding

2021 ◽  
Vol 25 (6) ◽  
pp. 475-482
Author(s):  
S. Ikeda ◽  
A. T. Cruz ◽  
J. R. Starke
Keyword(s):  
Drug Susceptibility ◽  
Case Finding ◽  
Contact Tracing ◽  
Active Case Finding ◽  
Susceptibility Data ◽  
Treatment Regimens ◽  
Source Case ◽  
Childhood Tb ◽  
Mediastinal Adenopathy ◽  
Epidemiological Characteristics

BACKGROUND: Childhood TB cases can be found using passive case finding (PCF), i.e., by diagnosing children presenting with symptoms, or using active case finding (ACF), i.e., by identifying children with TB through contact tracing. Our study determined epidemiologic, clinical, and radiographic differences between these groups.DESIGN/METHODS: Retrospective cohort study of children aged 0–19 years diagnosed with TB from January 1, 2012 to December 31, 2019 at a U.S. TB clinic, comparing clinical, radiographic, microbiologic, and epidemiological characteristics of children identified using PCF and ACF.RESULTS: Of 178 eligible patients, 99 (55.6%) were diagnosed using PCF. Children identified using PCF were older (mean 8.9 vs. 6.1 years, P = 0.003), more often non-US-born (OR 2.29, 95% CI 1.12–4.67), had more extrapulmonary disease (44.4% vs. 3.8%, OR 20.27, 95% CI 5.98–68.64) and severe intrathoracic findings (39.4% vs. 10.1%, OR 5.77, 95% CI 2.50–13.29). Children identified using ACF were often asymptomatic, had isolated hilar/mediastinal adenopathy, but had more availability of drug susceptibility data from a link to a source case.CONCLUSION: Children identified using PCF had more severe manifestations, while those identified using ACF had greater availability of drug susceptibility data. Clinicians should be aware that clinical and radiographic presentations in children identified using PCF and those identified using ACF differ, and that the latter may be eligible for shorter treatment regimens.

scholarly journals 1632. Comparing the epidemiology and clinical characteristics of childhood tuberculosis through active and passive case finding

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S807-S808
Author(s):  
Saki Ikeda ◽  
Andrea T Cruz ◽  
Jeffrey R Starke
Keyword(s):  
Clinical Manifestations ◽  
Central Nervous System Disease ◽  
Data Safety Monitoring Board ◽  
Case Finding ◽  
Childhood Tuberculosis ◽  
Contact Tracing ◽  
System Disease ◽  
Radiologic Findings ◽  
Mediastinal Adenopathy ◽  
Epidemiological Characteristics

Abstract Background Childhood tuberculosis can be found via passive case finding (PCF), diagnosing a symptomatic child, and active case finding (ACF), discovering a child through contact tracing. Most high prevalence areas perform PCF, but as ACF is introduced, the clinical and radiologic findings may differ. We compare clinical, radiographic, microbiologic and epidemiological characteristics of children diagnosed through PCF and ACF. Methods A retrospective cohort study of all patients diagnosed with TB from 01/01/2012-12/31/2019 at Texas Children’s Hospital. ACF is TB in a child who had not previously sought care before identified via contact tracing, immigration screening, or screening for incarceration. Severity of disease was based on location of illness, imaging and bacteriology/histopathology. Associations between PCF/ACF and demographics, disease severity, and microbiology were analyzed. Results Of 178 patients, 80 (45%) were diagnosed via ACF. ACF patients were more likely to be US-born (OR: 2.29, [95% Confidence interval (CI): 1.12-4.67]) and younger (mean 6.18 vs 8.84 years, p= 0.016). Only 2.5% of ACF patients had extrapulmonary disease, compared to 45% of the PCF group (p< 0.0001). All 14 severe extrathoracic cases were in the PCF group (10 central nervous system disease, 3 ocular disease, 1 spondylitis). Fewer patients in the ACF group had severe intrathoracic findings (11% vs 39%, p< 0.001): miliary disease (0% vs 10%, p=0.006), cavity (1% vs 9%, p=0.04), and multilobar involvement (7.5% vs 22.4%, p=0.006). ACF patients had more hilar/mediastinal adenopathy (OR: 2.51, [CI: 1.34-3.72], p=0.004). ACF patients were less often cultured (38% vs 89%, p< 0.0001) and had less microbiological confirmation by cultures or PCR (21% vs 52%, p=< 0.0001). Conclusion Patients in the ACF group were younger, had less severe clinical manifestations, and had almost no extrathoracic disease. Clinicians need to be aware that the common clinical and radiographic presentations in children differ between PCF and ACF. Disclosures Jeffrey R. Starke, MD, Otsuka Pharmaceuticals (Other Financial or Material Support, Member, Data Safety Monitoring Board)

scholarly journals Primary Drug-Resistant Tuberculosis in the Elderly in Shandong,China,from 2004 - 2019.

2020 ◽  
Author(s):  
Qiqi An ◽  
Wan-mei Song ◽  
Jin-yue Liu ◽  
Ning-ning Tao ◽  
Yao Liu ◽  
...  
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Drug Susceptibility ◽  
Drug Resistant ◽  
Chi Square ◽  
Susceptibility Data ◽  
Resistant Tuberculosis ◽  
Mdr Tb ◽  
Epidemiological Characteristics ◽  
Descriptive Statistical Analysis

Abstract Background: With an aging population, China is facing a huge buedern of elderly patients with drug resistant tuberculosisi (DR-TB), which has become an significant obscale for the global TB control targets. There is still few study on DR-TB among China so far.Thus, more researches on the epidemiological characteristics and trend of primary DR-TB among the elderly will be necessary. Methods: A retrospective study was conducted in Shandong, China from 2004-2019, 12661 primary TB and 4368 elderly (≥60 years of age) primary TB cases were involved. Clinical characteristics including age, sex, Cavity, Smoking, drinking, comorbidity and drug susceptibility data were included. Descriptive statistical analysis, Chi-square and linear regression were used for analyzing.Results: Among 4368 elderly patients with primary TB, the DR-TB and MDR-TB accounted for 17.19% and 2.29% respectively. During 2004 to 2019, the proportions of MDR-TB, PDR-TB, RFP-resistance increased by160.00%, 18.18%, 231.82%, and the rate of DR-TB among elderly patients with primary cavitary TB increased by 255%.Among the elderly with primary DR-TB, the proportion of male (from 85.19 to 89.06), cavity (from 7.41 to 46.88), RFP (from 3.70 to 21.88), SM (from 37.04 to 62.5) increased significantly(P<0.05) . And the proportion of female (from 14.81 to 10.94), non-cavity (from 92.59 to 32.81 ), INH (from 66.67 to 57.81 ) decreased significantly. (P<0.05) .Conclusion: Among the elderly, the proportions of MDR-TB, PDR-TB,RFP-resistance and cavitary DR-TB increased significantly. The pattern of DR-TB changed from female, non-cavity and INH-resistant groups to male, cavity and RFP, SM-resistant groups. For a better control on the elderly DR-TB in the future, we should pay more attention to, male, smoking, drinking, COPD and diabetes subgroups.

scholarly journals COVID-19 control strategies and intervention effects in resource limited settings: A modeling study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252570
Author(s):  
Kiran Raj Pandey ◽  
Anup Subedee ◽  
Bishesh Khanal ◽  
Bhagawan Koirala
Keyword(s):  
Control Strategies ◽  
Case Finding ◽  
Contact Tracing ◽  
Active Case Finding ◽  
Resource Limited Settings ◽  
Peak Demand ◽  
Active Case ◽  
Resource Limited ◽  
Base Scenario ◽  
Annual Mortality

Introduction Many countries with weaker health systems are struggling to put together a coherent strategy against the COVID-19 epidemic. We explored COVID-19 control strategies that could offer the greatest benefit in resource limited settings. Methods Using an age-structured SEIR model, we explored the effects of COVID-19 control interventions–a lockdown, physical distancing measures, and active case finding (testing and isolation, contact tracing and quarantine)–implemented individually and in combination to control a hypothetical COVID-19 epidemic in Kathmandu (population 2.6 million), Nepal. Results A month-long lockdown will delay peak demand for hospital beds by 36 days, as compared to a base scenario of no intervention (peak demand at 108 days (IQR 97-119); a 2 month long lockdown will delay it by 74 days, without any difference in annual mortality, or healthcare demand volume. Year-long physical distancing measures will reduce peak demand to 36% (IQR 23%-46%) and annual morality to 67% (IQR 48%-77%) of base scenario. Following a month long lockdown with ongoing physical distancing measures and an active case finding intervention that detects 5% of the daily infection burden could reduce projected morality and peak demand by more than 99%. Conclusion Limited resource settings are best served by a combination of early and aggressive case finding with ongoing physical distancing measures to control the COVID-19 epidemic. A lockdown may be helpful until combination interventions can be put in place but is unlikely to reduce annual mortality or healthcare demand.

scholarly journals The Use of Xpert MTB/Rif for Active Case Finding among TB Contacts in North West Province, South Africa

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Limakatso Lebina ◽  
Nigel Fuller ◽  
Tolu Osoba ◽  
Lesley Scott ◽  
Katlego Motlhaoleng ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Turnaround Time ◽  
Case Finding ◽  
Contact Tracing ◽  
Active Case Finding ◽  
North West ◽  
Active Case ◽  
Household Contacts ◽  
Significant Difference ◽  
Diagnosis Rate

Introduction.Tuberculosis is a major cause of morbidity and mortality especially in high HIV burden settings. Active case finding is one strategy to potentially reduce TB disease burden. Xpert MTB/Rif has recently been recommended for diagnosis of TB.Methods.Pragmatic randomized trial to compare diagnosis rate and turnaround time for laboratory testing for Xpert MTB/Rif with TB microscopy and culture in household contacts of patients recently diagnosed with TB.Results.2464 household contacts enrolled into the study from 768 active TB index cases. 1068 (44%) were unable to give sputum, but 24 of these were already on TB treatment. 863 (53%) participants sputum samples were tested with smear and culture and 2.7% (23/863; CI: 1.62–3.78) were diagnosed with active TB. Xpert MTB/Rif was used in 515 (21%) participants; active TB was diagnosed in 1.6% (8/515; CI: 0.52–2.68).Discussion and Conclusions.Additional 31 cases were diagnosed with contact tracing of household members. When Xpert MTB/Rif is compared with culture, there is no significant difference in diagnostic yield.

scholarly journals TB contact tracing for young children: an Australian cascade of care review

2021 ◽  
Vol 11 (2) ◽  
pp. 91-96
Author(s):  
N. Moyo ◽  
E. L Tay ◽  
A. Nolan ◽  
H. R. Graham ◽  
S. M. Graham ◽  
...  
Keyword(s):  
Young Child ◽  
Preventive Treatment ◽  
Case Finding ◽  
Contact Tracing ◽  
High Yield ◽  
Sputum Smear ◽  
Active Case Finding ◽  
Pulmonary Tb ◽  
Active Case ◽  
Cascade Of Care

OBJECTIVE: To evaluate care cascades for programmatic active case finding and latent TB infection (LTBI) management in young child TB contacts (aged <5 years) in Victoria, Australia.DESIGN: This was a retrospective review of public health surveillance data to identify contacts of all pulmonary TB cases notified from 2016 to 2019.RESULTS: Contact tracing identified 574 young child contacts of 251 pulmonary TB cases. Active TB was found in 28 (4.9%) contacts, none of whom had previously received bacille Calmette-Guérin vaccination, and 529 were tested for TB infection using the tuberculin skin test (TST). The overall TST positivity was 15.3% (95% CI 0.1–0.2). Among the 574 children, 150 (26.1%) were close contacts of sputum smear-positive cases and 25 (16.7%) of these were not referred to TB clinics. Of the 125 referred, 81 were considered to have LTBI, 79 agreed to commence TB preventive treatment (TPT) and 71 (89.9%) completed TPT. Following completion of TPT, no child was subsequently diagnosed with active TB.CONCLUSION: There was a high yield from active case finding and uptake of TPT. Notable losses in the cascade of care occurred around referral to tertiary clinics, but high treatment completion rates and good outcomes were found in those prescribed treatment.

scholarly journals COVID-19 Control Strategies and Intervention Effects in Resource Limited Settings: A Modeling Study

2020 ◽  
Author(s):  
Kiran Raj Pandey ◽  
Anup Subedee ◽  
Bishesh Khanal ◽  
Bhagawan Koirala
Keyword(s):  
Control Strategies ◽  
Case Finding ◽  
Contact Tracing ◽  
Active Case Finding ◽  
Resource Limited Settings ◽  
Peak Demand ◽  
Active Case ◽  
Resource Limited ◽  
Base Scenario ◽  
Annual Mortality

ABSTRACTBackgroundMany countries with weaker health systems are struggling to put together a coherent strategy against the COVID-19 epidemic. We explored COVID-19 control strategies that could offer the greatest benefit in resource limited settings.MethodsUsing an age-structured SEIR model, we explored the effects of COVID-19 control interventions--a lockdown, physical distancing measures, and active case finding (testing and isolation, contact tracing and quarantine)-- implemented individually and in combination to control a hypothetical COVID-19 epidemic in Kathmandu (population 2.6 million), Nepal.ResultsA month-long lockdown that is currently in place in Nepal will delay peak demand for hospital beds by 36 days, as compared to a base scenario of no interventions (peak demand at 108 days (Inter-Quartile Range IQR 97–119); a 2 month long lockdown will delay it by 74 days, without any difference in annual mortality, or healthcare demand volume. Year-long physical distancing measures will reduce peak demand to 36% (IQR 23%-46%) and annual morality to 67% (IQR 48%-77%) of base scenario. Following a month long lockdown with ongoing physical distancing measures and an active case finding intervention that detects 5% of the daily infection burden could reduce projected morality and peak demand by more than 99%.InterpretationLimited resources settings are best served by a combination of early and aggressive case finding with ongoing physical distancing measures to control the COVID-19 epidemic. A lockdown may be helpful until combination interventions can be put in place but is unlikely to reduce annual mortality or healthcare demand.

scholarly journals Europe’s initial experience with pandemic (H1N1) 2009 - mitigation and delaying policies and practices

2009 ◽  
Vol 14 (29) ◽  
Author(s):  
A Nicoll ◽  
D Coulombier
Keyword(s):  
Severe Disease ◽  
Case Finding ◽  
Contact Tracing ◽  
Active Case Finding ◽  
Transmission Rates ◽  
The Past ◽  
The United Kingdom ◽  
Influenza Activity ◽  
History Of ◽  
Initial Difference

Europe has experienced more than two months of the first transmissions and outbreak of the 2009 pandemic of A(H1N1)v. This article summarises some of the experience to date and looks towards the expected autumn increases of influenza activity that will affect every country. To date the distribution of transmission has been highly heterogenous between and within countries, with one country the United Kingdom (UK) experiencing the most cases and the highest transmission rates. Most infections are mild but there are steadily increasing numbers of people needing hospital care and more deaths are being reported. An initial difference in practice between Europe and North America was over case-finding and treatment with some authorities in Europe using active case-finding, contact tracing and treatment/prophylaxis with antivirals to try and delay transmission. This article details the history of this practice in the past two months and explains how and why countries are moving to mitigation, especially treating with antivirals those at higher risk of experiencing severe disease.

scholarly journals Five approaches to the suppression of SARS-CoV-2 without intensive social distancing

2021 ◽  
Vol 288 (1949) ◽  
Author(s):  
John M. Drake ◽  
Kyle Dahlin ◽  
Pejman Rohani ◽  
Andreas Handel
Keyword(s):  
Narrow Range ◽  
Case Finding ◽  
Contact Tracing ◽  
Active Case Finding ◽  
Protective Measures ◽  
Social Distancing ◽  
Targeted Interventions ◽  
Wide Range ◽  
Alternative Approaches ◽  
Pharmaceutical Interventions

Initial efforts to mitigate transmission of SARS-CoV-2 relied on intensive social distancing measures such as school and workplace closures, shelter-in-place orders and prohibitions on the gathering of people. Other non-pharmaceutical interventions for suppressing transmission include active case finding, contact tracing, quarantine, immunity or health certification, and a wide range of personal protective measures. Here we investigate the potential effectiveness of these alternative approaches to suppression. We introduce a conceptual framework represented by two mathematical models that differ in strategy. We find both strategies may be effective, although both require extensive testing and work within a relatively narrow range of conditions. Generalized protective measures such as wearing face masks, improved hygiene and local reductions in density are found to significantly increase the effectiveness of targeted interventions.

scholarly journals Expanding Tuberculosis Case Detection by Screening Household Contacts

2005 ◽  
Vol 120 (3) ◽  
pp. 271-277 ◽  
Author(s):  
Mercedes C. Becerra ◽  
Iliana F. Pachao-Torreblanca ◽  
Jaime Bayona ◽  
Rosa Celi ◽  
Sonya S. Shin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Finding ◽  
Self Report ◽  
Contact Tracing ◽  
Sputum Smear ◽  
Case Detection ◽  
Active Case Finding ◽  
Active Case ◽  
Tb Control ◽  
Household Contacts

Objectives. Tuberculosis (TB) case detection remains low in many countries, compromising the efficacy of TB control efforts. Current global TB control policy emphasizes case finding through sputum smear microscopy for patients who self-report to primary health centers. Our objective was to assess the feasibility and yield of a simple active case finding strategy in a high incidence population in northern Lima, Peru. Methods. We implemented this pilot strategy in one health center's catchment area. Health workers visited household contacts of new TB case subjects to identify symptomatic individuals and collect sputum for screening. Neighboring households were screened in the same manner. Secondary analyses measured risk of TB by ( 1) sputum smear status of the index case subject, ( 2) compliance with testing, and ( 3) risk factors for disease detected through active contact tracing in contrast to self-report. Results. The TB prevalence detected through combined active and passive case finding among 1,094 household contacts was 0.91% (914 per 100,000), much higher than with passive case finding alone (0.18%; 183 per 100,000; p=0.02). Among 2,258 neighbors, the combined strategy detected a TB prevalence of 0.22% (221 per 100,000) in contrast to 0.08% (80 per 100,000) detected through passive case finding alone ( p=0.25). Risk factors for being diagnosed through active case finding in contrast with self-report included age >55 years (odds ratio [OR]=5.5; 95% confidence interval [CI] 1.2, 22.8) and female gender (OR=3.9; 95% CI 0.99, 22.3). Conclusions. Risk of active TB among symptomatic household contacts of active case subjects in this community is very high. Results suggest that contact tracing in such settings may be a powerful means of improving case detection rates for active TB disease.

scholarly journals The Impact of Funding on Childhood TB Case Detection in Pakistan

2019 ◽  
Vol 4 (4) ◽  
pp. 146 ◽  
Author(s):  
Amyn A. Malik ◽  
Hamidah Hussain ◽  
Jacob Creswell ◽  
Sara Siddiqui ◽  
Junaid F. Ahmed ◽  
...  
Keyword(s):  
Case Finding ◽  
Active Case Finding ◽  
Average Case ◽  
Active Case ◽  
Implementation Period ◽  
Childhood Tb ◽  
Continuous Stream ◽  
The Cost ◽  
The Impact ◽  
Case Notification

This study is a review of routine programmatically collected data to describe the 5-year trend in childhood case notification in Jamshoro district, Pakistan from January 2013 to June 2018 and review of financial data for the two active case finding projects implemented during this period. The average case notification in the district was 86 per quarter before the start of active case finding project in October 2014. The average case notification rose to 322 per quarter during the implementation period (October 2014 to March 2016) and plateaued at 245 per quarter during the post-implementation period (April 2016 to June 2018). In a specialized chest center located in the district, where active case finding was re-introduced during the post implementation period (October 2016), the average case notification was 218 per quarter in the implementation period and 172 per quarter in the post implementation period. In the rest of the district, the average case notification was 160 per quarter in the implementation period and 78 during the post implementation period. The cost per additional child with TB found ranged from USD 28 to USD 42 during the interventions. A continuous stream of resources is necessary to sustain high notifications of childhood TB.

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