Old ideas to innovate tuberculosis control: preventive treatment to achieve elimination

Abstract

The introduction of new rapid diagnostic tools for tuberculosis (TB) and the promising TB drugs pipeline together with the development of a new World Health Organization Strategy post 2015 allows new discussions on how to direct TB control. The European Respiratory Society's European Forum for TB Innovation was created to stimulate discussion on how to best take advantage of old and new opportunities, and advances, to improve TB control and eventually progress towards the elimination of TB.While TB control is aimed at reducing the incidence of TB by early diagnosis and treatment of infectious cases of TB, TB elimination requires focus on sterilising the pool of latently infected individuals, from which future TB cases would be generated.This manuscript describes the three core components that are necessary to implement the elimination strategy fully. 1) Improve diagnosis of latent TB infected individuals. 2) Improve regimens to treat latent TB infection. 3) ensure public health commitment to make both 1) and 2) possible. Old and new evidence is critically described, focusing on the European commitment to reach elimination and on the innovative experiences and best practices available. @ERSpublications Diagnosis and treatment of latent TB infection is the core intervention to reach elimination

Costs of tuberculosis disease in the European Union: a systematic analysis and cost calculation

“…As it must be recognised, following current trends, Europe is unlikely to achieve elimination of the disease by the target date of 2050 [23,24], we urgently need new vaccines, as well as improved diagnostics [25,26] and new drugs [27][28][29]. With respect to economic considerations, the aim of the present study was to evaluate the costs associated with TB disease in order to determine whether they outweigh the investment needed to generate a new vaccine.…”

Immunological Signatures Identifying Different Stages of Latent Mycobacterium tuberculosis Infection and Discriminating Latent from Active Tuberculosis in Humans

“…This heterogeneity may lead to different outcomes, ranging from clearing the infection to pre-reactivation of the disease, probably reflecting various states of bacterial behaviour between dormancy and steady state replication [8][9][10][11]. The identification of these different LTBI subgroups is important, as it may help to target preventive therapy only to those subjects that have the highest risk to reactivate their infection [4,5]. We have previously reported that, in contrast to TST and the commercialized IGRA (QuantiFERON-TB Gold In-Tube assay or QFT -GIT and T-SPOT.TB), the IFN-γ response to the mycobacterial latency antigen heparin-binding haemagglutinin (HBHA) provides good discrimination between subjects with LTBI and patients with active TB [12,13].…”

“…Nevertheless, these LTBI subjects have a lifetime risk of about 10% to reactivate their infection, leading to progression to TB disease, this risk being higher in different clinical conditions associated with immune deficiency [2,3]. Despite being asymptomatic, these subjects constitute an enormous reservoir of M. tuberculosis and TB elimination requires focus on sterilizing the pool of LTBI individuals [4,5]. The WHO recommends systematic screening of contacts of TB patients and high-risk groups in order to achieve the post 2015 tuberculosis strategy aiming to reduce the tuberculosis incidence by 90% by 2035 compared with the 2015 incidence [6].…”

The association between public transport and active tuberculosis in Lima, Peru

“…With respect to the post-2015 World Health Organization goal of TB elimination, defined as fewer than one case per million population, by 2050, identifying and prioritising treatment of individuals with latent TB at high risk of progression is essential to prevention [10]. Given the demonstrated risk conveyed by prior household TB exposure, our study affirms the importance of household contact tracing for TB and latent TB case finding and treatment.…”