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Available from Available from A cluster of tuberculosis cases linked to smoking: An under-recognized challenge for tuberculosis elimination.

ABSTRACT: Background:Smoking is known to increase the risk of tuberculosis (TB) infection, active TB disease, relapse following treatment and death from TB, but its significance is often underappreciated as a potentially reversible risk factor in public health and clinical TB practice in Canada. Objective:To review the current evidence on smoking and the risk of TB, describe a cluster investigation of local TB transmission related to smoking in Toronto, Ontario, and discuss the practical implications of smoking for TB elimination in Canada. Investigation and public health response:Three TB cases were identified at the same workplace over a two year period. All three strains matched on genotyping. Extensive interviews with the cases and workplace / building managers confirmed that the three cases did not work or socialize together. The only epidemiologic link identified was that all three were regular smokers and used the same location outside the building for smoke breaks. A building ventilation assessment confirmed that unfiltered air was not recirculated between floors. Based on the epidemiological and laboratory evidence, we determined that transmission likely occurred at the partly-sheltered smoking area outside of the worksite. We established and advertised an active case-finding clinic on-site to all workers who frequented smoking areas near the building. Of 60 individuals screened with tuberculin skin testing (TST), no additional active TB cases were identified. One Canadianborn person was found to be TST positive. We also offered TB education sessions to all staff in the building, and used the opportunity to promote smoking cessation for interested individuals. Conclusion:This cluster shows compelling evidence for smoking-related transmission of TB in Toronto. The World Health Organization has called for integration of anti-smoking efforts as a key strategy toward TB elimination. Opportunities to integrate smoking and TB work in Canada include assessment for smoking-related transmission during contact investigations, routine use of smoking cessation supports for contacts and others with latent tuberculosis infection as well as those with active TB, and public health outreach.

SUBMITTER: Rea E

PROVIDER: S-EPMC6449123 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Available from Available from A cluster of tuberculosis cases linked to smoking: An under-recognized challenge for tuberculosis elimination.

Rea E E Leung T T

Canada communicable disease report = Releve des maladies transmissibles au Canada 20180301 3-4

<h4>Background</h4>Smoking is known to increase the risk of tuberculosis (TB) infection, active TB disease, relapse following treatment and death from TB, but its significance is often underappreciated as a potentially reversible risk factor in public health and clinical TB practice in Canada.<h4>Objective</h4>To review the current evidence on smoking and the risk of TB, describe a cluster investigation of local TB transmission related to smoking in Toronto, Ontario, and discuss the practical im ...[more]

PMID: 31007616

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Project description:BACKGROUND: In malaria endemic areas, continuous exposure to Plasmodium parasites leads to asymptomatic carriers that provide a fundamental reservoir of parasites, contributing to the persistence of malaria transmission. Therefore, in the present investigation, the presence and prevalence of malaria asymptomatic cases were determined to evaluate the reservoir of infection in two malaria endemic areas with a previous history of malaria transmission in the south of Iran, Bashagard and Ghale-Ganj districts of Hormozgan and Kerman provinces, respectively, where malaria transmission has been drastically reduced in the recent years. METHODS: The population samples (n = 500 from each of the studied areas) were randomly collected from non-febrile, long-term residing, aged two to over 60 years, during 20092010. Three identical surveys were carried out in both study areas and in each phase all the consent participants were interviewed and clinically examined. In all, three surveys to detect hidden parasite reservoirs (both Plasmodium falciparum and Plasmodium vivax), thick and thin blood smears and a highly sensitive nested-PCR were applied. In addition, the sero-prevalence survey for detecting malaria exposure was done by using a serological marker. RESULTS: In this study, P. vivax and P. falciparum parasites were not detected by light microscopy and nested-PCR assay in all three surveys of samples. Antibody responses against P. vivax and P. falciparum were detected in 1% and 0.2% of the total examined individuals, respectively, in Bashagard district. Regarding to Ghale-Ganj district, about 0.9% of the individuals had IgG -specific antibody to P. vivax at the first and second surveys, but at the third survey 0.45% of the participants had positive antibody to P. vivax parasite. IgG -specific antibody to P. falciparum was detected in 0.2% of the participants at the first and follow-up surveys. The overall regional differences were not statistically significant (P > 0.05). CONCLUSION: Taken together, the lack of asymptomatic carrier with the evidence of extremely low sero-positive to both P. vivax and P. falciparum among examined individuals supported the limited recent transmission in the studied areas and, therefore, these parts of Iran have potential to eliminate the disease in the next few years. However, continued follow up and action are still needed in both studied areas and also in their neighbouring province, Sistan and Baluchistan, which has the highest reported cases of malaria in Iran and also, has the largest border line with Afghanistan and Pakistan, with no elimination activities. This data will provide useful information for managing elimination activities in Iran.

Project description:BackgroundWhile traditional epidemiological approaches have supported significant reductions in malaria incidence across many countries, higher resolution information about local and regional malaria epidemiology will be needed to efficiently target interventions for elimination. The application of genetic epidemiological methods for the analysis of parasite genetics has, thus far, primarily been confined to research settings. To illustrate how these technical methods can be used to advance programmatic and operational needs of National Malaria Control Programmes (NMCPs), and accelerate global progress to eradication, this manuscript presents seven use cases for which genetic epidemiology approaches to parasite genetic data are informative to the decision-making of NMCPs.MethodsThe use cases were developed through a highly iterative process that included an extensive review of the literature and global guidance documents, including the 2017 World Health Organization's Framework for Malaria Elimination, and collection of stakeholder input. Semi-structured interviews were conducted with programmatic and technical experts about the needs and opportunities for genetic epidemiology methods in malaria elimination.ResultsSeven use cases were developed: Detect resistance, Assess drug resistance gene flow, Assess transmission intensity, Identify foci, Determine connectivity of parasite populations, Identify imported cases, and Characterize local transmission chains. The method currently used to provide the information sought, population unit for implementation, the pre-conditions for using these approaches, and post-conditions intended as a product of the use case were identified for each use case.DiscussionThis framework of use cases will prioritize research and development of genetic epidemiology methods that best achieve the goals of NMCPs, and ultimately, inform the establishment of normative policy guidance for their uses. With significant engagement of stakeholders from malaria endemic countries and collaboration with local programme experts to ensure strategic implementation, genetic epidemiological approaches have tremendous potential to accelerate global malaria elimination efforts.

Project description:BackgroundChildren < 5 years old in contact with TB cases are at high risk for developing severe and fatal forms of TB. Contact investigation, BCG vaccination, and isoniazid preventive therapy (IPT) are the most effective strategies to prevent TB among children. However, the implementation of IPT faces challenges at several stages of the cascade of care of TB infection among children, particularly those less than 5 years old. In Peru, a large proportion of children do not complete IPT, which highlights the need to design effective interventions that enhance preventive therapy adherence and completion. Although the body of evidence for such interventions has grown, interventions in medium TB incidence settings are lacking. This study aims to test the effectiveness, acceptability, and feasibility of an intervention package to increase information and motivation to complete IPT among children < 5 who have been prescribed IPT.MethodsAn open-label, cluster-randomized superiority trial will be conducted in two districts in South Lima, Peru. Thirty health facilities will be randomized as clusters, 10 to the intervention and 20 to control (standard of care). We aim to recruit 10 children from different households in each cluster. Participants will be caretakers of children aged < 5 years old who initiated IPT. The intervention consists of educational material, and short message services (SMS) reminders and motivators. The primary outcomes will be the proportion of children who picked up > 90% of the 24 weeks of IPT (22 pick-ups) and the proportion of children who picked up the 24 weeks of IPT. The standard of care is a weekly pick-up with monthly check-ups in a health facility. Feasibility and acceptability of the intervention will be assessed through an interview with the caretaker.DiscussionUnfavorable outcomes of TB in young children, high effectiveness of IPT, and low rates of IPT completion highlight the need to enhance adherence and completion of IPT among children < 5 years old. Testing of a context-adapted intervention is needed to improve IPT completion rates and therefore TB prevention in young children.Trial registrationClinicalTrials.gov NCT03881228. Registered on March 19, 2019.

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Available from Available from A cluster of tuberculosis cases linked to smoking: An under-recognized challenge for tuberculosis elimination.

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Available from Available from A cluster of tuberculosis cases linked to smoking: An under-recognized challenge for tuberculosis elimination.

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