Sustaining Togetherness; Family Engagement in Tuberculosis Prevention in Children Living in Tuberculosis Households in Indonesia

BACKGROUND: Preventing tuberculosis (TB) in children needs the family to be engaged; however, limited studies about how the family engages in TB prevention. AIM: This aimed of study was to develop the process of family engagement in TB prevention for children with household contact of TB patient. METHODS: Guided by Straussian grounded theory, we developed a substantive theory from 14 primary caregivers in West Java-Indonesia as the key participants of families whose child ≤5 years old received TB screening and preventive therapy, and have had an adult in the household with active TB diagnosis. Data were collected by in-depth interviews and analyzed by coding procedures. RESULTS: Sustaining togetherness aimed to maintain the children’s health, which underpinned three main stages that consisted of “moving from fear to realization,” “making the family’s collective decision,” and “holding on together.” CONCLUSION: Implications for nursing practice in providing optimum care of preventing TB among children through engagement of family.

Household contact tracing with intensified tuberculosis and HIV screening in South Africa: a cluster randomised trial

Background Household contact tracing for tuberculosis (TB) may facilitate TB diagnosis and identify individuals who may benefit from TB preventive therapy (TPT). In this cluster-randomised trial, we investigated whether household contact tracing and intensive TB/HIV screening would improve TB-free survival. Methods Household contacts of index TB patients in two Provinces of South Africa were randomised to home tracing and intensive HIV/TB screening (sputum Xpert and culture; HIV testing with treatment linkage; and TPT, if eligible), or standard of care (SOC, clinic referral letters). The primary outcome was incident TB or death at 15-months. Secondary outcomes included tuberculin skin test (TST) positivity in children ≤14 years and undiagnosed HIV. (ISRCTN16006202). Results From December 2016-March 2019, 1,032 index patients (4,459 contacts) and 1,030 (4,129 contacts) were randomised to the intervention and SOC arms. 3.2% (69/2166) of intervention arm contacts had prevalent microbiologically-confirmed TB. At 15-months, the cumulative incidence of TB or death did not differ between the intensive screening (93/3230, 2.9%) and SOC (80/2600, 3.1%) arms (hazard ratio: 0.90, 95% confidence interval (CI): 0.66-1.24). TST positivity was higher in the intensive screening arm (38/845, 4.5%) compared to the SOC arm (15/800, 1.9%, odds ratio: 2.25, 95% CI: 1.07-4.72). Undiagnosed HIV was similar between arms (41/3185, 1.3% vs. 32/2543, 1.3%; odds ratio: 1.02, 95% CI: 0.64-1.64). Conclusions Household contact tracing with intensive screening and referral did not reduce incident TB or death. Providing referral letters to household contacts of index patients is an alternative strategy to home visits in high TB/HIV-prevalence settings.

Social mixing patterns in the UK following the relaxation of COVID-19 pandemic restrictions: a cross-sectional online survey

Background Since 23 March 2020, social distancing measures have been implemented in the UK to reduce SARS-CoV-2 transmission. We conducted a cross-sectional survey to quantify and characterize non-household contact and to identify the effect of shielding and isolating on contact patterns. Methods Through an online questionnaire, the CoCoNet study measured daily interactions and mobility of 5143 participants between 28 July and 14 August 2020. Negative binomial regression modelling identified participant characteristics associated with contact rates. Results The mean rate of non-household contacts per person was 2.9 d-1. Participants attending a workplace (adjusted incidence rate ratio (aIRR) 3.33, 95%CI 3.02 to 3.66), self-employed (aIRR 1.63, 95%CI 1.43 to 1.87) or working in healthcare (aIRR 5.10, 95%CI 4.29 to 6.10) reported significantly higher non-household contact rates than those working from home. Participants self-isolating as a precaution or following Test and Trace instructions had a lower non-household contact rate than those not self-isolating (aIRR 0.58, 95%CI 0.43 to 0.79). We found limited evidence that those shielding had reduced non-household contacts compared to non-shielders. Conclusion The daily rate of non-household interactions remains lower than pre-pandemic levels, suggesting continued adherence to social distancing guidelines. Individuals attending a workplace in-person or employed as healthcare professionals were less likely to maintain social distance and had a higher non-household contact rate, possibly increasing their infection risk. Shielding and self-isolating individuals required greater support to enable them to follow the government guidelines and reduce non-household contact and therefore their risk of infection.

Prevalence and associated risk factors for hepatitis B and C viruses among refugee populations living in Mahama, Rwanda: A cross-sectional study

Introduction As part of the integration of refugees into Rwanda’s national hepatitis C elimination agenda, a mass screening campaign for hepatitis B (HBV) and hepatitis C (HCV) was conducted among Burundian refugees living in Mahama Camp, Eastern Rwanda. This cross-sectional survey used data from the screening campaign to report on the epidemiology of viral hepatitis in this setting. Methods Rapid diagnostic tests (RDTs) were used to screen for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV) among people of ≥15years old. We calculated seroprevalence for HBsAg and anti-HCV by age and sex and also calculated age-and-sex adjusted risk ratios (ARR) for other possible risk factors. Results Of the 26,498 screened refugees, 1,006 (3.8%) and 297 (1.1%) tested positive for HBsAg and Anti-HCV, respectively. HBsAg was more prevalent among men than women and most common among people 25–54 years old. Anti-HCV prevalence increased with age group with no difference between sexes. After adjusting for age and sex, having a household contact with HBsAg was associated with 1.59 times higher risk of having HBsAg (95% CI: 1.27, 1.99) and having a household contact with anti-HCV was associated with 3.66 times higher risk of Anti-HCV (95% CI: 2.26, 5.93). Self-reporting having HBV, HCV, liver disease, or previously screened for HBV and HCV were significantly associated with both HBsAg and anti-HCV, but RDT-confirmed HBsAg and anti-HCV statuses were not associated with each other. Other risk factors for HBsAg included diabetes (ARR = 1.97, 95% CI: 1.08, 3.59) and family history of hepatitis B (ARR = 1.32, 95% CI: 1.11, 1.56) and for anti-HCV included heart disease (ARR = 1.91, 95% CI: 1.30, 2.80) and history of surgery (ARR = 1.70, 95% CI: 1.24, 2.32). Conclusion Sero-prevalence and risks factors for hepatitis B and C among Burundian were comparable to that in the Rwandan general population. Contact tracing among household members of identified HBsAg and anti-HCV infected case may be an effective approach to targeted hepatitis screening given the high risk among self-reported cases. Expanded access to voluntary testing may be needed to improve access to hepatitis treatment and care in other refugee settings.

Cost-effectiveness of household contact investigation for detection of tuberculosis in Pakistan

ObjectivesDespite WHO guidelines recommending household contact investigation, and studies showing the impact of active screening, most tuberculosis (TB) programmes in resource-limited settings only carry out passive contact investigation. The cost of such strategies is often cited as barriers to their implementation. However, little data are available for the additional costs required to implement this strategy. We aimed to estimate the cost and cost-effectiveness of active contact investigation as compared with passive contact investigation in urban Pakistan.MethodsWe estimated the cost-effectiveness of ‘enhanced’ (passive with follow-up) and ‘active’ (household visit) contact investigations compared with standard ‘passive’ contact investigation from providers and the programme’s perspective using a simple decision tree. Costs were collected in Pakistan from a TB clinic performing passive contact investigation and from studies of active contact tracing interventions conducted. The effectiveness was based on the number of patients with TB identified among household contacts screened.ResultsThe addition of enhanced contact investigation to the existing passive mode detected 3.8 times more cases of TB per index patient compared with passive contact investigation alone. The incremental cost was US$30 per index patient, which yielded an incremental cost of US$120 per incremental patient identified with TB. The active contact investigation was 1.5 times more effective than enhanced contact investigation with an incremental cost of US$238 per incremental patient with TB identified.ConclusionOur results show that enhanced and active approaches to contact investigation effectively identify additional patients with TB among household contacts at a relatively modest cost. These strategies can be added to the passive contact investigation in a high burden setting to find the people with TB who are missed and meet the End TB strategy goals.

Serological and cellular non-responders in a long-term cross-sectional cohort of SARS-CoV-2-specific PCR-positive individuals

During the first pandemic wave, the dark figure of SARS-CoV-2 exposure was estimated to be high, however, an accelerated loss of antibodies was reported after about 6 months post infection. This study was performed to unveil the group of serological non-responders (NR) in PCR+ individuals 6-9 months after the first pandemic SARS-CoV-2 wave in spring 2020 and to evaluate their specific cellular immune response towards spike-molecule compared to PCR- and not PCR-tested (NT) household contact persons. SARS-CoV-2-specific antibodies were quantified using a commercial ELISA kit. The synergistic binding strength was assessed as relative avidity index (RAI) using ammonium-thiocyanate as chaotropic agent. The specific IFNγ-production in response to spike-protein was determined in spot-forming-units (SFU) by ELISPOT-assay. In PCR- 50.0%, in PCR+ 35.3% and in NT 20.7% had undetectable IgG-anti-SARS-CoV-2 and were considered non-responders (NR). All seropositive responders from the PCR-, 45.5% of PCR+ and 43.0% of NT developed high avidity (RAI>60%). In serological responders, cellular responses were detected in 75.0% PCR-, 75.8% PCR+ and 66.7% NT. In serological NR, positive SFU were found in 75.0% PCR-, 22.2% PCR+ and 17.4% NT. Significantly higher stimulation-indices were seen in PCR+ responders compared to PCR+ serological NR. Our findings showed that also PCR- and household contact persons who were not tested (NT) developed SARS-CoV-2-specific humoral and cellular immune responses. The relatively large proportion of serological non-responders but also the proportion of cellular non-responders within the group of IgG-positive individuals after PCR+ infection underlines the need for COVID-19 vaccinations in the reconvalescent group.

Diagnostic Yield of Screening for SARS-CoV-2 among Patients Admitted for Alternate Diagnoses

Objectives: To determine the diagnostic yield of screening patients for SARS-CoV-2 who were admitted with a diagnosis unrelated to COVID-19, and identify risk factors for positive tests. Design: Cohort from the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry Setting: 30 acute care hospitals across Canada Participants: Patients hospitalized for non-COVID-19 related diagnoses who were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 1, and December 29, 2020 Main outcome: Positive nucleic acid amplification test (NAAT) for SARS-CoV-2 Outcome measure: Diagnostic yield Results: We enrolled 15,690 consecutive eligible adults who were admitted to hospital without clinically suspected COVID-19. Among these patients, 122 tested positive for COVID-19, resulting in a diagnostic yield of 0.8% (95% CI 0.64% - 0.92%). Factors associated with a positive test included presence of a fever, being a healthcare worker, having a positive household contact or institutional exposure, and living in an area with higher 7-day average incident COVID-19 cases. Conclusions: Universal screening of hospitalized patients for COVID-19 across two pandemic waves had a low diagnostic yield and should be informed by individual-level risk assessment in addition to regional COVID-19 prevalence.

Tuberculosis infection screening in children with close contact: a hospital-based study

Background Identifying and prioritizing at-risk populations is critical for pediatric tuberculosis control. We aimed to identify a latent tuberculosis infection (LTBI) screening strategy that is appropriate for the Chinese context among children with different TB exposure levels and to explore its clinical importance. Methods During 2013–2015, we enrolled hospitalized children with suspected respiratory infectious disease (RID) for LTBI screening using the tuberculin skin test (TST) and interferon-γ release assay (IGRA) T-SPOT.TB as part of a work up for their RID. Participants with confirmed diagnosis were classified into three subgroups according to level of exposure to TB: no reported contact risk, with household contact risk, and with non-household contact risk. Results A total 6202 children (median age: 4.76 years; interquartile range: 1.0–8.0 years) were enrolled. Children with no reported contact risk had the lowest proportions of positive results for the IGRA (0.7%) and TST (3.3%). The proportion of positive results for each test was higher for household contacts than non-household contacts. The TST positive proportion was much higher than that for the IGRA in all three groups. Children with IGRA+/TST+ results had larger indurations than those with IGRA− /TST+ results (15 mm vs. 13 mm, P = 0.02). For IGRA, older age (> 5 years) and non-household or household contact risk were associated with a positive result. Conclusions Positive IGRA results in children with a contact risk can serve as a critical reference for LTBI management. IGRA can be used, in preference to TST, for Chinese children with a TB exposure risk.