Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-9 (of 9 Records) |
Query Trace: Talwar A[original query] |
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Association Between Birth Region and Time to Tuberculosis Diagnosis After US Entry Among Non–US-Born Persons (preprint)
Talwar A , Li R , Langer AJ . medRxiv 2020 2020.08.02.20160135 Approximately 90% of US tuberculosis (TB) cases among non–US-born persons are attributable to progression of latent TB infection to TB disease. Using survival analysis, we investigated if birthplace is associated with time of progression to TB disease among non–US-born persons. We derived a Cox regression model comparing differences in time to TB diagnosis after US entry among 19 global birth regions, adjusting for sex, birth year, and age at diagnosis. Compared with persons from Western Europe, the adjusted hazard rate of developing TB was significantly higher (p ≤0.05) for persons from all other regions, except North America and Northern Europe, and highest among persons from Middle Africa (adjusted hazard ratio = 7.0; 95% confidence interval: 6.5–7.4). Time to TB diagnosis among non–US-born persons therefore varied by birth region, which represents an important prognostic indicator for progression to TB disease.Competing Interest StatementThe authors have declared no competing interest.Funding StatementNeither the authors nor their institutions at any time received payment or services from a third party for any aspect of the submitted work.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:All data were collected as part of routine disease surveillance and were not part of human subjects research requiring institutional review board approval.All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesThe data contain information abstracted from the national tuberculosis case report form called the Report of Verified Case of Tuberculosis (RVCT) (OMB No. 0920-0026). These data have been reported voluntarily to CDC by state and local health departments, and are protected under the Assurance of Confidentiality (Sections 306 and 308(d) of the Public Health Service Act, 42 U.S.C. 242k and 242m(d)), which prevents disclosure of any information that could be used to directly or indirectly identify patients. For more information, see the CDC/ATSDR Policy on Releasing and Sharing Data (http://www.cdc.gov/maso/Policy/ReleasingData.pdf). A limited dataset is available at http://wonder.cdc.gov/TB.html. Researchers seeking additional data may apply to analyze National Tuberculosis Surveillance System data at CDC headquarters by contacting the Division of Tuberculosis Elimination (TBinfo{at}cdc.gov). |
Using the food and drug administrations sentinel system for surveillance of TB infection
Walker WL , Schmit KM , Welch EC , Vonnahme LA , Talwar A , Nguyen M , Stojanovic D , Langer AJ , Cocoros NM . Int J Tuberc Lung Dis 2022 26 (12) 1170-1176 BACKGROUND: We examined patterns in care for individuals treated for latent TB infection (LTBI) in the US Food and Drug Administration´s Sentinel System.METHODS: Using administrative claims data, we identified patients who filled standard LTBI treatment prescriptions during 2008-2019. In these cohorts, we assessed LTBI testing, clinical management, and treatment duration.RESULTS: Among 113,338 patients who filled LTBI prescriptions, 80% (90,377) received isoniazid (INH) only, 19% (21,235) rifampin (RIF) only, and 2% (1,726) INH + rifapentine (RPT). By regimen, the proportion of patients with documented prior testing for TBI was 79%, 54%, and 91%, respectively. Median therapy duration was 84 days (IQR 35-84) for the 3-month once-weekly INH + RPT regimen, 60 days (IQR 30-100) for the 6- to 9-month INH regimen, and 30 days (IQR 2-60) for the 4-month RIF regimen.CONCLUSIONS: Among the cohorts, INH-only was the most commonly prescribed LTBI treatment. Most persons who filled a prescription for LTBI treatment did not have evidence of completing recommended treatment duration. These data further support preferential use of shorter-course regimens such as INH + RPT. |
Association between Birth Region and Time to Tuberculosis Diagnosis among Non-US-Born Persons in the United States
Talwar A , Li R , Langer AJ . Emerg Infect Dis 2021 27 (6) 1645-1653 Approximately 90% of tuberculosis (TB) cases among non-US-born persons in the United States are attributable to progression of latent TB infection to TB disease. Using survival analysis, we investigated whether birthplace is associated with time to disease progression among non-US-born persons in whom TB disease developed. We derived a Cox regression model comparing differences in time to TB diagnosis after US entry among 19 birth regions, adjusting for sex, birth year, and age at entry. After adjusting for age at entry and birth year, the median time to TB diagnosis was lowest among persons from Middle Africa, 128 months (95% CI 116-146 months) for male persons and 121 months (95% CI 108-136 months) for female persons. We found time to TB diagnosis among non-US-born persons varied by birth region, which represents a prognostic indicator for progression of latent TB infection to TB disease. |
Tuberculosis Outbreak Associated With Delayed Diagnosis and Long Infectious Periods in Rural Arkansas, 2010-2018.
Labuda SM , McDaniel C , Talwar A , Braumuller A , Parker S , McGaha S , Blissett C , Wortham J , Mukasa L , Stewart RJ . Public Health Rep 2021 137 (1) 33354921999167 OBJECTIVES: During 2010-2018, the Arkansas Department of Health reported 21 genotype-matched cases of tuberculosis (TB) among residents of a rural county in Arkansas with a low incidence of TB and in nearby counties. The Arkansas Department of Health and the Centers for Disease Control and Prevention investigated to determine the extent of TB transmission and provide recommendations for TB control. METHODS: We reviewed medical and public health records, interviewed patients, and reviewed patients' social media posts to describe patient characteristics, identify epidemiologic links, and establish likely chains of transmission. RESULTS: We identified 21 cases; 11 reported during 2010-2013 and 10 during 2016-2018. All case patients were US-born non-Hispanic Black people. Eighteen case patients had the outbreak genotype, and 3 clinically diagnosed (non-culture-confirmed) case patients had epidemiologic links to patients with the outbreak genotype. Social media reviews revealed epidemiologic links among 10 case patients not previously disclosed during interviews. Eight case patients (38%) had ≥1 health care visit during their infectious period, and 7 patients had estimated infectious periods of >12 months. CONCLUSIONS: Delayed diagnoses and prolonged infectiousness led to TB transmission in this rural community. TB education and awareness is critical to reducing transmission, morbidity, and mortality, especially in areas where health care providers have limited TB experience. Use of social media can help elucidate people at risk, especially when traditional TB investigation techniques are insufficient. |
Clinical and Laboratory Findings in Patients with Potential SARS-CoV-2 Reinfection, May-July 2020.
Lee JT , Hesse EM , Paulin HN , Datta D , Katz LS , Talwar A , Chang G , Galang RR , Harcourt JL , Tamin A , Thornburg NJ , Wong KK , Stevens V , Kim K , Tong S , Zhou B , Queen K , Drobeniuc J , Folster JM , Sexton DJ , Ramachandran S , Browne H , Iskander J , Mitruka K . Clin Infect Dis 2021 73 (12) 2217-2225 BACKGROUND: We investigated patients with potential SARS-CoV-2 reinfection in the United States during May-July 2020. METHODS: We conducted case finding for patients with potential SARS-CoV-2 reinfection through the Emerging Infections Network. Cases reported were screened for laboratory and clinical findings of potential reinfection followed by requests for medical records and laboratory specimens. Available medical records were abstracted to characterize patient demographics, comorbidities, clinical course, and laboratory test results. Submitted specimens underwent further testing, including RT-PCR, viral culture, whole genome sequencing, subgenomic RNA PCR, and testing for anti-SARS-CoV-2 total antibody. RESULTS: Among 73 potential reinfection patients with available records, 30 patients had recurrent COVID-19 symptoms explained by alternative diagnoses with concurrent SARS-CoV-2 positive RT-PCR, 24 patients remained asymptomatic after recovery but had recurrent or persistent RT-PCR, and 19 patients had recurrent COVID-19 symptoms with concurrent SARS-CoV-2 positive RT-PCR but no alternative diagnoses. These 19 patients had symptom recurrence a median of 57 days after initial symptom onset (interquartile range: 47 - 76). Six of these patients had paired specimens available for further testing, but none had laboratory findings confirming reinfections. Testing of an additional three patients with recurrent symptoms and alternative diagnoses also did not confirm reinfection. CONCLUSIONS: We did not confirm SARS-CoV-2 reinfection within 90 days of the initial infection based on the clinical and laboratory characteristics of cases in this investigation. Our findings support current CDC guidance around quarantine and testing for patients who have recovered from COVID-19. |
A Proposed Framework and Timeline of the Spectrum of Disease Due to SARS-CoV-2 Infection: Illness Beyond Acute Infection and Public Health Implications.
Datta SD , Talwar A , Lee JT . JAMA 2020 324 (22) 2251-2252 Although much of the response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has focused on acute coronavirus disease 2019 (COVID-19) illness, accumulating evidence demonstrates morbidity beyond acute SARS-CoV-2 infection.1-4 At least 2 other periods of illness appear to be temporally associated with SARS-CoV-2 infection: a rare postacute hyperinflammatory illness and late inflammatory and virological sequelae. These 3 illness periods not only define the temporal course of SARS-CoV-2 infection at the population level but also capture distinct phases of host-viral interaction. |
Notes from the Field: Multidrug-Resistant Tuberculosis Among Workers at Two Food Processing Facilities - Ohio, 2018-2019.
Talwar A , Stewart R , Althomsons SP , Rinsky J , Jackson DA , Galvis ME , Graham P , Huaman MA , Karrer J , Kondapally K , Mitchell S , Wortham J , de Fijter S . MMWR Morb Mortal Wkly Rep 2020 69 (32) 1104-1105 During 2018–2019, the Ohio Department of Health (ODH) reported three cases of multidrug-resistant tuberculosis (MDR TB)* in persons who worked in two food processing facilities. The National Tuberculosis Molecular Surveillance Center† performed whole genome sequencing of a Mycobacterium tuberculosis isolate from each patient; phylogenetic analysis revealed the isolates were genetically identical. Prompted by concern for MDR TB transmission associated with these workplaces and surrounding communities, ODH began an investigation in February 2019. CDC was invited to assist with the investigation and deployed a team to Ohio on April 14, 2019. |
Tuberculosis - United States, 2018
Talwar A , Tsang CA , Price SF , Pratt RH , Walker WL , Schmit KM , Langer AJ . Am J Transplant 2019 19 (5) 1582-1588 In 2018, a total of 9,029 new tuberculosis (TB) cases were reported in the United States, representing a 0.7% decrease from 2017.* The U.S. TB incidence in 2018 (2.8 per 100,000 persons) represented a 1.3% decrease from 2017; the rate among non–U.S.-born persons was >14 times that in U.S.-born persons. This report summarizes provisional TB surveillance data reported to CDC’s National Tuberculosis Surveillance System (NTSS) through 2018. Although the total number of cases and incidence are the lowest ever reported in the United States, a recent model predicted that the U.S. TB elimination goal (annual incidence of <1 case per 1 million persons) will not be attained in the 21st century without greatly increased investment in detection and treatment of latent TB infection (LTBI).1 Programs to identify, test, and treat populations at high risk for TB remain important to eliminating TB in the United States. |
Reply to ST McSorley et al
Suchdev PS , Young MF , Williams AM , Addo Y , Namaste SML , Aaron GJ , Neufeld L , Raiten DJ , Flores-Ayala R . Am J Clin Nutr 2018 108 (1) 202-203 We thank McSorley, Talwar, and McMillan for their comments on the series of publications on assessing iron status in settings of inflammation, from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Specifically, the authors highlight the lack of availability of α1-acid glycoprotein (AGP) in clinical settings as a measure of inflammation and suggest instead, to use C-reactive protein (CRP) and serum albumin, which are more routinely available. We acknowledge that assessment of the acute phase response is complicated and that many potential biomarkers of inflammation could be used depending on factors such as the stage of inflammation (e.g., acute compared with chronic), clinical compared with population use, and applicability in resource-limiting settings. The advantages and disadvantages of available biomarkers of inflammation have been recently reviewed, and there has been a call for field-friendly and cost-effective biomarkers that are standardized across laboratories (1, 2). In the datasets that were compiled for the BRINDA project, no surveys measured albumin, so we were unable to assess its relationship with the various biomarkers of nutrition. Serum albumin, which has a long half-life (∼20 d), is most commonly used to identify malnutrition in clinical settings; however, because albumin also acts as a negative acute phase protein, concentrations are lowered by infection, injury, or inflammation irrespective of nutritional status (3, 4). We concur with the authors that the utility of serum albumin or other inflammatory biomarkers, as a potential replacement of AGP as a measure of long-term inflammation, could be explored further. |
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