Association of Tuberculin Sensitivity in Dutch Adults with History of Travel to Areas of with a High Incidence of Tuberculosis

Cobelens, Frank; Deutekom, H. van; Draayer-Jansen, Inez W E; Schepp-Beelen, Ank C H M; Gerven, P. J. H. J. Van; Kessel, R van; Mensen, M.

doi:10.1086/321882

Cited by 39 publications

(9 citation statements)

References 15 publications

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“…23 However, the risk is increased substantially when travelling for 90 days or longer. 24–27 Moreover, children visiting friends and relatives overseas have a high risk of acquiring infection. 28 In one study 29 of children (aged ≤6 years), travel to tuberculosis-endemic countries in the preceding 12 months increased the risk of acquiring tuberculosis infection by almost four times.…”

Section: Review and Discussionmentioning

confidence: 99%

Extensively drug-resistant tuberculosis in a young child after travel to India

Salazar-Austin

Ordoñez

Hsu

et al. 2015

The Lancet Infectious Diseases

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Extensively drug-resistant (XDR) tuberculosis is becoming increasingly prevalent worldwide, but little is known about XDR tuberculosis in young children. In this Grand Round we describe a 2-year-old child from the USA who developed pneumonia after a 3 month visit to India. Symptoms resolved with empirical first-line tuberculosis treatment; however, a XDR strain of Mycobacterium tuberculosis grew in culture. In the absence of clinical or microbiological markers, low-radiation exposure pulmonary CT imaging was used to monitor treatment response, and guide an individualised drug regimen. Management was complicated by delays in diagnosis, uncertainties about drug selection, and a scarcity of child-friendly formulations. Treatment has been successful so far, and the child is in remission. This report of XDR tuberculosis in a young child in the USA highlights the risks of acquiring drug-resistant tuberculosis overseas, and the unique challenges in management of tuberculosis in this susceptible population.

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Section: Review and Discussionmentioning

confidence: 99%

Extensively drug-resistant tuberculosis in a young child after travel to India

Salazar-Austin

Ordoñez

Hsu

et al. 2015

The Lancet Infectious Diseases

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“…The role of travel to visit friends and relatives on the risk of TB infection during an international travel is not exactly known. However the risk for an international traveler approximates the risk of transmission in the local population of the country of destination,47 and it is associated with duration of travel 48. Among travelers, immigrant visiting friends and relatives, especially children, are likely to represent a group at higher risk, perhaps due to their closer contact with the local population as shown by several studies that report an association between TST positivity and return to the country of origin 49…”

Section: Epidemiology and Determinants Of Tuberculosis In Immigrantsmentioning

confidence: 99%

Tuberculosis in Tropical Areas and Immigrants

Zammarchi

Bartalesi²,

Bartoloni³

2014

Mediterr J Hematol Infect Dis

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About 95% of cases and 98% of deaths due to tuberculosis (TB) occur in tropical countries while, in temperate low incidence countries, a disproportionate portion of TB cases is diagnosed in immigrants.Urbanization, poverty, poor housing conditions and ventilation, poor nutritional status, low education level, the HIV co-epidemic, the growing impact of chronic conditions such as diabetes are the main determinants of the current TB epidemiology in tropical areas. TB care in these contests is complicated by several barriers such as geographical accessibility, educational, cultural, sociopsychological and gender issues. High quality microbiological and radiological facilities are not widely available, and erratic supply of anti-TB drugs may affect tropical areas from time to time. Nevertheless in recent years, TB control programs reached major achievements in tropical countries as demonstrated by several indicators.Migrants have a high risk of acquire TB before migration. Moreover, after migration, they are exposed to additional risk factors for acquiring or reactivating TB infection, such as poverty, stressful living conditions, social inequalities, overcrowded housing, malnutrition, substance abuse, and limited access to health care. TB mass screening programs for migrants have been implemented in low endemic countries but present several limitations. Screening programs should not represent a stand-alone intervention, but a component of a wider approach integrated with other healthcare activities to ensure the health of migrants.

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“…For the majority, the estimated lifetime risk of developing active TB for individuals with an LTBI is 10% within the first years after infection [3, 4]. Identifying and treating people with (recently acquired) LTBI is important in disease control, especially in countries with a low incidence of TB.…”

Section: Introductionmentioning

confidence: 99%

Screening travellers to high-endemic countries for infection with Mycobacterium tuberculosis using interferon gamma release assay; a prospective study

et al. 2014

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BackgroundInternational travel from low-incidence to high-incidence countries for tuberculosis (TB) is regarded as a risk factor for acquiring TB infection. In this prospective study among long-term travellers we examined the incidence of TB infection using Interferon gamma release assay (IGRA) test and compared these data with results from a visit to the TB department to which all long-term travellers were routinely referred.MethodsImmunocompetent adults, travelling for 13–52 weeks to TB-endemic countries, donated blood pre- and post-travel for IGRA. The pre-travel IGRA was only tested in case of a positive IGRA post-travel. Results from their visit(s) to the TB department for TST pre- and post-travel were collected and compared with study results.ResultsWe found two IGRA conversions in a group of 516 travellers, resulting in an attack rate (AR) of 0.4% (95% CI: 0.5 - 13.9) and an incidence rate (IR) of 0.85 per 1000 person-months (95% CI: 0.1-3.1).We found 5 tuberculin skin test (TST) conversions, resulting in AR of 1.9% (5/261; 95% CI: 0.6 - 4.4) and an IR of 4.26 per 1000 person-months (95% CI: 1.38- 9.94). In our study these converters all had a negative IGRA. One traveller however, who was retested later at the TB department due to a positive TST, then appeared to have seroconverted.ConclusionsThe risk of long-term travellers among our study population acquiring TB infection is low. We conclude that post-travel IGRA alone could be used for screening for TB infection among long-term travellers to high-endemic TB countries, but preferably not earlier than 8 weeks after return. One might even argue that IGRA testing should be limited to only those travellers who are going to work in a medical setting. A person with a positive IGRA should be referred to a TB physician for further evaluation.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-515) contains supplementary material, which is available to authorized users.

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Association of Tuberculin Sensitivity in Dutch Adults with History of Travel to Areas of with a High Incidence of Tuberculosis

Abstract: . (2001). Association of tuberculin sensitivity in Dutch adults with history of travel to areas of with a high incidence of tuberculosis. Clinical infectious diseases, 33, 300-304.

Cited by 39 publications

References 15 publications

Extensively drug-resistant tuberculosis in a young child after travel to India

Extensively drug-resistant tuberculosis in a young child after travel to India

Tuberculosis in Tropical Areas and Immigrants

Screening travellers to high-endemic countries for infection with Mycobacterium tuberculosis using interferon gamma release assay; a prospective study

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