Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3–4 month isoniazid plus rifampicin; or 3–4 month rifampicin alone.

BackgroundControl of latent tuberculosis infection (LTBI) is an important step towards tuberculosis elimination. Preventive treatment will prevent the development of disease in most cases diagnosed with LTBI. However, low initiation and completion rates affect the effectiveness of preventive treatment. The objective was to systematically review data on initiation rates and completion rates for LTBI treatment regimens in the general population and specific populations with LTBI.MethodsA systematic review of the literature (PubMed, Embase) published up to February 2014 was performed.ResultsForty-five studies on initiation rates and 83 studies on completion rates of LTBI treatment were found. These studies provided initiation rates (IR) and completion rates (CR) in people with LTBI among the general population (IR 26–99 %, CR 39–96 %), case contacts (IR 40–95 %, CR 48–82 %), healthcare workers (IR 47–98 %, CR 17–79 %), the homeless (IR 34–90 %, CR 23–71 %), people who inject drugs (IR 52–91 %, CR 38–89 %), HIV-infected individuals (IR 67–92 %, CR 55–95 %), inmates (IR 7–90 %, CR 4–100 %), immigrants (IR 23–97 %, CR 7–86 %), and patients with comorbidities (IR 82–93 %, CR 75–92 %). Generally, completion rates were higher for short than for long LTBI treatment regimens.ConclusionInitiation and completion rates for LTBI treatment regimens were frequently suboptimal and varied greatly within and across different populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1550-y) contains supplementary material, which is available to authorized users.

BackgroundLatent tuberculosis infection (LTBI) control relies on high initiation and completion rates of preventive treatment to preclude progression to tuberculosis disease. Specific interventions may improve initiation and completion rates. The objective was to systematically review data on determinants of initiation, adherence and completion of LTBI treatment, and on interventions to improve initiation and completion.MethodsA systematic review of the literature (PubMed, Embase) published up to February 2014 was performed. Relevant prospective intervention studies were assessed using GRADE.ResultsSixty-two articles reporting on determinants of treatment initiation and completion were included and 23 articles on interventions. Determinants of LTBI treatment completion include shorter treatment regimen and directly observed treatment (DOT, positive association), adverse events and alcohol use (negative association), and specific populations with LTBI (both positive and negative associations). A positive effect on completion was noted in intervention studies that used short regimens and social interventions; mixed results were found for intervention studies that used DOT or incentives.ConclusionLTBI treatment completion can be improved by using shorter regimens and social interventions. Specific needs of the different populations with LTBI should be addressed taking into consideration the setting and condition in which the LTBI treatment programme is implemented.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1549-4) contains supplementary material, which is available to authorized users.

Achondroplasia is a genetic disorder that results in disproportionate short stature. The true prevalence of achondroplasia is unknown as estimates vary widely. This systematic literature review and meta‐analysis was conducted to better estimate worldwide achondroplasia birth prevalence. PubMed, Embase, Scielo, and Google Scholar were searched, complemented by manual searching, for peer‐reviewed articles published between 1950 and 2019. Eligible articles were identified by two independent researchers using predefined selection criteria. Birth prevalence estimates were extracted for analysis, and the quality of evidence was assessed. A meta‐analysis using a quality effects approach based on the inverse variance fixed effect model was conducted. The search identified 955 unique articles, of which 52 were eligible and included. Based on the meta‐analysis, the worldwide birth prevalence of achondroplasia was estimated to be 4.6 per 100,000. Substantial regional variation was observed with a considerably higher birth prevalence reported in North Africa and the Middle East compared to other regions, particularly Europe and the Americas. Higher birth prevalence was also reported in specialized care settings. Significant heterogeneity (Higgins I2 of 84.3) was present and some indication of publication bias was detected, based on visual asymmetry of the Doi plot with a Furuya‐Kanamori index of 2.73. Analysis of pooled data from the current literature yields a worldwide achondroplasia birth prevalence of approximately 4.6 per 100,000, with considerable regional variation. Careful interpretation of these findings is advised as included studies are of broadly varying methodological quality.

@ERSpublications Management of latent tuberculosis infection is crucial to end TB in low-incidence settings

Background Meningococcal disease is caused by the bacteria Neisseria meningitidis , leading to substantial mortality and severe morbidity; with serogroups A, B, C, W135, X and Y most significant in causing disease. An outbreak is defined as multiple cases of the same serogroup occurring in a population over a short time-period. A systematic review was performed to gain insight into outbreaks of meningococcal disease and to describe the temporal pattern over the last 50 years in non-African countries. Methods PubMed and EMBASE were searched for English-language publications on outbreaks of meningococcal disease in non-African countries between January 1966 and July 2017, with an additional grey literature search. Articles and reports were considered eligible if they reported confirmed meningococcal outbreak cases, included the region, number of cases, and the start and end dates of the outbreak. Data on outbreaks was stratified by geographical region in accordance with the World Health Organization (WHO) regional classification, and case-fatality rates (CFRs) were calculated. Results Of the identified publications, 3067 were screened and 73 included, reporting data from 83 outbreaks. The majority of outbreaks were identified in the regions of the Americas (41/83 outbreaks), followed by the European region (30/83 outbreaks). In each of the Western Pacific, Eastern Mediterranean, and South-East Asian regions there were <10 outbreaks reported. The predominant serogroup in the majority of outbreaks was serogroup C (61%), followed by serogroup B (29%), serogroup A (5%) and serogroup W135 (4%). Outbreaks showed a peak in the colder months of both the Northern and Southern Hemispheres. Of the 54 outbreaks where CFR was calculable for all outbreak cases, it ranged from 0%-80%. Conclusions These data present a retrospective view of the patterns for meningococcal disease outbreaks in non-African countries, and provide valuable data for monitoring future changes in disease epidemiology and informing preventive measures.

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ventilator-associated pneumonia, where there are available alternatives but a rising antimicrobial resistance leading to lower treatment responses. Methods: A costeffectiveness model in hospitalized adult population was conducted to assess potential clinical and economic benefits of ceftazidime/avibactam (CAZ-AVI), an extended-spectrum cephalosporin along with a novel non-b-lactam b-lactamase inhibitor, with the standard treatment for nosocomial pneumonia (including ventilator-associated pneumonia). Clinical cure rates were adjusted by resistance rates published by Mexican healthcare institutions in accordance to crescent resistance of aerobic gram-negative organisms (i.e. Klebsiella pneumoniae and Pseudomonas aeruginosa) to currently available anti-infectives. The analysis was from the institutional perspective and considered public sector resource use and costs. Deterministic and probabilistic sensitive analyses were conducted to evaluate robustness of clinical and economic outcomes. Results: CAZ-AVI offers an incremental clinical cure rate of 12.09% (73.83%-61.74%); furthermore, ceftazidime/avibactam has a lower cost per healed patient (CAZ-AVI: USD 32,409; meropenem: USD 37,652) when considering microbiological sensitivity test, where the patient continues the treatment only if the pathogen turns out to be sensitive to the medication. Conclusions: Ceftazidime/ avibactam is a cost-effective alternative in the treatment of nosocomial pneumonia, including ventilator-associated pneumonia, for Mexican public sector. Adequate usage of CAZ-AVI allows healthcare professionals to implement strategies as recommended by WHO in the Global Action Plan on Antimicrobial Resistance to propitiate the availability and correct use of antibiotics as the main containment measure in the face of wide antimicrobial resistance spread.