MyMedR

BACKGROUND: Source case investigation, for children with tuberculosis (TB), is conducted to establish the source of infection and to minimize the extent of on-going transmission from infectious persons in the community. The aim of the study was to evaluate the secondary TB cases and to investigate the risk factors in developing TB among the household contacts (HHC) of children with active TB.

METHODS: A prospective cross-sectional study was conducted where 443 caregivers, of 508 children with active TB receiving treatment, were interviewed using a structured questionnaire. Logistic regression analysis was used to examine the risk factors for TB.

RESULTS: A total of 2397 family members at the median of 5 persons were recorded. Of these, 223 (9.3%) were screened on symptoms basis and 35 (15.7%) of these contacts were diagnosed with TB. Multivariate analysis revealed HHC with TB (OR = 15.288, 95% CI: 5.378-43.457), HHC with smoking (OR = 7.094, 95% CI: 2.128-23.648), and contact of > 18 h with TB individual (OR = 4.681, 95% CI: 1.198-18.294) as statistically significant risk factors of TB among the HHC.

CONCLUSION: With the current system of contact screening for TB, only 9.3% of all HHC were screened. The low rates of contacts screened are possibly a repercussion of the passive nature of the program, which mainly depend on distinctive clinical symptoms being experienced by the contacts. Strategies are required to certify adherence with contact screening among children with active TB and to critically consider the factors responsible for TB transmission.

Matched MeSH terms: Tuberculosis, Pulmonary/prevention & control*

Fulltext BCG programme in the Republic of Singapore

Chew CH, Hu PY

Singapore Med J, 1974 Dec;15(4):241-5.

PMID: 4549136

Mass BCG Vaccination is an effective and an inexpensive method of tuberculosis control. In Singapore, a nation wide BCG Vaccination programme was implemented in 1957, and from 1957 to 1972, i.e. a 16 year period, over 1 million vaccinations had been performed: 680,098 for infants, 512,797 for school students, 49,417 for contacts of tuberculosis patients and 7,775 for other special groups. The coverage of newborn infants has been over 90% from 1967 to 1972. In 1972, it was estimated that 90% of primary school children and 75% of secondary school students have been covered with BCG vaccinations. Although no controlled studies have been done in Singapore, it is observed from our analysis that the BCG programme has contributed in no small measure to the decline in tuberculosis incidence and mortality rates. Thus for 1972, the tuberculosis incidence rates per 100,000 were 5 for the BCG vaccinated group and 37 for the non-vaccinated group of primary school students, and 34 and 127 for the corresponding groups of secondary school students. In 1956, the death rate per 100,000 of respiratory tuberculosis was 4 and that of non-respiratory tuberculosis was 23 for children aged 4 and below, and the corresponding rates were 0.5 and 6.7 for those aged 5 to 9, and 0.8 and 3.7 for the group aged 10 to 14. In 1971 there were no tuberculosis deaths in children under 10 years of age, and the death rates for the age group 10-14 were 0.3 per 100,000 for either form of 241 tuberculosis.

Matched MeSH terms: Tuberculosis, Pulmonary/prevention & control*

Fulltext Case-finding for pulmonary tuberculosis in Penang

Hooi LN

Med J Malaysia, 1994 Sep;49(3):223-30.

PMID: 7845270

The process of case-finding was studied in 100 consecutive patients with pulmonary tuberculosis treated by the Chest Clinic, Penang Hospital. The median time from the onset of the illness until the initial medical consultation was two weeks (patient's delay). This delay was longer in males, patients with lower than secondary education and drug abusers. Only 47% of patients were put on treatment with a correct diagnosis within one month of the first consultation (doctor's delay). Almost all patients had at least one symptom suggestive of tuberculosis at presentation and the mean number of consultations before diagnosis was three. Patients who first visited government medical facilities had shorter doctor's delay than those who first saw private practitioners, and patients who first consulted a private practitioner were the least likely to be appropriately investigated by sputum examination and chest radiography. The median total delay was three months and at the time of diagnosis, 95% of patients had moderate or far advanced disease radiologically. In order to shorten doctor's delay, all medical practitioners, especially those in the private sector, should be made aware of the importance of early diagnosis and the proper management of tuberculosis. Health education campaigns for the public should also be undertaken to shorten patient's delay.
Study site: Chest clinic, Hospital Pulau Pinang, Malaysia

Matched MeSH terms: Tuberculosis, Pulmonary/prevention & control*

Fulltext Protective effect of a lipid-based preparation from Mycobacterium smegmatis in a murine model of progressive pulmonary tuberculosis

García Mde L, Borrero R, Lanio ME, Tirado Y, Alvarez N, Puig A, et al.

Biomed Res Int, 2014;2014:273129.

PMID: 25548767 DOI: 10.1155/2014/273129

A more effective vaccine against tuberculosis (TB) is urgently needed. Based on its high genetic homology with Mycobacterium tuberculosis (Mtb), the nonpathogenic mycobacteria, Mycobacterium smegmatis (Ms), could be an attractive source of potential antigens to be included in such a vaccine. We evaluated the capability of lipid-based preparations obtained from Ms to provide a protective response in Balb/c mice after challenge with Mtb H37Rv strain. The intratracheal model of progressive pulmonary TB was used to assess the level of protection in terms of bacterial load as well as the pathological changes in the lungs of immunized Balb/c mice following challenge with Mtb. Mice immunized with the lipid-based preparation from Ms either adjuvanted with Alum (LMs-AL) or nonadjuvanted (LMs) showed significant reductions in bacterial load (P < 0.01) compared to the negative control group (animals immunized with phosphate buffered saline (PBS)). Both lipid formulations showed the same level of protection as Bacille Calmette and Guerin (BCG). Regarding the pathologic changes in the lungs, mice immunized with both lipid formulations showed less pneumonic area when compared with the PBS group (P < 0.01) and showed similar results compared with the BCG group. These findings suggest the potential of LMs as a promising vaccine candidate against TB.

Matched MeSH terms: Tuberculosis, Pulmonary/prevention & control*

Mycobacterium smegmatis proteoliposome induce protection in a murine progressive pulmonary tuberculosis model

Tirado Y, Puig A, Alvarez N, Borrero R, Aguilar A, Camacho F, et al.

Tuberculosis (Edinb), 2016 12;101:44-48.

PMID: 27865396 DOI: 10.1016/j.tube.2016.07.017

Tuberculosis (TB) remains an important cause of mortality and morbidity. The TB vaccine, BCG, is not fully protective against the adult form of the disease and is unable to prevent its transmission although it is still useful against severe childhood TB. Hence, the search for new vaccines is of great interest. In a previous study, we have shown that proteoliposomes obtained from Mycobacterium smegmatis (PLMs) induced cross reactive humoral and cellular response against Mycobacterium tuberculosis (Mtb) antigens. With the objective to evaluate the protective capability of PLMs, a murine model of progressive pulmonary TB was used. Animals immunized with PLMs with and without alum (PLMs/PLMsAL respectively) showed protection compared to non-immunized animals. Mice immunized with PLMsAL induced similar protection as that of BCG. Animals immunized with BCG, PLMs and PLMsAL showed a significant decrease in tissue damage (percentage of pneumonic area/lung) compared to non-immunized animals, with a more prominent effect in BCG vaccinated mice. The protective effect of the administration of PLMs in mice supports its future evaluation as experimental vaccine candidate against Mtb.

Matched MeSH terms: Tuberculosis, Pulmonary/prevention & control*

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

Reid MJA, Arinaminpathy N, Bloom A, Bloom BR, Boehme C, Chaisson R, et al.

Lancet, 2019 Mar 30;393(10178):1331-1384.

PMID: 30904263 DOI: 10.1016/S0140-6736(19)30024-8

Matched MeSH terms: Tuberculosis, Pulmonary/prevention & control*

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