Search

BACKGROUND: One of the challenges of TB elimination in low-incidence countries is the relatively high incidence of TB in migrants in these countries, even after multiple years of residence.OBJECTIVE: To describe and compare TB incidence and characteristics of migrant TB patients residing in the Netherlands for at least (≥)5 years at diagnosis with non-foreign-born TB patients in order to identify additional strategies that could reduce TB incidence in the former group.METHODS: A retrospective cohort study was conducted in migrants from Somalia, Morocco, Suriname, Turkey and Indonesia who were diagnosed with TB in the Netherlands in 2003–2018. TB incidences were calculated and multivariate logistic regression was used to identify differences in characteristics of TB patients per country of birth compared to non-foreign-born patients.RESULTS: TB incidence was highest in individuals from Somalia (162.5/100,000 population in 2018), followed by individuals from Morocco (37.1/100,000). In the non-foreign-born population, TB incidence was 1.2/100,000. Differences in characteristics of TB patients compared to non-foreign-born patients varied by country of birth.CONCLUSION: Our findings underline the importance of being aware of the heterogeneity of TB incidence and characteristics of patients in the migrant population residing ≥5 years in the Netherlands.

Additional file 1.

Additional file 3.

Additional file 2.

Tuberculosis (TB) still occurs frequently in the Netherlands among immigrants from countries where the disease is highly endemic, despite the mandatory TB screening upon settling in the Netherlands. The TB-ENDPoint study shows that immigrants from populations at risk for TB are prepared to be screened for latent TB infection (LTBI) and to complete preventative treatment. Cost-effectiveness analysis will have to determine whether and in which target groups screening can replace the present X-ray screening for TB. A targeted approach, in which LTBI screening is combined with screening for other infectious diseases such as hepatitis B and C and HIV, could favourably influence cost-effectiveness. Further research into implementation, involving all stakeholders, would be useful to optimize combined screening.

The Xpert® MTB/RIF assay is being implemented as a substitute for sputum smear microscopy (SSM) in many low and high tuberculosis (TB) burden countries, including Brazil, a country with low multidrug resistance and moderate human immunodeficiency virus co-infection rates. Brazilian National TB Programme (NTP). We estimated the incremental cost-effectiveness ratio (ICER) of Xpert as a substitute for two SSM tests in the diagnosis of drug-susceptible TB. The costs for confirming each additional case and for avoiding treatment due to false-positive empirical diagnoses were estimated. The ICER was US$943 for each additional TB diagnosis and US$356 for each additional TB diagnosis with bacteriological confirmation, assuming 80% specificity of clinical diagnosis using both strategies. For every 100 000 patients with suspected TB, the NTP would spend an additional US$1.2 million per year to confirm 3344 more TB patients. The model was highly sensitive to specificity of clinical diagnosis after a negative test. Although the NTP has no threshold for cost-effectiveness, our model can provide support for decision makers in Brazil and other countries with a low prevalence of drug resistance among TB patients. Financial benefit can potentially be expected if physicians rely more on a negative Xpert result and empirical treatment is reduced

The immune regulatory mechanisms involved in the acquisition of Mycobacterium tuberculosis infection in children are largely unknown. We investigated the influence of parasitic infections, malnutrition and plasma cytokine profiles on tuberculin skin test (TST) positivity in Warao Amerindians in Venezuela. Pediatric household contacts of sputum smear-positive tuberculosis (TB) cases were enrolled for TST, chest radiograph, plasma cytokine analyses, QuantiFERON-TB Gold In-Tube (QFT-GIT) testing and stool examinations. Factors associated with TST positivity were studied using generalized estimation equations logistic regression models. Of the 141 asymptomatic contacts, 39% was TST-positive. After adjusting for age, gender and nutritional status, TST positivity was associated with Trichuris trichiura infections (OR 3.5, 95% CI 1.1-11.6) and low circulating levels of T helper 1 (Th1) cytokines (OR 0.51, 95% CI 0.33-0.79). Ascaris lumbricoides infections in interaction with Th2- and interleukin (IL)-10-dominated cytokine profiles were positively associated with TST positivity (OR 3.1, 95% CI 1.1-8.9 and OR 2.4,95% CI 1.04-5.7, respectively). A negative correlation of QFT-GIT mitogen responses with Th1 and Th2 levels and a positive correlation with age were observed (all p

In Kenya and Kazakhstan, integration of human immunodeficiency virus (HIV) testing results into the routine surveillance of multidrug-resistant tuberculosis (MDRTB) proved feasible and useful. The integration process improved overall data quality and data validation capacity, and integrated data are a useful addition to routine cohort and treatment outcome data. Besides their importance for individual patient care, they provide trends on the association of MDR-TB and HIV in the routine programme setting. They also form a useful epidemiological basis for more specific studies, such as on nosocomial outbreaks. Whether the system itself is sensitive enough to monitor possible outbreaks needs further investigation.

A 1999-2000 measles epidemic in the Netherlands started with an outbreak in an orthodox reformed elementary school with 7% vaccine coverage. The overall attack rate was 37%: 213 clinical cases among the 255 participating pupils (response 62%) and 327 household members. The attack rate ranged from 0% for the oldest groups of pupils to 88% for the youngest, who had not been exposed in previous measles epidemics. None of 25 vaccinated pupils had clinical symptoms. Among pupils with clinical symptoms, the self-reported complication rate was 25%. These data confirm that measles infection causes severe disease and that vaccination is the most effective means of preventing the disease and its complications. The data also show that clusters of persons refraining from vaccination interfere with measles elimination even in populations with very high overall vaccine coverage (96%).

SETTING: Kazakhstan is a country with a low HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome) burden but a high prevalence of multidrug-resistant tuberculosis (MDR-TB). METHODS: We describe the epidemiology of multidrug resistance and HIV among TB patients using the 2007-2011 national electronic TB register. RESULTS: HIV test results were available for 97.2% of TB patients. HIV prevalence among TB patients increased from 0.6% in 2007 to 1.5% in 2011. Overall 41.6% of patients had a positive smear at diagnosis 38.6% a positive culture and 51.7% either a positive smear or culture. Drug susceptibility testing (DST) results were available for 92.7% of culture-positive cases. Socio-economic factors independently associated with both HIV and MDR-TB were urban residency drug use homelessness and a history of incarceration. In adjusted analysis HIV positivity was not associated with MDR-TB (OR 1.0 95%CI 0.86-1.2). Overall among TB patients with DST and HIV test results available 65.0% were positive for neither HIV nor MDR-TB 33.5% only for MDR-TB 0.9% only for HIV and 0.6% for both HIV and MDR-TB. Among injection drug users 12.5% were positive for HIV and MDR-TB. CONCLUSION: We showed increasing HIV prevalence among TB patients in Kazakhstan. HIV was not an independent risk factor for MDR-TB but risk factors were largely overlapping and we did identify subgroups at particular risk of HIV-MDR-TB co-infection notably drug users. Enhanced efforts are necessary to provide care to these socially vulnerable populations.

Het Regenboog-project is een samenwerkingsverband tussen het RIVM, CBS en GGD Nederland en GGD'en. Het doel van het Regenboogproject is een beeld te krijgen van de gezondheidssituatie van de Nederlandse bevolking op het gebied van chronische en infectieziekten. Een aselecte steekproef wordt getrokken door het CBS. Bij deze personen wordt thuis de gezondheidsenquete afgenomen. Vervolgens wordt gevraagd om deel te nemen aan een aanvullend lichamelijk onderzoek op de GGD. Hierop reageert 60,9% positief. Het onderzoek op de GGD bestaat uit het invullen van een vragenlijst over infectieziekten, meting van bloeddruk, lengte, gewicht en middel-heupomtrek. Tot slot wordt er een gewrichtsfunctietest en 4 buisjes bloed afgenomen. Van de geinterviewde personen komt uiteindelijk 30,0 % op de GGD voor het lichamelijk onderzoek. De prevalentie van hypertensie is voor mannen 19% en vrouwen 16%. De prevalentie van overgewicht neemt toe met de leeftijd. De schatting van overgewicht blijkt sterk te verschillen tussen gerapporteerde en gemeten lengte en gewicht. Met name bij vrouwen is dit verschil duidelijk aanwezig. De onderzochte groep blijkt een bruikbare afspiegeling van de Nederlandse bevolking.

Het Regenboog-project is een samenwerkingsverband tussen het RIVM, CBS en GGD Nederland en GGD'en. Het doel van het Regenboogproject is een beeld te krijgen van de gezondheidssituatie van de Nederlandse bevolking op het gebied van chronische en infectieziekten. Een aselecte steekproef wordt getrokken door het CBS. Bij deze personen wordt thuis de gezondheidsenquete afgenomen. Vervolgens wordt gevraagd om deel te nemen aan een aanvullend lichamelijk onderzoek op de GGD. Hierop reageert 56,9% positief. Het onderzoek op de GGD bestaat uit het invullen van een vragenlijst over infectieziekten, meting van bloeddruk, lengte, gewicht en middel-heupomtrek. Tot slot wordt er een gewrichtsfunctietest en 4 buisjes bloed afgenomen. Van de geinterviewde personen komt uiteindelijk 28,0 % op de GGD voor het lichamelijk onderzoek. De prevalentie van hypertensie is voor mannen 40% en vrouwen 32%. De prevalentie van overgewicht neemt toe met de leeftijd. De schatting van overgewicht blijkt sterk te verschillen tussen gerapporteerde en gemeten lengte en gewicht. Met name bij vrouwen is dit verschil duidelijk aanwezig. De onderzochte groep blijkt een bruikbare afspiegeling van de Nederlandse bevolking.