Turning off the tap: stopping tuberculosis transmission through active case-finding and prompt effective treatment

Abstract

To halt the global tuberculosis epidemic, transmission must be stopped to prevent new infections and new cases. Identification of individuals with tuberculosis and prompt initiation of effective treatment to rapidly render them non-infectious is crucial to this task. However, in settings of high tuberculosis burden, active case-finding is often not implemented, resulting in long delays in diagnosis and treatment. A range of strategies to find cases and ensure prompt and correct treatment have been shown to be effective in high tuberculosis-burden settings. The population-level effect of targeted active case-finding on reducing tuberculosis incidence has been shown by studies and projected by mathematical modelling. The inclusion of targeted active case-finding in a comprehensive epidemic-control strategy for tuberculosis should contribute substantially to a decrease in tuberculosis incidence.

Perfil epidemiológico da tuberculose no município de São Paulo de 2006 a 2013

“…The increase in diagnosis through active case search and contact investigation was verified in this study. Such actions are feasible and efficient to improve case detection and thus reduce transmission and incidence of TB, especially when targeted at at-risk groups, including children who are contacts of TB patients with positive smear microscopy 15,16 . However, it is worth mentioning that hospital and emergency services still represent an important part of the responsibility for diagnosing TB in the MSP.…”

Contact Investigation: A Priority for Tuberculosis Control Programs

“…Infectious, chemical, or toxic insults acting directly on the lung are key factors in ARDS, as are extrapulmonary infectious, chemical, or toxic insults, such as in secondary ARDS in abdominal disease. Sepsis, the other "queen" of the intensive care kingdom, is strictly interwoven with ARDS, which we consider per se an "organ-specific sepsis" due, in some cases, to the loss of compartmentalization (4). The hemodynamic effects and respiratory impairment of the septic state finally converge in the severe disturbances of the acid-base and electrolyte equilibrium.…”

Molecular, Spatial, and Field Epidemiology Suggesting TB Transmission in Community, Not Hospital, Gaborone, Botswana

“…Furthermore, the finding of recently infected persons suggests ongoing transmission of TB, which can be interrupted by prompt identification and treatment of undiagnosed cases (3). However, finding undiagnosed cases remains a challenge (4).…”