Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-17 (of 17 Records) |
Query Trace: Jereb J[original query] |
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Delayed Tuberculosis Diagnoses During the COVID-19 Pandemic in 2020 - King County, Washington.
Narita M , Hatt G , Toren KG , Vuong K , Pecha M , Jereb JA , Goswami ND . Clin Infect Dis 2021 73 S74-S76 In 2020, a total of 92 tuberculosis (TB) cases were reported in Seattle and King County, Washington, 5% fewer than the median of 97 (range = 94 –132) reported during the same period 2015–2019 and 30% fewer than 132 cases reported in 2019. Interviews and chart reviews were completed as part of a public health investigation. This activity was reviewed by Centers for Disease Control and Prevention (CDC) and was conducted consistent with applicable federal law and CDC policy. Results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests performed prior to TB diagnosis were available to TB public health officials for 40 (43%) patients with TB: 3 had a positive result; 37 had negative results, with 12 having been tested twice or more. We were not able to verify SARS-CoV-2 testing status or results prior to TB diagnosis for 52 TB cases. We attempted to reach out to all pulmonary TB cases diagnosed in March 2020 or later and were able to interview 29 patients by telephone or in person about how pandemic coronavirus disease 2019 (COVID-19) affected their medical care. Four of them stated that their TB diagnosis had been delayed because of pandemic-related problems. Of these, 3 waited to seek care because of fear of contracting COVID-19, and one, patient 1, was told that she probably had COVID-19 by at least 2 healthcare providers. The stories of the following 3 patients who had prolonged respiratory illnesses with fever illustrate the delays in TB diagnosis during the COVID-19 pandemic. |
Confusion in the Genesis of Art and Disease: Charles Laval, Paul Gauguin, and Tuberculosis
Chorba T , Jereb J . Emerg Infect Dis 2020 26 (3) 634-5 Charles Laval (1861–1894) was a Parisian painter whose brief life ended in an untimely death from underlying tuberculosis. He was a colleague and contemporary of two other post-Impressionists: Vincent van Gogh (1853–1890) and Paul Gauguin (1848–1903). In part because of misattribution, Laval’s work has receded into a historical footnote to the career of Gauguin, whose output far exceeded that of Laval. Gauguin, among the most renowned of the late 19th century European artists, was a pioneer of the Synthetist school of painting. This post-Impressionist movement encouraged artists to depict their emotions about the subject, beyond its outward appearance, with bold displays of color, relaxation of exactitude, and portrayal of form based on memory. | | Laval studied under realist painter Léon Bonnat at the École des Beaux-Arts in Paris. In the summer of 1886, he became acquainted with van Gogh and Gauguin at Pont-Aven, a growing artist colony in Brittany. In April 1887, Laval and Gauguin set sail for Panama, an adventure that was ostensibly pursued for employment at the invitation of Gauguin’s brother-in-law, a Chilean with business interests in Panama. In June 1887, after several misadventures, Laval and Gauguin left Panama for Martinique, where they painted together before returning to France in November of the same year. |
High rate of treatment completion in program settings with 12-dose weekly isoniazid and rifapentine (3HP) for latent Mycobacterium tuberculosis infection
Sandul AL , Nwana N , Holcombe JM , Lobato MN , Marks S , Webb R , Wang SH , Stewart B , Griffin P , Hunt G , Shah N , Marco A , Patil N , Mukasa L , Moro RN , Jereb J , Mase S , Chorba T , Bamrah-Morris S , Ho CS . Clin Infect Dis 2017 65 (7) 1085-1093 Background: RCTs demonstrated the newest LTBI regimen, 12 weekly doses of directly observed isoniazid and rifapentine (3HP), as efficacious as 9 months of isoniazid (9H) with a greater completion rate (82% versus 69%); however, 3HP has not been assessed in routine health care settings. Methods: Observational cohort of LTBI patients receiving 3HP through 16 US programs was used to assess treatment completion, adverse drug reactions (ADRs), and factors associated with treatment discontinuation. Results: Of 3288 patients eligible to complete 3HP, 2867 (87.2%) completed treatment. Children 2-17 years had the highest completion rate, 94.5% (155/164). Patients reporting homelessness had a completion rate of 81.2% (147/181). In univariable analyses, discontinuation was lowest among children (relative risk [RR], 0.44 [95% CI, 0.23-0.85]; P = .014), and highest in persons ≥65 years (RR, 1.72 [95% CI, 1.25-2.35] P = .001). In multivariable analyses, discontinuation was lowest among contacts of patients with TB disease (adjusted relative risk [ARR], 0.68 [95% CI, 0.52-0.89]; P = .005), and students (ARR, 0.45 [95% CI, 0.21-0.98]; P = .044); highest with incarceration (ARR, 1.43 [95% CI, 1.08-1.89]; P=.013) and homelessness (ARR, 1.72 [95% CI, 1.25-2.39]; P = .001). ADRs were reported by 1174 (35.7%) patients, of whom 891 (76.0%) completed treatment. Conclusions: Completion of 3HP in routine health care settings was greater overall than rates reported from clinical trials, and greater than historically observed using other regimens among reportedly nonadherent populations. Widespread use of 3HP for LTBI treatment could accelerate elimination of TB disease in the United States. |
Keeping it in the family: The childhood burden of tuberculosis
Chorba T , Jereb J . Emerg Infect Dis 2017 23 (3) 561-562 My art must be seen against the background of the heavy freight of my inheritance,–tuberculosis on Mother’s side, mental illness on Father’s side (Grandfather’s phthisis),–my art is a self confession… The illness followed me all through my childhood and youth,–the germ of consumption placed its blood-red banner victoriously on the white handkerchief. | —Edvard Munch | Edvard Munch, born in December 1863, was the second of 5 children of Laura Bjølstad and Christian Munch, a physician, in Løten, Norway. As an infant, he moved with his family to Christiania (now Oslo). There Laura died in 1868 of tuberculosis (TB), after which Christian dealt with profound depression. At the time of Laura’s death, 14 years before Robert Koch announced that Mycobacterium tuberculosis was the cause of the disease, an estimated 285 persons per 100,000 died of phthisis (pulmonary TB or a similar progressive systemic disease) annually in Norway; most deaths occurred among those of child-bearing age. In 1896–1900, after the technique for diagnostic sputum smears was widely known and practiced, the death rate from TB in Norway was 415 per 100,000 for women 20–39 years of age; the difference from the earlier number perhaps reflected increased diagnostic acumen. |
Interpreting false positive tuberculosis tests in occupational screening: The fault of the test, the testing schedule, or both?
Jereb JA . Ann Am Thorac Soc 2016 13 (7) 1189-90 After reviewing their experiences with an interferon gamma release assay (IGRA) for annually testing emergency responders, Gamsky and colleagues reported excessive positive results, with 27.4% (7 years cumulative) for one subset of workers (1). The positive results were deemed false, based on retesting to the point of reversion to negative. | The results from all the cellular immunity tests for Mycobacterium tuberculosis infection (i.e., the skin test with either of two tuberculin solutions and the two commercial IGRA methods) are influenced by biological factors and technical problems with the tests. Although more than 80 years of experience with the current tuberculin skin test (TST) method has taught us to anticipate problems, we are in the early phases of learning about the IGRA methods. Gamsky already reported a high rate of false-positive IGRA results that were attributed to endotoxin-contaminated blood collection tubes at his setting during 2007; substituting new tubes corrected the problem (2). He did not indicate whether those earlier data were included in the present study, although the periods overlap. |
Possible Airborne Person-to-Person Transmission of Mycobacterium bovis - Nebraska 2014-2015.
Buss BF , Keyser-Metobo A , Rother J , Holtz L , Gall K , Jereb J , Murphy CN , Iwen PC , Robbe-Austerman S , Holcomb MA , Infield P . MMWR Morb Mortal Wkly Rep 2016 65 (8) 197-201 Mycobacterium bovis, one of several mycobacteria of the M. tuberculosis complex, is a global zoonotic pathogen that primarily infects cattle. Humans become infected by consuming unpasteurized dairy products from infected cows; possible person-to-person airborne transmission has also been reported. In April 2014, a man in Nebraska who was born in Mexico was determined to have extensive pulmonary tuberculosis (TB) caused by M. bovis after experiencing approximately 3 months of cough and fever. Four months later, a U.S.-born Hispanic girl from a nearby town who had been ill for 4-5 months was also determined to have pulmonary TB caused by M. bovis. The only social connection between the two patients was attendance at the same church, and no common dietary exposure was identified. Both patients had pulmonary cavities on radiography and acid-fast bacilli (AFB) on sputum-smear microscopy, indicators of being contagious. Whole-genome sequencing results of the isolates were nearly indistinguishable. Initial examination of 181 contacts determined that 39 (22%) had latent infection: 10 (42%) of 24 who had close exposure to either patient, 28 (28%) of 100 who were exposed to one or both patients in church, and one (2%) of 57 exposed to the second patient at a school. Latent infection was diagnosed in six contacts on follow-up examination, 2 months after an initial negative test result, for an overall latent infection rate of 25%. No infected contacts recalled consuming unpasteurized dairy products, and none had active TB disease at the initial or secondary examination. Persons who have M. bovis TB should be asked about consumption of unpasteurized dairy products (2), and contact investigations should follow the same guidance as for M. tuberculosis TB. |
Tuberculosis contact investigations - United States, 2003-2012
Young KH , Ehman M , Reves R , Maddox BL , Khan A , Chorba TL , Jereb J . MMWR Morb Mortal Wkly Rep 2016 64 1369-74 Mycobacterium tuberculosis is transmitted through the air from an infectious patient (index patient) to other persons (contacts) who share space. Exposure to M. tuberculosis can result in tuberculosis (TB) disease or latent TB infection (LTBI), which has no clinical symptoms or radiologic evidence of disease. The cycle of transmission can be ended by isolating and treating patients with TB disease, examining contacts, and treating LTBI to prevent progression to TB disease. CDC systematically collects aggregate data on contact investigations from the 50 states, the District of Columbia (DC), and Puerto Rico. Data from 2003-2012 were analyzed for trends in yields from contact investigations, in terms of numbers of contacts elicited and examined and the estimated number of TB cases averted through treatment of LTBI among contacts in 2012. During 2003-2012, the number of TB cases decreased, while the number of contacts listed per index patient with contacts elicited increased. In 2012, U.S. public health authorities reported 9,945 cases of TB disease (1) and 105,100 contacts. Among these contacts, 84,998 (80.9%) were examined; TB was diagnosed in 532 (0.6%) and LTBI in 15,411 (18.1%). Among contacts with LTBI, 10,137 (65.8%) started treatment, and 6,689 (43.4% of all contacts with LTBI) completed treatment. By investigating contacts in 2012, an estimated 128 TB cases (34% of all potential cases) over the initial 5 years were averted, but an additional 248 cases (66%) might have been averted if all potentially contagious TB patients had contacts elicited, all contacts were examined, and all infected contacts completed treatment. Enhancing contact investigation activities, particularly by ensuring completion of treatment by contacts recently infected with M. tuberculosis, is essential to achieve the goal of TB elimination. |
Pharmacokinetics and dosing of levofloxacin in children treated for active or latent multidrug-resistant tuberculosis, Federated States of Micronesia and Republic of the Marshall Islands
Mase SR , Jereb JA , Gonzalez D , Martin F , Daley CL , Fred D , Loeffler A , Menon L , Morris SB , Brostrom R , Chorba T , Peloquin CA . Pediatr Infect Dis J 2015 35 (4) 414-21 BACKGROUND: In the Federated States of Micronesia (FSM) and then the Republic of the Marshall Islands (RMI), levofloxacin pharmacokinetics (PK) were studied in children receiving directly observed once-daily regimens (10 mg/kg, age <5 years; 15 20 mg/kg, age ≤5 years) for either multidrug-resistant tuberculosis (MDR TB) disease or latent infection after MDR TB exposure, to inform future dosing strategies. METHODS: Blood samples were collected at 0 (RMI only), 1, 2, and 6 hours (50 children, aged 6 months to 15 years) after oral levofloxacin at >6 weeks of treatment. Clinical characteristics and levofloxacin Cmax, elimination half-life (t1/2), and area under the curve from 0 to 24 hours (AUC0-24 hours * microg/mL) were correlated to determine optimal dosage and to examine associations. Population PK and target attainment were modeled. With results from FSM, dosages were increased in RMI toward the target maximal drug concentration (Cmax) for Mycobacterium tuberculosis, 8-12 microg/ml. RESULTS: Cmax correlated linearly with per-weight dosage. Neither Cmax nor t1/2 was associated with gender, age, body mass index, concurrent medications, or pre-dose meals. At levofloxacin dosage of 15-20 mg/kg, Cmax ≥ 8 microg/ml was observed, and modeling corroborated a high target attainment across the ratio of the area under the free-concentration-versus-time curve to minimum inhibitory concentration (fAUCss,0-24/MIC) values. CONCLUSIONS: Levofloxacin dosage should be 15-20 mg/kg for Cmax ≥ 8 microg/ml and a high target attainment across fAUCss,0-24/MIC values in children ≥2 years of age. |
Surgical interventions for drug-resistant tuberculosis: a systematic review and meta-analysis
Marrone MT , Venkataramanan V , Goodman M , Hill AC , Jereb JA , Mase SR . Int J Tuberc Lung Dis 2013 17 (1) 6-16 BACKGROUND: With the emergence of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB), surgery, which had been replaced by short-course chemotherapy, is again being considered a viable treatment option. OBJECTIVE: To assess the literature on the effectiveness of surgical interventions in the treatment of drug-resistant TB. METHODS: Medline, EMBASE, and PubMed were searched from 1975 to April 2012 in addition to hand searching reference lists, and the International Journal of Tuberculosis and Lung Disease. Potentially relevant studies were assessed according to pre-defined eligibility criteria: MDR- and XDR-TB patients undergoing surgical and non-surgical treatment. Treatment outcomes were extracted according to internationally accepted definitions and included in meta-analyses using random effects models. RESULTS: Summary meta-analysis of 24 comparison studies revealed a significant association between surgery and successful treatment compared to non-surgical interventions (OR 2.24, 95%CI 1.68-2.97). A meta-analysis from 23 single-arm studies demonstrated that respectively 92% (95%CI 88.1-95) and 87% (95%CI 83-91) of surgical patients achieved successful short- and long-term outcomes. Subgroup analyses showed that favorable surgical outcomes were associated with increased drug resistance in studies reporting surgical and non-surgical treatment outcomes. CONCLUSIONS: While the results suggest that surgical intervention is associated with successful treatment outcomes in patients with drug-resistant TB, there is insufficient evidence to recommend surgery plus chemotherapy over chemotherapy alone, to evaluate the potential harm from surgery and to determine the optimal conditions for surgery. Controlled studies are needed to better assess the effectiveness of surgery and to investigate other contextual issues. |
Interferon-gamma release assays for prediction of tuberculosis
Kawamura LM , Grinsdale JA , Ho CS , Jereb JA . Lancet Infect Dis 2012 12 (8) 584 Molebogeng Rangaka and colleagues1 have comprehensively reviewed the prognostic characteristics of interferon-γ release assays (IGRAs). Their findings show that the advantages of these assays are not offset by any loss of ability to predict development of tuberculosis in people with latent Mycobacterium tuberculosis infection. | Studies that directly compared the assay with the tuberculin skin test confirm the low accuracy of both for estimation of prognosis; tuberculosis will never develop in most people with a positive result from either test, but tuberculosis will develop in some who had negative results. Although the accuracy of both tests is disappointing, IGRAs are no worse—and for some comparisons are better—than tuberculin skin test. | In USA, the benefits of IGRAs support their wide adoption. First, most of our tuberculosis caseload has shifted to BCG-vaccinated immigrant groups, and IGRAs have greater specificity in this group.2 Our experience in San Francisco, CA—where IGRAs have replaced tuberculin skin test in most settings—is that the proportion of immigrants and homeless people with positive test results decreased substantially after switching the in tests (table). The subsequent decrease in medical assessment improves efficiency and cost-effectiveness and fewer patients are inconvenienced by treatment and its toxic effects than if tuberculin skin test was used. The studies reviewed by Rangaka and colleagues report that IGRAs offer these benefits with fewer false-negative results than tuberculin skin test. |
Monitoring for tuberculosis drug hepatotoxicity: moving from opinion to evidence
Saukkonen JJ , Powell K , Jereb JA . Am J Respir Crit Care Med 2012 185 (6) 598-9 The treatment of tuberculosis (TB) is complicated by drug-induced hepatotoxicity, with reported rates ranging widely, from approximately 3 to 25%, depending on the hepatotoxicity definitions, the regimens, the methodologies, and the study populations (1). Several recent studies utilizing American Thoracic Society (ATS) or similar transaminase criteria for hepatotoxicity place the rate at about 3 to 13% (2–5). However, not all increases in serum alanine aminotransferase concentration (ALT) indicate true drug-induced liver injury (DILI). Hepatic adaptation (i.e., temporary stress or mild injury to the liver) occurs in 20% or more of patients treated with anti-TB medications (1, 6). Current recommendations (1, 7) are to obtain baseline biochemical testing in all patients being treated for TB, and then to target those deemed to be at risk for drug-induced liver injury for serial ALT monitoring. Because we lack a robust evidence base, these recommendations are based on observational studies and expert opinion. We need more data—and could readily generate a wealth of data—to help guide TB drug hepatotoxicity monitoring strategies. | In this issue of the Journal, Singanayagam and colleagues from Imperial College London (ICL) (pp. 653–659) provided a fresh look at monitoring for hepatotoxicity during anti-TB treatment (8). In a single-center retrospective cohort study, they monitored 288 patients for hepatotoxicity. They compared the utility of a uniform scheme of measuring the baseline and the 2-week serum ALT concentrations to that of the ATS recommendations, which target only patients with putative hepatotoxicity-predictive factors for serial biochemical monitoring after a baseline test (1, 7). Intensive early ALT monitoring in the ICL study detected DILI within 2 weeks in about 4% of patients, but was poor at predicting who would be among the 3% of patients having DILI later (8). The forecasting ability of the ATS putative predictive clinical factors for DILI (1, 7) was similarly mediocre. |
Tuberculin skin test conversions in hospital housekeepers
Jereb JA , Privett TD , Pearson ML . Int J Tuberc Lung Dis 2012 16 (2) 279 In a recent edition of the Journal, Sherman and colleagues reported that compared to other groups of | health care workers, hospital housekeepers had the | highest rate of tuberculin skin test conversion during routine surveillance at a tertiary care hospital.1 | We found the same while investigating a nosocomial | multidrug-resistant tuberculosis outbreak at an urban community hospital in the early 1990s.2 Our | point-estimate of the period-adjusted conversion rate | for the housekeepers was 9.4 times the rate for hospital personnel who did not work in patient care areas, | such as clerical staff in medical records. We referenced two earlier reports of occupational skin test | surveillance with fi ndings similar to ours.3,4 |
Tuberculosis in indigenous peoples in the U.S., 2003-2008
Bloss E , Holtz TH , Jereb J , Redd JT , Podewils LJ , Cheek JE , McCray E . Public Health Rep 2011 126 (5) 677-89 OBJECTIVES: We examined trends and epidemiology of tuberculosis (TB) across racial/ethnic groups to better understand TB disparities in the United States, with particular focus on American Indians/Alaska Natives (AI/ANs) and Native Hawaiians/other Pacific Islanders (NH/PIs). METHODS: We analyzed cases in the U.S. National Tuberculosis Surveillance System and calculated TB case rates among all racial/ethnic groups from 2003 to 2008. Socioeconomic and health indicators for counties in which TB cases were reported came from the Health Resources and Services Administration Area Resource File. RESULTS: Among the 82,836 TB cases, 914 (1.1%) were in AI/ANs and 362 (0.4%) were in NH/PIs. In 2008, TB case rates for AI/ANs and NH/PIs were 5.9 and 14.7 per 100,000 population, respectively, rates that were more than five and 13 times greater than for non-Hispanic white people (1.1 per 100,000 population). From 2003 to 2008, AI/ANs had the largest percentage decline in TB case rates (-27.4%) for any racial/ethnic group, but NH/PIs had the smallest percentage decline (-3.5%). AI/ANs were more likely than other racial/ethnic groups to be homeless, excessively use alcohol, receive totally directly observed therapy, and come from counties with a greater proportion of people living in poverty and without health insurance. A greater proportion of NH/PIs had extrapulmonary disease and came from counties with a higher proportion of people with a high school diploma. CONCLUSIONS: There is a need to develop flexible TB-control strategies that address the social determinants of health and that are tailored to the specific needs of AI/ANs and NH/PIs in the U.S. |
Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection - United States, 2010
Mazurek GH , Jereb J , Vernon A , LoBue P , Goldberg S , Castro K . MMWR Recomm Rep 2010 59 1-25 In 2005, CDC published guidelines for using the QuantiFERON-TB Gold test (QFT-G) (Cellestis Limited, Carnegie, Victoria, Australia) (CDC. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR;54[No. RR-15]:49-55). Subsequently, two new interferon gamma (IFN- gamma) release assays (IGRAs) were approved by the Food and Drug Administration (FDA) as aids in diagnosing M. tuberculosis infection, both latent infection and infection manifesting as active tuberculosis. These tests are the QuantiFERON-TB Gold In-Tube test (QFT-GIT) (Cellestis Limited, Carnegie, Victoria, Australia) and the T-SPOT.TB test (T-Spot) (Oxford Immunotec Limited, Abingdon, United Kingdom). The antigens, methods, and interpretation criteria for these assays differ from those for IGRAs approved previously by FDA. For assistance in developing recommendations related to IGRA use, CDC convened a group of experts to review the scientific evidence and provide opinions regarding use of IGRAs. Data submitted to FDA, published reports, and expert opinion related to IGRAs were used in preparing these guidelines. Results of studies examining sensitivity, specificity, and agreement for IGRAs and TST vary with respect to which test is better. Although data on the accuracy of IGRAs and their ability to predict subsequent active tuberculosis are limited, to date, no major deficiencies have been reported in studies involving various populations. This report provides guidance to U.S. public health officials, health-care providers, and laboratory workers for use of FDA-approved IGRAs in the diagnosis of M. tuberculosis infection in adults and children. In brief, TSTs and IGRAs (QFT-G, QFT-GIT, and T-Spot) may be used as aids in diagnosing M. tuberculosis infection. They may be used for surveillance purposes and to identify persons likely to benefit from treatment. Multiple additional recommendations are provided that address quality control, test selection, and medical management after testing. Although substantial progress has been made in documenting the utility of IGRAs, additional research is needed that focuses on the value and limitations of IGRAs in situations of importance to medical care or tuberculosis control. Specific areas needing additional research are listed. |
Integrated preparedness for continuity of tuberculosis care after Hurricanes Gustav and Ike: Louisiana and Texas, 2008
Miner MC , Burns-Grant G , DeGraw C , Wallace C , Pozsik C , Jereb J . Public Health Rep 2010 125 (4) 518-9 In 2005, Hurricane Katrina forced numerous tuberculosis (TB) patients in Louisiana and Texas to evacuate to other states. As a result of this disaster, a strategic plan was implemented in July 2008, when Hurricane Gustav forced TB patients to evacuate to other locales. This article details the lessons learned from these experiences and suggests a strategic plan that can be implemented by other states in the event of a similar disaster. | On August 29, 2005, Hurricane Katrina made landfall in New Orleans, Louisiana. The storm and its aftermath displaced 130 TB patients, all of whom were under directly observed therapy (DOT). After the storm, all TB patients were located, and 62 patients (48%) were traced to 15 states.1 By July 2006, TB program officials in Louisiana and Texas had planned for a similar disaster by using the lessons learned from Hurricane Katrina. The strategic elements included (1) supplying two weeks or 30 days of medicine to each patient who was likely to relocate, (2) providing each patient with a personal card listing contact numbers of TB program personnel, (3) sending a list of patient names to the National Tuberculosis Controllers Association (NTCA) for sharing with program officials in other states, and (4) establishing a referral center at the Centers for Disease Control and Prevention (CDC) Division of TB Elimination in Atlanta, Georgia. |
Interferon-gamma release assays: new diagnostic tests for Mycobacterium tuberculosis infection, and their use in children
Lewinsohn DA , Lobato MN , Jereb JA . Curr Opin Pediatr 2009 22 (1) 71-6 PURPOSE OF REVIEW: The testing and treatment of children at risk for Mycobacterium tuberculosis infection represents an important public health priority in the United States. Until recently, diagnosis has relied upon the tuberculin skin test (TST). New interferon-gamma release assays (IGRAs) offer improvements over TST, but these tests have not been studied in children until recently. RECENT FINDINGS: Evidence regarding IGRA performance in children is accumulating rapidly. Overall, the findings demonstrate performance of IGRAs equivalent or superior to that of the TST. However, IGRAs have biological limitations similar to TST and some technical problems of their own, and critical gaps in our knowledge remain. SUMMARY: Current evidence supports usage of IGRAs in children aged 5 years or older. IGRAs are preferred over TST when specificity is paramount or wherein patients might fail to return for TST reading. Evidence for use in children aged less than 5 years is insufficient at this time: the sensitivity is poorly defined, and TST is preferred for testing these children. Future IGRA research should focus on children aged less than 5 years for informing expanded usage in this vulnerable population. |
Pandemic influenza: implications for programs controlling for HIV infection, tuberculosis, and chronic viral hepatitis
Heffelfinger JD , Patel P , Brooks JT , Calvet H , Daley CL , Dean HD , Edlin BR , Gensheimer KF , Jereb J , Kent CK , Lennox JL , Louie JK , Lynfield R , Peters PJ , Pinckney L , Spradling P , Voetsch AC , Fiore A . Am J Public Health 2009 99 S333-9 Among vulnerable populations during an influenza pandemic are persons with or at risk for HIV infection, tuberculosis, or chronic viral hepatitis. HIV-infected persons have higher rates of hospitalization, prolonged illness, and increased mortality from influenza compared with the general population. Persons with tuberculosis and chronic viral hepatitis may also be at increased risk of morbidity and mortality from influenza because of altered immunity and chronic illness. These populations also face social and structural barriers that will be exacerbated by a pandemic. Existing infrastructure should be expanded and pandemic planning should include preparations to reduce the risks for these populations. |
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