Tuberculosis contact-tracing among Syrian refugee populations: lessons from Jordan

Hosten, Edouard; Mehta, Mandana; André, Emmanuel; Rumman, Khaled Abu; Linden, Dimitri Van der

doi:10.1186/s13031-018-0164-y

Cited by 15 publications

(16 citation statements)

References 18 publications

(20 reference statements)

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“…In the current study, as in previous studies, smear positivity of the index case was a strong risk factor for LTBI for all contacts combined [8,10,16]. However, when stratifying by age, this association completely dissipated for contacts below 15 years of age suggesting that children are also at high risk to be infected by smear negative cases.…”

Section: Discussionsupporting

confidence: 82%

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Implementing contact tracing for tuberculosis in Kyrgyz Republic and risk factors for positivity using QuantiFERON-TB Gold plus

et al. 2020

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Background Effective active case finding (ACF) activities are essential for early identification of new cases of active tuberculosis (TB) and latent TB infection (LTBI). Accurate diagnostics as well as the ability to identify contacts at high risk of infection are essential for ACF, and have not been systematically reported from Central Asia. The objective was to implement a pilot ACF program to determine the prevalence and risk factors for LTBI and active TB among contacts of individuals with TB in Kyrgyz Republic using Quantiferon-TB Gold plus (QuantiFERON). Methods An enhanced ACF project in the Kyrgyz Republic was implemented in which close and household (home) contacts of TB patients from the Issyk-Kul Oblast TB Center were visited at home. QuantiFERON and the tuberculin skin test (TST) alongside clinical and bacteriological examination were used to identify LTBI and active TB cases among contacts. The association for QuantiFERON positivity and risk factors were analysed and compared to TST results. Results Implementation of ACF with QuantiFERON involved close collaboration with the national sanitary and epidemiological services (SES) and laboratories in the Kyrgyz Republic. From 67 index cases, 296 contacts were enrolled of whom 253 had QuantiFERON or TST results; of those 103 contacts had LTBI (positive TST or IGRA), and four (1.4%) active TB cases were detected. Index case smear microscopy (OR 1.76) and high household density (OR 1.97) were significant risk factors for QuantiFERON positivity for all contacts. When stratified by age, association with smear positivity disappeared for children below 15 years. TST was not associated with any risk factor. Conclusions This is the first time that ACF activities have been reported for Central Asia, and provide insight for implementation of effective ACF in the region. These ACF activities using QuantiFERON led to increase in the detection of LTBI and active cases, prior to patients seeking treatment. Household density should be taken into consideration as an important risk factor for the stratification of future ACF activities.

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Section: Discussionsupporting

confidence: 82%

“…Stratified analysis was separately conducted for adults (≥15 years) and children (< 15 years) due to an association of Quan-tiFERON positivity with age [15]. Analysis was further stratified by index case smear results [16]. Significant differences were those with a p ≤ 0.05.…”

Section: Statistical Analysesmentioning

confidence: 99%

Implementing contact tracing for tuberculosis in Kyrgyz Republic and risk factors for positivity using QuantiFERON-TB Gold plus

et al. 2020

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“…Of note, all cases age less than 15 had complete investigations. A recent study in Jordan of contact investigations among Syrian refugee TB cases found a high proportion of contacts were investigated, but noted a need for increased attention to children under 5 [22]. In this evaluation, there were insufficient data on diagnostic tests or treatments provided to investigated contacts to evaluate the effectiveness of the investigations.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of a tuberculosis case-finding and treatment program among Syrian refugees—Jordan and Lebanon, 2013–2015

Boyd

Cookson

Almashayek³

et al. 2019

Confl Health

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Background The displacement crisis in Syria poses challenges for tuberculosis (TB) control across the region. Since 2012 in Jordan and 2013 in Lebanon, the International Organization for Migration (IOM) has supported the National TB Program (NTP) in detecting and treating TB among Syrian refugees. In December 2016, IOM asked US Centers for Disease Control and Prevention (CDC) staff to evaluate its program of support to Jordan and Lebanon’s NTPs for TB control among Syrian refugees. This manuscript focuses on case-finding, including contact investigations, and treatment components of the IOM program during 2013–2015 in Jordan and 2015 in Lebanon. Methods The evaluation consisted of a retrospective review of de-identified Jordan and Lebanon line lists of TB cases and of investigated contacts (Lebanon only). Syrian refugee TB cases were categorized by sex, age group (age < 5 years, 5–14 years, ≥15 years), TB type (pulmonary versus extra-pulmonary), and additionally in Jordan, by refugee camp status (residence in versus outside a refugee camp), to evaluate differences in treatment completion and contact investigation. Results In Jordan, Syrian refugee cases represented 24.4% of TB cases in 2013, when Syrian refugees made up 6.8% of the country’s population, and 13.8% of TB cases in 2015, when Syrians made up 8.3% of the total population. In Lebanon in 2015, Syrian refugee cases represented 21.4% of TB cases, when Syrians made up 20.1% of the total population. In Jordan, the proportion of Syrian TB cases residing in refugee camps (29.3%) was higher than the proportion of Syrians refugees residing in camps (17.1%). Of Syrian TB cases in 2015, 94.8% in Jordan and 87.8% in Lebanon completed treatment. In Lebanon, among Syrian TB cases with household contacts listed, contact investigation was completed for 77.8% of cases. Conclusion IOM’s program of NTP support provides critical TB services for Syrian refugees with high treatment completion rates. More community and health practitioner outreach for enhanced active case finding among community-based Syrian refugees in Jordan may improve TB case detection in populations outside of refugee camps. Thorough contact investigations need continued emphasis, including completely recording investigations in both countries, to find active TB cases.

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“…The risk of tuberculosis in Jordan is relatively low and estimated to be 5.8 cases per 100,000 inhabitants per year. 23 Tuberculosis was ruled out through negative acid fast bacilli and mycobacterial culture from bronchoalveolar lavage. Negative purified protein derivative testing was utilized in patients who declined bronchopscopy for bronchoalevolar lavage or when the procedure was not feasible at that time or clinically contraindicated.…”

Section: Methodsmentioning

confidence: 99%

Sarcoidosis in Jordan: A Study of the Clinical Phenotype and Disease Outcome

et al. 2020

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Objectives: This study aims to evaluate the clinical phenotypic features of sarcoidosis in a single-center academic hospital in Jordan. Patients and methods: A retrospective file review was performed at an academic medical center in Jordan that included all patients diagnosed with sarcoidosis between January 2000 and December 2018. A total of 150 patients with sarcoidosis (38 males, 112 females; mean age 47.8±11.7 years; range, 17 to 79 years) were evaluated. Clinical data extracted from the files included the sex of the patient, the age at time of diagnosis, diagnosis date, the season during which the diagnosis was established, and smoking history. Biopsy histopathology, spirometry, nerve conduction, echocardiography, and imaging reports including plain radiographs, ultrasonographic, magnetic resonance and computed tomography reports were reviewed. Data including laboratory values, medication usage, clinical outcomes, and morbidity/mortality were collected. Pulmonary function tests including spirometry and lung volumes along with the diffusing capacity for carbon monoxide were reviewed for the presence of restriction, obstruction or reduction in the diffusion capacity of carbon monoxide. Identification of extra-thoracic organ involvement was determined in each patient in accordance with the criteria suggested by the updated World Association of Sarcoidosis and Other Granulomatous Disorders. Results: A total of 77.3% of the patients were diagnosed by biopsy. One case of Lofgren's syndrome was identified. Of the patients, 18.0% had isolated pulmonary sarcoidosis, 75.3% had pulmonary and extra-pulmonary sarcoidosis and 6.7% had isolated extra-pulmonary sarcoidosis while 81.3% had respiratory symptoms, mostly shortness of breath and cough. Extra-thoracic organ involvement mostly involved the musculoskeletal system (33%) followed by the skin (20%). Female patients had more extra-thoracic involvement but the sex difference was only statistically significant for cutaneous involvement. Of the patients, 84% received treatment while 20% had disease remission during the first two years after diagnosis and 70% required treatment beyond two years after diagnosis. Conclusion: Various sarcoidosis clinical phenotypes are seen among Jordanian patients. Jordanian females are more affected by the disease and have more extra-thoracic involvement compared to male patients. A large number of the study patients received treatment.

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Tuberculosis contact-tracing among Syrian refugee populations: lessons from Jordan

Cited by 15 publications

References 18 publications

Implementing contact tracing for tuberculosis in Kyrgyz Republic and risk factors for positivity using QuantiFERON-TB Gold plus

Implementing contact tracing for tuberculosis in Kyrgyz Republic and risk factors for positivity using QuantiFERON-TB Gold plus

An evaluation of a tuberculosis case-finding and treatment program among Syrian refugees—Jordan and Lebanon, 2013–2015

Sarcoidosis in Jordan: A Study of the Clinical Phenotype and Disease Outcome

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