Resurgent Tuberculosis in New York City: Human Immunodeficiency Virus, Homelessness, and the Decline of Tuberculosis Control Programs

Brudney, Karen; Dobkin, Jay F.

doi:10.1164/ajrccm/144.4.745

Cited by 589 publications

(175 citation statements)

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“…Delayed demonstra-tion of bacteriologic conversion from a positive to a negative sputum culture and failure to ensure completion of therapy among source cases allow for prolonged infectiousness that may permit TB transmission. [23][24][25] All 43 identified source cases were family members, caregivers, or household members. Shortening their infectious periods may have prevented transmission to children.…”

Section: Discussionmentioning

confidence: 99%

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Missed Opportunities for Preventing Tuberculosis Among Children Younger Than Five Years of Age

2000

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ABSTRACT. Objectives. Childhood tuberculosis (TB)is an important indicator of public health success in interrupting and preventing TB transmission. To determine the frequency and types of missed opportunities for preventing TB among children <5 years of age.Methods. We collected data from the public health records of child TB cases and their adult source cases. These children were from health jurisdictions where TB case rates in children were higher than the California average for this age group.Results. We reviewed the records for 165 children reported with TB (20% confirmed by culture). These children were evaluated for TB because of signs or symptoms of illness (32%), a contact investigation (26%), screening (22%), a source case investigation (4%), and unknown reasons (16%). Excluding 4 children infected by Mycobacterium bovis, only 59 of 161 children (37%) had a source case found. Children found in a contact investigation, born in the United States, <1 year of age, or who were black were more likely to have a source case found than children who did not have one of these characteristics. Of 43 children found in a contact investigation, improvements in contact investigations may have prevented TB in 17 of these children (40%). Among the 43 adult source cases, factors that may have facilitated transmission include delayed reporting in 23%, a delayed contact investigation in 21%, and delayed or nondocumented bacteriologic sputum conversion in 42% of culture-positive cases.Conclusions. Important missed opportunities to prevent TB in children include the failure to find and appropriately manage adult source cases and failure to completely evaluate and properly treat children exposed to TB. Improvements in case detection, case management, and contact investigations are necessary to eliminate TB in children. Pediatrics 2000;106(6). URL: http://www. pediatrics.org/cgi/content/full/106/6/e75; tuberculosis, children, prevention, missed opportunities.ABBREVIATIONS. TB, tuberculosis; TST, tuberculin skin test; RR, relative risk; CI, confidence interval; INH, isoniazid. D espite recent declines in the incidence of tuberculosis (TB) in the United States, TB continues to be an important health problem in specific social and racial groups. As public health agencies increasingly focus on strategies to eliminate TB in the United States, 1 childhood TB becomes an important indicator of program success in interrupting and preventing recent TB transmission. TB cases among children indicate recent transmission of Mycobacterium tuberculosis usually from an infectious adult, often a family or household member, 2,3 and are a sensitive indicator of deficiencies in efforts to prevent TB transmission. The mainstays of TB prevention in children are the timely diagnosis, reporting, and curative treatment of adults with TB disease so that the transmission of M tuberculosis is interrupted. 4,5 In addition, children exposed to infectious cases need a thorough medical evaluation and, if TB disease is excluded, prompt initiation of treatment f...

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Section: Discussionmentioning

confidence: 99%

“…[23][24][25] All 43 identified source cases were family members, caregivers, or household members. Shortening their infectious periods may have prevented transmission to children.…”

Section: Ofmentioning

confidence: 99%

Missed Opportunities for Preventing Tuberculosis Among Children Younger Than Five Years of Age

2000

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“…There is a significant risk that these encouraging results may not be sustained. The risk of dual HIV-TB infection is such that ongoing, targeted surveillance of this high risk population will need to persist if the currently reported declining rates of TB among aboriginal persons in British Columbia are to continue, and we are to avoid the documented rising rates of HIV-related TB reported from New York City and other large urban centres in the United States (24). Further studies, especially randomized, controlled trials with appropriate cost effectiveness analysis, are needed urgently to support our recommendations that directly observed therapy should be used on a more widespread basis.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis among Aboriginal and Nonaboriginal Persons in British Columbia

Wang

Noertjojo

et al. 2000

Canadian Respiratory Journal

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OBJECTIVE:To compare cases of tuberculosis (TB) diagnosed among aboriginal persons with a random sample of nonaboriginal persons diagnosed with TB, and evaluate the trends in rates of disease between both groups during the same period. DESIGN: A case-control study. SETTING: A provincial TB control program. PATIENTS AND METHODS: All patients with TB diagnosed among aboriginal persons in British Columbia between 1992 and 1996 were compared with control patients diagnosed during the same period. For each patient a control patient was identified. INTERVENTION:The demographic details, type of disease, bacteriology, risk factors for TB, therapy received as well as mode of administration were documented. The number of contacts identified for each patient as well as the number of patients completing chemoprophylaxis were identified. The rates of disease during the same period were also documented. RESULTS: During the study, 202 patients with TB were diagnosed among aboriginal persons and 201 controls were chosen. Apart from age at diagnosis (35.1±20 years versus 45.7±19.7), differences in the prevalence of lymphadenopathy (5.9% versus 16.4%, P=0.0008) and pleural disease (21.3% versus 16.4%, P=0.00008), there were no differences in presentation between aboriginal and nonaboriginal people. Aboriginal people were more likely to have a history of contact with a patient with TB (53% versus 17.9%, P<0.05), to have received directly observed therapy (55% versus 33.8%, P=0.00002) and to have contacts who were purified protein derivative (PPD) positive (4±9 versus 2±3, P=0.002). These contacts were more likely to start isoniazid (2±3 versus 1±1, P=0.002). Overall, there was a significant decline in rates of TB among aboriginal persons compared with the general population, but there was a small increase in rates among all subjects in the final year of the study. CONCLUSIONS: In the present study, significant variations in rates of TB among different population groups in British Columbia were found. During the study period, there was a greater decline in the rates of TB among aboriginal persons. A greater use of directly observed therapy and greater use of chemoprophylaxis occurred among aboriginal persons, which may have contributed to this decline, or alternatively, it simply reflects the natural evolution of the TB epidemic.

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“…However, by the 1980s tuberculosis could no longer be ignored, since the incidence and prevalence of TB had drastically increased in developing countries, specifically in sub-Saharan Africa, Asia, and South America [9]. By the 1990s, even in many European countries and the U.S., increasing rates of TB infection were seen, often related to immigrant populations from other endemic areas [10,11]. An equally important contributing factor to the increase in TB worldwide was the occurrence of the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) pandemic [12,13].…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis: From an Untreatable Disease in Antiquity to an Untreatable Disease in Modern Times?

Boire¹

2013

J Anc Dis Prev Rem

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The history of tuberculosis (TB) is intricately connected to the history of humanity. The disease is considered one of the oldest infectious diseases afflicting mankind. Its history is that of colorful, often vibrant descriptions and interpretations, in the attempt of human societies to demystify the origins, causality, and course of this grave and lethal disease, and in the ultimate pursuit of finding a cure. The discovery of the tubercle bacillus on March 24 th 1882, by Robert Koch, led to an unprecedented increase in international research efforts, ultimately resulting in the development of a vaccine and many potent antimicrobial agents and treatment regimens. However, the course of history is often not without some irony, commonly perceived as being unpredictable by those who find themselves immersed in history's path. In this sense, and despite the advances that were made in diagnostics and treatment during the past 70 years, TB continues to challenge mankind on numerous levels even today. The most recent emergence of multidrug-resistant and extensively-drug-resistant strains of Mycobacterium tuberculosis is only a small but significant reflection of the ongoing challenges in the attempt of eradicating this disease. Here we provide a review of the historic aspects of TB leading to a discussion of the current state of the approach to antituberculous treatment, including the aspects of microbiology, diagnostics, antimicrobial therapy, and public health.

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Resurgent Tuberculosis in New York City: Human Immunodeficiency Virus, Homelessness, and the Decline of Tuberculosis Control Programs

Cited by 589 publications

References 7 publications

Missed Opportunities for Preventing Tuberculosis Among Children Younger Than Five Years of Age

Missed Opportunities for Preventing Tuberculosis Among Children Younger Than Five Years of Age

Tuberculosis among Aboriginal and Nonaboriginal Persons in British Columbia

Tuberculosis: From an Untreatable Disease in Antiquity to an Untreatable Disease in Modern Times?

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