Social Behaviour Risk Factors for Drug Resistant Tuberculosis in Mainland China: a Meta-analysis
|
|
- Mildred Shauna Smith
- 7 years ago
- Views:
Transcription
1 The Journal of International Medical Research 2012; 40: Social Behaviour Risk Factors for Drug Resistant Tuberculosis in Mainland China: a Meta-analysis P ZHAO 1,a, XJ LI 2,a, SF ZHANG 1, XS WANG 3 AND CY LIU 4 1 Chaoyang Centre for Disease Control and Prevention, Beijing, China; 2 Department of Geriatrics, Southwest Hospital, and 3 Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Chongqing, China; 4 Department of Respiratory Medicine, First Hospital, Jilin University, Changchun, China OBJECTIVE: To determine risk factors associated with drug resistant tuberculosis (TB) in mainland China. METHODS: PubMed and Chinese BioMedical databases were searched. Cohort, case control and cross-sectional studies providing effect estimates of risk factors for any-drug resistant or multidrug resistant (MDR) TB were included. RESULTS: The meta-analysis included 16 studies. Any-drug resistant TB was significantly associated with poor quality directly observed treatment, shortcourse (DOTS) (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.22, 5.79), long term illness > 1 year (OR 2.71, 1.34, 5.48), poor treatment adherence (OR 2.00, 1.17, 3.40), previous treatment (OR 4.54, 2.71, 7.61) and age years (OR 1.62, 1.10, 2.38). MDR-TB was significantly associated with poor quality DOTS (OR 1.84, 1.36, 2.49), poor treatment adherence (OR 4.39, 2.97, 6.50), previous treatment (OR 3.83, 2.12, 6.89) and poverty (OR 1.87, 1.38, 2.52). CONCLUSIONS: Previous treatment, poor quality DOTS, poor treatment adherence, long term illness, age years and poverty are associated with a greater risk of drug resistant TB in mainland China. KEY WORDS: TUBERCULOSIS; DRUG RESISTANCE; MULTIDRUG RESISTANT TUBERCULOSIS; RISK FACTORS; META-ANALYSIS Introduction Tuberculosis (TB) remains one of the greatest health problems for people living in the developing world. 1 China has the second highest prevalence of TB worldwide 2 and one of the highest rates of drug resistant TB. 3 Based on a recent national anti-tb drug resistance survey, it was estimated that approximately new multidrug a P Zhao and XJ Li contributed equally to this work. resistant (MDR) TB cases emerge annually in China, including 9000 extensively drug resistant TB (XDR-TB) cases, accounting for approximately 24% of the global MDR-TB burden. 4 The emergence of drug resistant TB, especially MDR-TB 5 and XDR-TB, 6,7 poses a substantial threat to TB control programs worldwide. In addition to the direct transmission of drug resistant strains from one individual to another, 8 drug resistant TB 436
2 cases may be caused by the social behavioural risk factors of patients themselves. Previous studies have identified several risk factors for drug resistant TB in mainland China, 9 18 but there was little consensus between different study populations. For example, floating populations were strongly associated with drug resistant TB in some studies, 9,11,17 but this association was not significant in another study. 10 A nationwide survey on the risk factors associated with drug resistant TB in mainland China has not been performed. The present meta-analysis aimed to weigh the strength and quality of the evidence of a causal association between risk factors and drug resistant TB and MDR-TB in mainland China. Materials and methods LITERATURE SEARCH The PubMed and Chinese BioMedical databases were searched by two researchers (X.J.L., S.F.Z.) to identify relevant publications indexed before October The following search terms were used as a combination of free text and thesaurus terms: tuberculosis ; drug resistance ; multi-drug resistance ; China ; risk factors ; and epidemiologic determinants. The Chinese Journal of Tuberculosis and Respiratory Diseases and the Journal of the Chinese Antituberculosis Association were selected as the key journals for hand searching. Each article chosen for inclusion was reviewed for data extraction by three independent reviewers (P.Z., X.S.W., C.Y.L.). INCLUSION AND EXCLUSION CRITERIA Original research reports from mainland China published in Chinese and English were included in the review, and comments, editorials and reviews were excluded. Cohort, case control or cross-sectional studies providing effect estimates of the association between any-drug resistant TB or MDR-TB and risk factors were selected for inclusion. The following types of article were excluded: (i) those with < 10 cases; (ii) those involving drug efficacy testing in vitro or in clinical trials; and (iii) those studying indications for management or the treatment of drug resistant TB. Selected articles were reviewed for information on sample size, population source, age and gender. STUDY DEFINITIONS The meta-analysis used the following definitions: MDR-TB, TB resistant to at least both isoniazid and rifampicin; any-drug resistant TB, TB resistant to at least one of four first-line anti-tb drugs (isoniazid, rifampicin, ethambutol and streptomycin) except for MDR-TB cases; poor quality directly observed treatment, short-course (DOTS), not strictly complying with the World Health Organization s (WHO)- recommended DOTS strategy; 19 poor treatment adherence, not following the treatment plan, including the increasing or decreasing of drug dosages by patients, antibiotic abuse or short-term interruption of treatment (< 60 days); interruption of treatment, the interruption of treatment for 60 days in a course of treatment; delay in diagnosis and treatment, > 30 days from the discovery of symptoms to diagnosis. QUALITY ASSESSMENT Each article received three independent reviews and was assessed for quality according to the following criteria: (i) cases were defined adequately; (ii) cases were consecutive or obviously representative; (iii) cases and controls were drawn from the same population; (iv) controls were defined 437
3 adequately; (v) secure record or structured interview blind to case/control status; (vi) same method of diagnosis for cases and controls; (vii) similar nonresponse rate between groups; (viii) study design adequate to measure an association; (ix) adequate definition of risk factors; (x) use of univariate and multivariate analyses. The articles received one point for each of the criteria listed. A score of < 5 was considered to be low quality, 5 7 was considered medium quality, and > 7 was considered high quality. STATISTICAL ANALYSES Data were collected and analysed using Review Manager (RevMan) software, version 4.2 (The Cochrane Collaboration, Oxford, UK). Data heterogeneity was analysed using the χ 2 -test (α = 0.05), with the extent of heterogeneity determined using the I 2 method (I 2 values of 25%, 50% and 75% were indicative of low, medium and high heterogeneity, respectively). Statistically homogenous data were assessed using a fixed effects model. A random effects model was used to interpret heterogeneity further and improve test performance. The fail-safe number for P = 0.05 (N fs0.05 ) was used statistically to assess publication bias (N fs0.05 < 10 was considered indicative of statistically significant publication bias). Sensitivity analysis was performed by two methods ( html/mod14-2.htm): one to exclude those studies that included univariate analyses alone in order to eliminate bias, and the other to exchange analysis models. If the conclusion for some risk factors changed slightly or not at all after using these two methods, the results of the meta-analysis were deemed reliable. Results The literature search identified a total of 365 articles published in Chinese or English, 349 of which were excluded from the analysis based on the inclusion and exclusion criteria for the meta-analysis. The final metaanalysis, therefore, included 16 studies from 16 different regions or provinces (the studies being from 16 different regions or provinces was a coincidence). 9 18,20 25 All were case control studies published between 2004 and Of these articles, 11 were extracted from journals, 9,10,12,15,16,20 25 two were master s degree in medicine (MM) theses, 11,13 and three were doctoral degree in medicine (MD) dissertations. 14,17,18 There were 12 studies regarding risk factors in any-drug resistant TB and 11 in MDR-TB. The quality of the articles was variable, with three of low quality, 21,23,24 eight of medium quality, 12 16,18,22,25 and five of high quality. 9 11,17,20 Meta-analysis revealed a significant association between any-drug resistant TB and poor quality DOTS (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.22, 5.79), duration of illness > 1 year (OR 2.71, 1.34, 5.48), poor treatment adherence (OR 2.00, 1.17, 3.40), previous treatment (OR 4.54, 2.71, 7.61) and age years (OR 1.62, 1.10, 2.38) (Fig. 1). There was a significant association between MDR-TB and poor quality DOTS (OR 1.84, 1.36, 2.49), poor treatment adherence (OR 4.39, 2.97, 6.50), previous treatment (OR 3.83, 2.12, 6.89), poverty (OR 1.87, 1.38, 2.52), floating population (OR 1.44, 1.08, 1.91) and smoking (OR 1.37, 1.08, 1.76) (Fig. 2). Although MDR-TB was associated with a floating population using the fixed effects model approach for sensitivity analysis, this conclusion was reversed in the random model approach (Fig. 3). There were no other differences in the findings between the two sensitivity analyses. There were no 438
4 A B Wei et al. 10 Yang 14 Zheng 13 Zhou [1.98, 7.51] 3.12 [1.64, 5.92] 2.86 [1.15, 7.09] [1.43, ] 0.89 [0.56, 1.41] Total () 2.65 [1.22, 5.79] Test for heterogeneity: χ 2 = 20.87, df = 4 (P = ), I 2 = 80.8% Test for overall effect: Z = 2.46 (P = 0.01) Wei et al. 10 Yang et al. 20 Zheng 13 Zhou [1.79, 5.58] 0.94 [0.59, 1.51] 3.70 [1.96, 6.98] 2.27 [1.05, 4.91] 6.00 [3.57, 10.10] Total () 2.71 [1.34, 5.48] Test for heterogeneity: χ 2 = 29.42, df = 4 (P < ), I 2 = 86.4% Test for overall effect: Z = 2.78 (P = 0.005) C D E Li et al. 21 Wei et al. 10 Zhang 15 Zhou [1.51, 5.44] 2.26 [1.19, 4.27] 1.93 [1.26, 2.96] 5.80 [1.47, 22.96] 0.90 [0.60, 1.35] Total () 2.00 [1.17, 3.40] Test for heterogeneity: χ 2 = 16.11, df = 4 (P = 0.003), I 2 = 75.2% Test for overall effect: Z = 2.54 (P = 0.01) Lin et al. 16 Xu et al. 22 Yang 14 Yang et al. 20 Zhang et al [0.51, 6.33] 1.31 [0.78, 2.20] 2.10 [1.65, 2.68] 3.30 [1.17, 9.30] 0.71 [0.21, 2.41] 1.04 [1.01, 1.07] 3.10 [0.89, 10.84] Zheng [0.26, 7.52] Zhou [1.04, 3.94] Total () 1.62 [1.10, 2.38] Test for heterogeneity: χ 2 = 44.82, df = 8 (P = ), I 2 = 82.2% Test for overall effect: Z = 2.46 (P = 0.01) Lin et al. 16 Wei et al. 10 Xu et al. 22 Xu et al. 24 Yang 14 Yang et al. 20 Zhang et al. 15 Zheng 13 Zhou 11 Zhu et al. 12 Total () 4.54 [2.71, 7.61] Test for heterogeneity: χ 2 = , df = 11 (P < ), I 2 = 94.4% Test for overall effect: Z = 5.74 (P < ) [1.41, 4.36] 4.20 [2.97, 5.94] 2.30 [2.02, 2.62] 2.12 [1.45, 3.09] 2.16 [1.14, 4.09] 1.82 [0.97, 3.39] 3.31 [1.40, 7.83] [10.14, 27.80] 4.90 [2.58, 9.32] 8.00 [5.13, 12.48] [22.30, 57.68] 4.64 [1.92, 11.23] FIGURE 1: Forest plots for meta-analysis outcomes of risk factors for any-drug resistant tuberculosis (TB), showing odds ratios (OR) and 95% confidence intervals (CI). Anydrug resistant TB was defined as TB resistant to at least one of four first-line anti-tb drugs (isoniazid, rifampicin, ethambutol and streptomycin), but not both isoniazid and rifampicin. Plots were generated using combined analysis. (A) Poor-quality directly observed treatment, short-course (DOTS), defined as not strictly complying with the World Health Organization s. 19 recommended DOTS strategy. (B) Long term illness (> 1 year). (C) Poor treatment adherence (not following the treatment plan, including the increasing or decreasing of drug dosages by patients, antibiotics abuse or short-term [< 60 days] interruption of treatment). (D) Previous TB treatment. (E) Aged years multivariate analyses regarding smoking in the studies included in the meta-analysis, and there was evidence of publication bias in MDR-TB studies on smoking (N fs.0.05 = 2; Table 1). N fs.0.05 values for all other risk factors assessed in the meta-analysis were > 10, indicating little publication bias (Table 1). Discussion Studies have identified several risk factors in drug resistant TB worldwide. 8,26 29 Differences in the social system and living habits of people in mainland China compared with the rest of the world suggest that the social behaviour risk factors for drug 439
5 A B Yang 14 Zheng [1.21, 2.31] 3.01 [1.10, 8.23] 5.04 [1.08, 23.59] Total () 1.84 [1.36, 2.49] Test for heterogeneity: χ 2 = 2.90, df = 2 (P = 0.23), I 2 = 31.0% Test for overall effect: Z = 3.94 (P < ) Xu et al [0.73, 1.54] 2.10 [1.35, 3.27] 3.63 [0.48, 27.25] Total () 1.44 [1.08, 1.91] Test for heterogeneity: χ 2 = 6.13, df = 2 (P = 0.05), I 2 = 67.4% Test for overall effect: Z = 2.51 (P = 0.01) C D Wang [1.64, 7.13] 4.85 [3.05, 7.70] Total () 4.39 [2.97, 6.50] Test for heterogeneity: χ 2 = 0.62, df = 1 (P = 0.43), I 2 = 0% Test for overall effect: Z = 7.41 (P < ) Wang [0.83, 1.76] 1.51 [1.09, 2.09] Total () 1.37 [1.08, 1.76] Test for heterogeneity: χ 2 = 0.77, df = 1 (P = 0.38), I 2 = 0% Test for overall effect: Z = 2.54 (P = 0.01) E F Li et al. 21 Lin et al. 16 Sun et al. 25 Wang 18 Xu et al. 24 Yang 14 Zhang et al [1.23, 3.08] 2.47 [0.89, 6.87] [6.88, 16.34] 4.10 [3.22, 5.23] 3.94 [1.59, 9.74] 4.85 [3.05, 7.70] 5.31 [2.59, 10.90] 1.42 [0.54, 3.73] 1.24 [1.12, 1.37] Zheng [7.03, 22.89] Zhu et al [2.19, 11.30] Total () 3.83 [2.12, 6.89] Test for heterogeneity: χ 2 = , df = 10 (P < ), I 2 = 95.8% Test for overall effect: Z = 4.47 (P < ) 1.56 [0.80, 3.04] Lin et al [1.11, 2.40] Sun et al [1.41, 31.44] Wang [1.13, 1.86] Yang [0.71, 4.40] Zhang et al [1.91, 3.64] Total () 1.87 [1.38, 2.52] Test for heterogeneity: χ 2 = 11.47, df = 5 (P = 0.04), I 2 = 56.4% Test for overall effect: Z = 4.08 (P < ) FIGURE 2: Forest plots for meta-analysis outcomes of risk factors for multidrug resistant tuberculosis (MDR-TB), showing odds ratios (OR) and 95% confidence intervals (CI). MDR-TB was defined as TB resistant to at least both isoniazid and rifampicin. Plots were generated using combined analysis. (A) Poor-quality directly observed treatment, short-course (DOTS), defined as not strictly complying with the World Health Organization s recommended DOTS strategy. 19 (B) Floating population. (C) Poor adherence to treatment (not following the treatment plan, including the increasing or decreasing of drug dosages by patients, antibiotics abuse or short-term [< 60 days] interruption of treatment). (D) Smoking. (E) Previous TB treatment. (F) Poverty A B Xu et al [0.73, 1.54] 2.10 [1.35, 3.27] 3.63 [0.48, 27.25] Total () 1.44 [1.08, 1.91] Test for heterogeneity: χ 2 = 6.13, df = 2 (P = 0.05), I 2 = 67.4% Test for overall effect: Z = 2.51 (P = 0.01) Xu et al [0.73, 1.54] 2.10 [1.35, 3.27] 3.63 [0.48, 27.25] Total () 1.59 [0.86, 2.94] Test for heterogeneity: χ 2 = 6.13, df = 2 (P = 0.05), I 2 = 67.4% Test for overall effect: Z = 1.47 (P = 0.14) FIGURE 3: Forest plots for sensitivity analysis of meta-analysis outcomes, showing odds ratios (OR) and 95% confidence intervals (CI). (A) OR of floating populations using the fixed effects model. (B) OR of floating populations using the random effects model 440
6 TABLE 1: Assessment of publication bias in the current meta-analysis of risk factors associated with any-drug resistant tuberculosis (TB) and multidrug resistant TB in mainland China a Any drug-resistant TB Multidrug resistant TB Risk factor No. of studies N fs.0.05 No. of studies N fs.0.05 Poor quality DOTS Duration of illness > 1 year Poor adherence to treatment Previous TB treatment Poverty 6 91 Smoking 2 2 Aged years 9 95 a Publication bias was assessed using the fail-safe number for P = 0.05 (N fs0.05 ). Any-drug resistant TB, TB resistant to at least one of four first-line anti-tb drugs (isoniazid, rifampicin, ethambutol and streptomycin), but not both isoniazid and rifampicin; multidrug resistant TB, TB resistant to at least both isoniazid and rifampicin; DOTS, directly observed treatment, short-course; poor-quality DOTS, not strictly complying with the World Health Organization s recommended DOTS strategy; 19 poor treatment adherence, not following the treatment plan, including the increasing or decreasing of drug dosages by patients, antibiotics abuse or short-term (< 60 days) interruption of treatment. resistant TB may differ from those in other countries. The aim of the present metaanalysis was to determine the risk factors for drug resistant TB in mainland China. Several independent risk factors for anydrug resistance and MDR were identified among TB patients in China. The risk factors for any-drug resistant TB included poor quality DOTS, duration of illness > 1 year, poor treatment adherence, previous treatment and being aged years. Risk factors for MDR-TB included poor quality DOTS, poor treatment adherence, previous treatment and poverty. A previous history of treatment for TB was the most widely reported risk factor for MDR- TB 8,26 29 and was the strongest risk factor for both any-drug resistant TB and MDR-TB in the present meta-analysis. Drug resistant Mycobacterium tuberculosis strains arise after repeated cycles of killing (during treatment) and regrowth (after treatment). 30 When patients are medicated repeatedly, the mutant strains become dominant. Resistance to a single drug is followed by the emergence of mutant strains that are resistant to multiple drugs, and the occurrence of MDR- TB. 28 In our opinion, it is likely that inadequate treatment is the main reason for drug resistance in previously treated cases. Delays in disease diagnosis or recognition of drug resistance, inappropriate chemotherapy regimens, inadequate or irregular drug supply, and poor adherence by both patients and clinicians are reported reasons for inadequate treatment. 31,32 The DOTS strategy for TB control was launched by the WHO in The strategy is based around short course treatment regimens for a minimum of 6 months, but it also requires political commitment, good management practices, sputum smear microscopy for diagnosis, and the direct observation of doses to ensure adherence. 33 To date, DOTS remains the cornerstone of global efforts at TB control. 34 The present meta-analysis showed that poor quality DOTS was associated with a 2.65-fold increased risk of any-drug resistant TB, and a 1.84-fold 441
7 increased risk of MDR-TB in mainland China. DOTS has been shown to reduce transmission of TB, 35,36 reduce the incidence of drug resistance 37 and prevent the acquisition of drug resistance. 36,38 A study of patients with TB in Beijing between 1978 and 1996 found that DOTS could effectively reduce the prevalence of initial drug resistance when the number of patients in floating populations was low, 39 suggesting that good quality DOTS may prevent the development of drug resistance. In accordance with the findings of others, 26 the present meta-analysis revealed that any-drug resistant TB and MDR-TB were both associated with poor treatment adherence. Improving the treatment compliance of patients with TB may be an effective way to reduce drug resistant TB and increase the cure rate. The reasons for poor treatment adherence in mainland China may include the side-effects of treatment, the advanced age of the population, low education level, poverty and distractions of a busy working life or education. 17,40 Poor quality DOTS may be related to this poor treatment adherence. Patients with long term illness (> 1 year) had a 2.71-fold increased risk of any-drug resistant TB in the present analysis. Some drug resistance mutations are spontaneous, and the frequency of mutation is stable. 30 Over time, these mutations build up and drug resistance may occur. 30 The present analysis found no association between MDR- TB and long term illness; this may have been influenced by bias since many of the papers included in the analysis had not studied the association between MDR-TB and long term illness. This association needs to be studied further. The 1.62-fold increase in risk of anydrug resistant TB in patients aged years may be related to the previously reported poor adherence to treatment by patients in this age group. 40 There was no association between MDR-TB and patients aged years in the present analysis, in spite of the inclusion of one report 9 (covering five relevant articles) 9,12,14,16,17 to the contrary. The Chinese Ministry of Health s Fourth National Epidemiological Sampling Survey of TB, conducted in 2000, 41 found that 77.9% of all patients with TB in China had below average per capita income, and 53.1% of interrupted treatment and positive sputum smear cases were attributable to poverty. Studies in other countries have also found a close association between poverty and TB or MDR-TB. 42,43 Poverty was associated with MDR-TB in the present analysis. This may be due to the increased risk of contracting TB in crowded and poor living conditions, 28,29 as well as the longer infectious period associated with a shortage of medical and healthcare services. 31 There were several limitations to the present analysis. First, the majority of the included studies (14/16) were published in Chinese, 10 18,21 25 and the quality of the reports was not as high as those from English language journals. Some studies did not include all the required information, 12,13 such as the age and gender of the study population. There was heterogeneity in the pooled estimates of any-drug resistant TB and MDR-TB for some risk factors. These factors may be mutually confounding, and the analysis did not include any cohort studies. Secondly, the possibility of publication bias cannot be completely excluded since positive results are more likely to be published, although no major publication bias was observed. Thirdly, meta-analysis has well-known inherent limitations, including publication and citation bias, misclassification bias, selection and inclusion bias, and the 442
8 combination of heterogeneous data. 44 Metaanalysis reduces random error but does not necessarily reduce (and may even increase) systematic error. In spite of these limitations, meta-analysis is an attractive approach for combining the findings from independent studies. In this way, the necessary number of patients may be reached and relatively small effects can be detected or excluded with confidence. Meta - analysis can also contribute to considerations regarding the generalizability of study results. In conclusion, the present meta-analysis indicated that previous treatment is the strongest determinant of drug resistant TB in mainland China, with poor quality DOTS and poor treatment adherence both significantly associated with any-drug resistant TB and MDR-TB. Long term illness (> 1 year) and being aged years were both significantly associated with increased risk of any-drug resistant TB, and poverty was significantly associated with MDR-TB. These social behaviour risk factors deserve special attention in mainland China, and the screening of patients with these risk factors would assist in both the prevention of drug resistance and the control of TB in general. Conflicts of interest The authors had no conflicts of interest to declare in relation to this article. Received for publication 24 November 2011 Accepted subject to revision 30 November 2011 Revised accepted 10 February 2012 Copyright 2012 Field House Publishing LLP References 1 Gie R, International Union against Tuberculosis and Lung Disease (The Union): Diagnostic Atlas of Intrathoracic Tuberculosis in Children: a Guide for Low Income Countries. Paris: International Union Against Tuberculosis and Lung Disease (The Union), World Health Organization: Global Tuberculosis Control: Epidemiology, Strategy, Financing: WHO Report Geneva: WHO, 2009; WHO/HTM/TB/ World Health Organization: Multidrug and Extensively Drug-resistant TB (M/XDR-TB): 2010 Global Report on Surveillance and Response. Geneva: WHO, 2010; WHO/HTM/TB/ Ministry of Health of the People s Republic of China: Nationwide Anti-tuberculosis Drug Resistant Baseline Surveillance in China ( ). Beijing: People s Public Health Press: 2010 [in Chinese]. 5 Aziz M A, Wright A, Laszlo A, et al: Epidemiology of antituberculosis drug resistance (The Global Project on Anti-tuberculosis Drug Resistance Surveillance): an updated analysis. Lancet 2006; 368: Wright A, Bai G, Barrera L, et al: Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs worldwide, MMWR 2006; 55: Gandhi N R, Moll A, Sturm A W, et al: Extensively drug-resistant tuberculosis as a cause of death in patients coinfected with tuberculosis and HIV in a rural area of South Africa. Lancet 2006; 368: Faustini A, Hall AJ, Perucci CA: Risk factors for multidrug resistant tuberculosis in Europe: a systematic review. Thorax 2006; 61: Shen X, DeRiemer K, Yuan ZA, et al: Drugresistant tuberculosis in Shanghai, China, : prevalence, trends, and risk factors. Int J Tuberc Lung Dis 2009; 13: Wei CY, Wang Q, Chen J: Study on risk factors for acquired drug resistant tuberculosis in some province. Mod Prev Med 2007; 34: [in Chinese, English abstract]. 11 Zhou LX: A Case Control Study on Risk Factor for Acquired Drug Resistant Tuberculosis of Adult. MM Thesis, Guangxi Medical University, China, Zhu JF, Wang WB, Wang XC, et al: Epidemic pattern of drug-resistant tuberculosis and its risk factors in Deqing County. Zhejiang J Prev Med 2009; 21: 6 8 [in Chinese, English abstract]. 13 Zheng Z: Epidemiological Studies on the Prevalence Rate and the Impact Factors of Drug Resistant Tuberculosis Among Pulmonary Tuberculosis Inpatients. MM Thesis, Xiangya Medical College, Central South University, China, Yang BF: Determinants and Molecular Epidemiology of Drug-resistant Tuberculosis in Rural Area of North Jiangsu Province. MD Dissertation, Fudan University, China,
9 15 Zhang H, Zhang A, Zhao P, et al: Analysis of the status and risk factors of drug resistant tuberculosis in Chaoyang District in Beijing. J Chin Antituberc Assoc 2009; 31: [in Chinese, English abstract]. 16 Lin H, Liu J, Chen L, et al: Drug resistance of tuberculosis from 2003 to 2006 in Chongqing. Acta Academiae Medicinae Militaris Tertiae 2008; 30: [in Chinese, English abstract]. 17 Chen J: Preliminary Study on Social Behavior Factors of TB Patients and Genotyping of Mycobacterium tuberculosis. MD Dissertation, Sichuan University, China, Wang WH: Study of Risk Factors of Multi-drug Resistant Pulmonary Tuberculosis and the Quality of Life of Patients. MD Dissertation, Huazhong Science and Technology University, China, World Health Organization: WHO Report on the Tuberculosis Epidemic, Stop TB at the Source. Geneva: WHO, 1995; Report No. WHO/TB/ Yang X, Li Y, Wen X, et al: Risk factors for drug resistance in pulmonary tuberculosis inpatients. J Evid Based Med 2010; 3: Li H, Yan CL, Zhu SJ, et al: Risk factors of multidrug-resistant tuberculosis. J Clin Pulm Med 2010; 15: [in Chinese, English abstract]. 22 Xu B, Hu Y, Wang WB, et al: Molecularepidemiological study on the transmission of drug resistant tuberculosis and its influencing factors in rural areas of eastern China. Zhonghua Liu Xing Bing Xue Za Zhi 2010; 31: Zhang M, Lou P, Liu L, et al: Drug resistance and its influencing factors among patients with multidrug-resistant tuberculosis. Chin J Public Health 2010; 26: [in Chinese, English abstract]. 24 Xu L, Yang Z, Lv DL, et al: Analysis of the situation of anti-tb drug resistance and its risk factors in Shenzhen City. China Trop Med 2010; 10: [in Chinese, English abstract]. 25 Sun B, Hu Y, Zhu FD, et al: Prevalence and analysis of the multidrug-resistant tuberculosis factors in rural areas of north Jiangsu. Chin Prim Health Care 2008; 22: [in Chinese, English abstract]. 26 Pritchard AJ, Hayward AC, Monk PN, et al: Risk factors for drug resistant tuberculosis in Leicestershire poor adherence to treatment remains an important cause of resistance. Epidemiol Infect 2003; 130: Moniruzzaman A, Elwood RK, Schulzer M, et al: A population-based study of risk factors for drug resistant TB in British Columbia. Int J Tuberc Lung Dis 2006; 10: Espinal MA, Laserson K, Camacho M, et al: Determinants of drug-resistant tuberculosis: analysis of 11 countries. Int J Tuberc Lung Dis 2001; 5: Law WS, Yew WW, Chiu Leung C, et al: Risk factors for multidrug-resistant tuberculosis in Hong Kong. Int J Tuberc Lung Dis 2008; 12: Mitchison DA: How drug resistance emerges as a result of poor compliance during short course chemotherapy for tuberculosis. Int J Tuberc Lung Dis 1998; 2: Pablos-Méndez A, Raviglione MC, Laszlo A, et al: Global surveillance for antituberculosis-drug resistance, World Health Organization International Union against Tuberculosis and Lung Disease Working Group on Anti-tuberculosis Drug Resistance Surveillance. N Engl J Med 1998; 338: World Health Organization: Anti-tuberculosis Drug Resistance in the World, Report No. 3. Geneva: WHO, 2004; WHO/HTM/TB/ Cox HS, Morrow M, Deutschmann PW: Long term efficacy of DOTS regimens for tuberculosis: systematic review. BMJ 2008; 336: World Health Organization: The Stop TB Strategy: Building on and Enhancing DOTS to Meet the TB-related Millennium Development Goals. Geneva: WHO, 2006; WHO/HTM/STB/ Frieden TR, Fujiwara PI, Washko RM, et al: Tuberculosis in New York City turning the tide. N Engl J Med 1995; 333: Munsiff SS, Li J, Cook SV, et al: Trends in drugresistant Mycobacterium tuberculosis in New York City, Clin Infect Dis 2006; 42: DeRiemer K, García-García L, Bobadilla-del- Valle M, et al: Does DOTS work in populations with drug-resistant tuberculosis? Lancet 2005; 365: Yew WW: Directly observed therapy, shortcourse: the best way to prevent multidrugresistant tuberculosis. Chemotherapy 1999; 45(suppl 2): Zhang LX, Tu DH, Enarson DA: The impact of directly-observed treatment on the epidemiology of tuberculosis in Beijing. Int J Tuberc Lung Dis 2000; 4: Liu YN, Hou M, Wang W, et al: Investigation of impact factors for chemotherapy compliance of tuberculosis patients in Beijing. J Capital Med Univ 2011; 32: [in Chinese, English abstract]. 41 National Technical Steering Group of the Epidemiological Sampling Survey for Tuberculosis: Report on Fourth National Epidemiological Sampling Survey of Tuberculosis. Chin J Tuberc Respir Dis 2002; 25: 3 7 [in Chinese, English abstract]. 42 Marahatta SB: Multi-drug resistant tuberculosis burden and risk factors: an update. Kathmandu Univ Med J (KUMJ) 2010; 8: Keshavjee S, Gelmanova IY, Pasechnikov AD, et al: Treating multidrug-resistant tuberculosis in 444
10 Tomsk, Russia: developing programs that address the linkage between poverty and disease. Ann NY Acad Sci 2008; 1136: Tacconelli E, Cataldo MA: Identifying risk factors for infections: the role of meta-analyses. Infect Dis Clin North Am 2009; 23: Authors address for correspondence Dr Xingsheng Wang Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, 10 Changjiang zhi Road, Daping, Yuzhong District, Chongqing , China. meiyi2433@sohu.com Dr Chaoying Liu Department of Respiratory Medicine, First Hospital, Jilin University, 1 Xinmin Street, Chaoyang District, Changchun, Jilin Province , China. liuchaoyingliuchao@126.com 445
TUBERCULOSIS CONTROL INDIA
TUBERCULOSIS CONTROL INDIA In terms of population coverage, India now has the second largest DOTS (Directly Observed Treatment, Short course) programme in the world. However, India's DOTS programme is
More informationEmerging Infectious Disease (4): Drug-Resistant Tuberculosis
S67 Drug-Resistant Tuberculosis Emerging Infectious Disease (4): Drug-Resistant Tuberculosis Chi-Fang You, MD; Han-Ping Ma, MD; Tzong-Luen Wang, MD, PhD; Aming Chor-Min Lin, MD Abstract Before the discovery
More informationDrug-resistant Tuberculosis
page 1/6 Scientific Facts on Drug-resistant Tuberculosis Source document: WHO (2008) Summary & Details: GreenFacts Context - Tuberculosis (TB) is an infectious disease that affects a growing number of
More informationTuberculosis OUR MISSION THE OPPORTUNITY
Tuberculosis OUR MISSION Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. Our Global Health Program is
More informationDrug-resistant tuberculosis control in China: progress and challenges
Long et al. Infectious Diseases of Poverty (2016) 5:9 DOI 10.1186/s40249-016-0103-3 OPINION Open Access Drug-resistant tuberculosis control in China: progress and challenges Qian Long 1,2, Yan Qu 3* and
More informationCase 3 Controlling Tuberculosis in China
Case 3 Controlling Tuberculosis in China Geographic area: China Health condition: Tuberculosis (TB) is the leading cause of death from infectious disease among adults in China. Every year, 1.4 million
More informationAlcohol abuse and smoking
Alcohol abuse and smoking Important risk factors for TB? 18 th Swiss Symposium on tuberculosis Swiss Lung Association 26 Mach 2009 Knut Lönnroth Stop TB Department WHO, Geneva Full implementation of Global
More informationTreatment of TB a pharmacy perspective
Treatment of TB a pharmacy perspective Colm McDonald, Antimicrobial Stewardship Pharmacist (Acting) National TB Conference, St. James s Hospital 6 th May 2011 Overview of presentation Role of the pharmacist
More informationTHE WORLD HEALTH ORGANIZAtion
ORIGINAL CONTRIBUTION Standard Short-Course Chemotherapy for Drug-Resistant Tuberculosis Outcomes in 6 Countries Marcos A. Espinal, MD, DrPH Sang Jae Kim, ScD Pedro G. Suarez, MD Kai Man Kam, MB Alexander
More informationManagement of Tuberculosis: Indian Guidelines
Chapter 105 Management of Tuberculosis: Indian Guidelines Kuldeep Singh Sachdeva INTRODUCTION Tuberculosis (TB) is an infectious disease caused predominantly by Mycobacterium tuberculosis and among the
More informationTreatment of tuberculosis. guidelines. Fourth edition
Treatment of tuberculosis guidelines Fourth edition Treatment of tuberculosis Guidelines Fourth edition WHO Library Cataloguing-in-Publication Data: Treatment of tuberculosis: guidelines 4th ed. WHO/HTM/TB/2009.420
More informationTuberculosis in Myanmar Progress, Plans and Challenges
Tuberculosis in Myanmar Progress, Plans and Challenges Myanmar is one of the world s 22 high tuberculosis (TB) burden countries, with a TB prevalence rate three times higher than the global average and
More informationTuberculosis and HIV/AIDS Co-Infection: Epidemiology and Public Health Challenges
Tuberculosis and HIV/AIDS Co-Infection: Epidemiology and Public Health Challenges John B. Kaneene, DVM, MPH, PhD University Distinguished Professor of Epidemiology Director, Center for Comparative Epidemiology
More informationNON-COMMERCIAL CULTURE AND DRUG-SUSCEPTIBILITY TESTING METHODS FOR SCREENING OF PATIENTS AT RISK OF MULTI-DRUG RESISTANT TUBERCULOSIS
NON-COMMERCIAL CULTURE AND DRUG-SUSCEPTIBILITY TESTING METHODS FOR SCREENING OF PATIENTS AT RISK OF MULTI-DRUG RESISTANT TUBERCULOSIS - POLICY STATEMENT - July 2010 TABLE OF CONTENTS 1. Background... 1
More informationTuberculosis Treatment in Japan: Problems and perspectives
From the Japanese Association of Medical Sciences The Japanese Society for Tuberculosis Tuberculosis Treatment in Japan: Problems and perspectives How to expand the Japanese version of DOTS JMAJ 52(2):
More informationDr Malgosia Grzemska Global TB programme, WHO/HQ Meeting of manufacturers Copenhagen, Denmark, 23-26 November 2015
TB burden and treatment guidelines Dr Malgosia Grzemska Global TB programme, WHO/HQ Meeting of manufacturers Copenhagen, Denmark, 23-26 November 2015 Outline Latest epidemiological data Global programme
More informationTB preventive therapy in children. Introduction
TB preventive therapy in children H S Schaaf Department of Paediatrics and Child Health, and Desmond Tutu TB Centre Stellenbosch University, and Tygerberg Children s Hospital Introduction Children are
More informationRESEARCH AGENDA ON DRUG RESISTANT TUBERCULOSIS With A Focus On Scaling-up Programmes
RESEARCH AGENDA ON DRUG RESISTANT TUBERCULOSIS With A Focus On Scaling-up Programmes Background The Working Group on MDR-TB is an inter-institutional working group involving institutions/agencies and experts
More informationChapter 1 Overview of Tuberculosis Epidemiology in the United States
Chapter 1 Overview of Tuberculosis Epidemiology in the United States Table of Contents Chapter Objectives.... 1 Progress Toward TB Elimination in the United States.... 3 TB Disease Trends in the United
More informationGeneral Information on Tuberculosis
General Information on Tuberculosis ON THE MOVE AGAINST TUBERCULOSIS: Transforming the fi ght towards elimination World TB Day 2011 SAARC Tuberculosis & HIV/AIDS Centre GPO Box No 9517, Kathmandu, Nepal
More informationManagement of a child failing first line TB treatment.
Management of a child failing first line TB treatment. Robert Gie Desmond Tutu Tuberculosis Centre Department of Paediatric and Child Health Stellenbosch University South Africa. Tygerberg Hospital Complex
More informationGuideline. Treatment of tuberculosis in pregnant women and newborn infants. Version 3.0
Guideline Treatment of tuberculosis in pregnant women and newborn infants Version 3.0 Key critical points The decision to treat tuberculosis (TB) in pregnancy must consider the potential risks to mother
More informationTREATING DRUG-SENSITIVE TB IN INDIA: IMPLEMENTATION OF DAILY THERAPY WITH FIXED DOSE COMBINATIONS
TREATING DRUG-SENSITIVE TB IN INDIA: IMPLEMENTATION OF DAILY THERAPY WITH FIXED DOSE COMBINATIONS Policy brief, March 2015 Tuberculosis (TB), a communicable disease that affects 9 million people worldwide,
More informationNo. prev. doc.: 9392/08 SAN 77 DENLEG 48 VETER 5 Subject: EMPLOYMENT, SOCIAL POLICY, HEALTH AND CONSUMER AFFAIRS COUNCIL MEETING ON 9 AND 10 JUNE 2008
COUNCIL OF THE EUROPEAN UNION Brussels, 22 May 2008 9637/08 SAN 88 DENLEG 52 VETER 7 NOTE from: Committee of Permanent Representatives (Part 1) to: Council No. prev. doc.: 9392/08 SAN 77 DENLEG 48 VETER
More informationMODULE THREE TB Treatment. Treatment Action Group TB/HIV Advocacy Toolkit
MODULE THREE TB Treatment Treatment Action Group TB/HIV Advocacy Toolkit 1 Topics to be covered TB treatment fundamentals Treatment of TB infection and disease TB treatment research Advocacy issues 2 Section
More informationTB Prevention, Diagnosis and Treatment. Accelerating advocacy on TB/HIV 15th July, Vienna
TB Prevention, Diagnosis and Treatment Accelerating advocacy on TB/HIV 15th July, Vienna Diagnosis Microscopy of specially stained sputum is the main test for diagnosing TB (1 2 days) TB bacilli seen in
More informationFeasibility and cost-effectiveness of standardised second-line drug treatment for chronic tuberculosis patients: a national cohort study in Peru
Feasibility and cost-effectiveness of standardised second-line drug treatment for chronic tuberculosis patients: a national cohort study in Peru Pedro G Suárez, Katherine Floyd, Jaime Portocarrero, Edith
More informationScreening and preventive therapy for MDR/XDR-TB exposed/infected children (and adults)
Screening and preventive therapy for MDR/XDR-TB exposed/infected children (and adults) H S Schaaf Department of Paediatrics and Child Health, and Desmond Tutu TB Centre Stellenbosch University, and Tygerberg
More informationDrug prescribing indicators in village health clinics across 10 provinces of Western China
Family Practice 2011; 28:63 67 doi:10.1093/fampra/cmq077 Advance Access published on 27 September 2010 Ó The Author 2010. Published by Oxford University Press. All rights reserved. For permissions, please
More informationSUCCEEDING IN PATIENT ADHERENCE TO THERAPY
CASE MANAGEMENT AND CONTACT INVESTIGATION INTENSIVE SUCCEEDING IN PATIENT ADHERENCE TO THERAPY OBJECTIVES Upon completion of this session, participants will be able to: 1. List factors that influence adherence
More informationAMBULATORY TREATMENT AND PUBLIC HEALTH MEASURES FOR A PATIENT WITH UNCOMPLICATED PULMONARY TUBERCULOSIS
AMBULATORY TREATMENT AND PUBLIC HEALTH MEASURES FOR A PATIENT WITH UNCOMPLICATED PULMONARY TUBERCULOSIS (UPDATE 2004) Internal guidelines of the Tuberculosis & Chest Service of the Department of Health
More informationFOREWORD. Member States in 2014 places patients and communities at the heart of the response. Here is an introduction to the End TB Strategy.
FOREWORD We stand at a crossroads as the United Nations move from the 2015 Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs) for 2030. Integral to this transition, the world
More informationGUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS IN SOUTH AFRICA
GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS IN SOUTH AFRICA 2010 1 TB prophylaxis GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS Background
More informationPROPOSAL by Bangladesh, Barbados Bolivia, and Suriname. Prize Fund for Development of Low-Cost Rapid Diagnostic Test for Tuberculosis. Date: 09.04.
PROPOSAL by Bangladesh, Barbados Bolivia, and Suriname Prize Fund for Development of Low-Cost Rapid Diagnostic Test for Tuberculosis Executive Summary Date: 09.04.15 The governments of Bangladesh, Barbados,
More informationTuberculosis patient expenditure on drugs and tests in subsidised, public services in China: a descriptive study
Tropical Medicine and International Health doi:10.1111/j.1365-3156.2009.02427.x volume 15 no 1 pp 26 32 january 2010 Tuberculosis patient expenditure on drugs and tests in subsidised, public services in
More informationCosts of inpatient treatment for multi-drug resistant tuberculosis in South Africa
Costs of inpatient treatment for multi-drug resistant tuberculosis in South Africa Kathryn Schnippel 1, Sydney Rosen 1,2, Kate Shearer 1, Neil Martinson 3,4, Lawrence Long 1, Ian Sanne 1,2, Ebrahim Variava
More informationDirectly Observed Therapy (DOT) for Tuberculosis
MINISTRY OF HEALTH MANATU HAUORA Directly Observed Therapy (DOT) for Tuberculosis 2001 Dr Lester Calder, Medical Officer of Health, Public Health Protection, Auckland Healthcare This paper has been endorsed
More informationTreatment seeking for symptoms suggestive of TB: comparison between migrants and permanent urban residents in Chongqing, China
Tropical Medicine and International Health doi:10.1111/j.1365-3156.2008.02093.x volume 13 no 7 pp 927 933 july 2008 Treatment seeking for symptoms suggestive of TB: comparison between migrants and permanent
More informationGuidance on how to measure contributions of public-private mix to TB control
Guidance on how to measure contributions of public-private mix to TB control Project report to the Tuberculosis Control Assistance Programme (TB CAP) Project number: APA4, C3-01 The World Health Organization
More informationMANAGEMENT OF TUBERCULOSIS IN PRISONS: Guidance for prison healthcare teams
MANAGEMENT OF TUBERCULOSIS IN PRISONS: Guidance for prison healthcare teams Document control Title Type Author/s Management of tuberculosis in prisons: Guidance for prison healthcare teams Operational
More informationTB Case Definitions Revision May 2011
TB Case Definitions Revision May 2011 Table of contents TABLE OF CONTENTS 1 1. BACKGROUND 3 2. CURRENT WHO DEFINITIONS OF CASES AND TREATMENT OUTCOMES 4 3. COMMENTARY ON CURRENT WHO DEFINITIONS OF CASES
More informationTB CARE EARLY DETECTION AND PREVENTION OF TUBERCULOSIS (TB) IN CHILDREN. Risk factors in children acquiring TB:
EARLY DETECTION AND PREVENTION OF TUBERCULOSIS (TB) IN CHILDREN Risk factors in children acquiring TB: Children living in the same household as a lung TB patient (especially children under 5) Children
More informationTuberculosis STRATEGY OVERVIEW OUR MISSION THE OPPORTUNITY OUR STRATEGY
Tuberculosis STRATEGY OVERVIEW OUR MISSION Guided by the belief that all lives have equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. Our Global
More informationPRIORITY RESEARCH TOPICS
PRIORITY RESEARCH TOPICS Understanding all the issues associated with antimicrobial resistance is probably impossible, but it is clear that there are a number of key issues about which we need more information.
More informationAge In London TB is more common in younger adults aged 15-44 years and peaks in the 25-34 age group (3).
4. TUBERCULOSIS INTRODUCTION Tuberculosis (TB) is an infectious, notifiable disease (meaning there is a requirement by law to report it to government authorities) caused by the bacterium Mycobacterium
More informationTuberculosis Transmission in Households and Communities
Tuberculosis Transmission in Households and Communities Christopher C. Whalen, M.D., M.S. Department of Epidemiology and Biostatistics 2008, The University of Georgia. All rights reserved. Model for M.
More informationThe Role of the Health Service Administrator in TB Control. National Tuberculosis Control Programme
The Role of the Health Service Administrator in TB Control Goal/Objectives of NTP Mandate: To provide leadership for the health sector response to combat Tuberculosis in Ghana. Goal: To reduce the burden
More informationDr. Nimalan Arinaminpathy, Department of Infectious Disease Epidemiology, Imperial College London
Outline of the Tuberculosis transmission model Dr. Nimalan Arinaminpathy, Department of Infectious Disease Epidemiology, Imperial College London Background Tuberculosis (TB) is a leading cause of mortality
More informationRevised National Tuberculosis Control Programme (RNTCP) Dr. NAVPREET
Revised National Tuberculosis Control Programme (RNTCP) Dr. NAVPREET Assistant Prof., Deptt. of Community Medicine GMCH Chandigarh Problem Statement of TB in India India accounts for nearly 1/4 th of global
More informationContact centred strategies to reduce transmission of M. leprae
Contact centred strategies to reduce transmission of M. leprae Jan Hendrik Richardus, MD, PhD Department of Public Health Erasmus MC, University Medical Center Rotterdam The Netherlands Outline lecture
More informationPromise versus reality - Optimism bias in package inserts of TB diagnostics
Promise versus reality - Optimism bias in package inserts of TB diagnostics Claudia Denkinger, MD PhD Beth Israel Deaconess Medical Center, Boston McGill University, Montreal cdenking@bidmc.harvard.edu
More informationSummary of the risk management plan (RMP) for Sirturo (bedaquiline)
EMA/16634/2014 Summary of the risk management plan (RMP) for Sirturo (bedaquiline) This is a summary of the risk management plan (RMP) for Sirturo, which details the measures to be taken in order to ensure
More informationTuberculosis Prevention and Control Protocol, 2008
Tuberculosis Prevention and Control Protocol, 2008 Preamble The Ontario Public Health Standards (OPHS) are published by the Minister of Health and Long- Term Care under the authority of the Health Protection
More informationLessons from the Stanford HIV Drug Resistance Database
1 Lessons from the Stanford HIV Drug Resistance Database Bob Shafer, MD Department of Medicine and by Courtesy Pathology (Infectious Diseases) Stanford University Outline 2 Goals and rationale for HIVDB
More informationTuberculosis Exposure Control Plan for Low Risk Dental Offices
Tuberculosis Exposure Control Plan for Low Risk Dental Offices A. BACKGROUND According to the CDC, approximately one-third of the world s population, almost two billion people, are infected with tuberculosis.
More informationBorderless Diseases By Sunny Thai
Borderless Diseases By Sunny Thai Millennium Development Goal #6 6. Combat HIV/AIDS, malaria and other borderless diseases. A. Halt and begin reversing spread of HIV by 2015. B. Achieve universal access
More informationRisk Factors for Alcoholism among Taiwanese Aborigines
Risk Factors for Alcoholism among Taiwanese Aborigines Introduction Like most mental disorders, Alcoholism is a complex disease involving naturenurture interplay (1). The influence from the bio-psycho-social
More informationTREATMENT OF TUBERCULOSIS: GUIDELINES FOR NATIONAL PROGRAMMES THIRD EDITION
WHO/CDS/TB/2003.313 TREATMENT OF TUBERCULOSIS: GUIDELINES FOR NATIONAL PROGRAMMES THIRD EDITION World Health Organization - Geneva 2003 First edition, 1993 Second edition, 1997 Third edition, 2003 TREATMENT
More informatione-tb Manager: A Comprehensive Web-Based Tool for Programmatic Management
e-tb Manager: A Comprehensive Web-Based Tool for Programmatic Management of TB and Drug-Resistant TB Management Sciences for Health Facts about TB* TB is contagious and airborne; each untreated person
More informationChildhood Tuberculosis Some Basic Issues. Jeffrey R. Starke, M.D. Baylor College of Medicine
Childhood Tuberculosis Some Basic Issues Jeffrey R. Starke, M.D. Baylor College of Medicine TUBERCULOSIS IS A SOCIAL DISEASE WITH MEDICAL IMPLICATIONS THE GREAT PARADOX OF TUBERCULOSIS A CAUTIONARY TALE
More informationCourse on Multidrug-Resistant Tuberculosis MDR-TB
Course on Multidrug-Resistant Tuberculosis MDR-TB COURSE ON MULTIDRUG-RESISTANT TUBERCULOSIS MDR-TB World Medical Association The World Medical Association (WMA) is an international organization representing
More informationMANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS POLICY GUIDELINES
MANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS POLICY GUIDELINES 2010 FOREWORD The following policy guidelines are intended for use by health care professionals involved in the complex and difficult task of
More informationPhiladelphia TB Newsletter
Philadelphia Department of Public Health Philadelphia TB Newsletter Volume 6, 6, Issue Issue 1 1 WORLD TB DAY EDITION Spring 2012 500 S. Broad Street, 2nd Floor Philadelphia, PA 19146 Michael Nutter Mayor
More informationDrug-Resistant Tuberculosis: Old Disease New Threat (April 2013)
The Global Fund Drug-Resistant Tuberculosis: Old Disease New Threat (April 2013) This report was written by the APPG on Global Tuberculosis s Policy Adviser, Simon Logan, in close consultation with the
More informationecompliance: Revolutionizing Tuberculosis Treatment Designed in collaboration with: Microsoft Research India & Innovators In Health 1
ecompliance: Revolutionizing Tuberculosis Treatment Designed in collaboration with: Microsoft Research India & Innovators In Health 1 Overview Operation ASHA is a non-profit bringing tuberculosis treatment
More informationOPEN LETTER Re: Cartridge prices, extended warranties and business in Russia and the People s Republic of China
6 January 2014 Mr. John L. Bishop Chief Executive Officer Cepheid 904 Caribbean Drive Sunnyvale, CA 94089 USA OPEN LETTER Re: Cartridge prices, extended warranties and business in Russia and the People
More informationChapter 8 Community Tuberculosis Control
Chapter 8 Community Tuberculosis Control Table of Contents Chapter Objectives.... 227 Introduction.... 229 Roles and Responsibilities of the Public Health Sector Providers.... 229 Roles and Responsibilities
More informationData Extraction and Quality Assessment
Data Extraction and Quality Assessment Karen R Steingart, MD, MPH Francis J. Curry International Tuberculosis Center University of California, San Francisco Berlin, 12 November 2010 karenst@uw.edu The
More informationChapter 6 Treatment of Tuberculosis Disease
Chapter 6 Treatment of Tuberculosis Disease Table of Contents Chapter Objectives.... 139 Introduction.... 141 Treatment and Monitoring Plan.... 143 Adherence Strategies... 143 TB Disease Treatment Regimens....
More informationCOMMITTEE FOR VETERINARY MEDICINAL PRODUCTS GUIDELINE FOR THE CONDUCT OF POST-MARKETING SURVEILLANCE STUDIES OF VETERINARY MEDICINAL PRODUCTS
The European Agency for the Evaluation of Medicinal Products Veterinary Medicines and Information Technology EMEA/CVMP/044/99-FINAL COMMITTEE FOR VETERINARY MEDICINAL PRODUCTS GUIDELINE FOR THE CONDUCT
More information2013 Indiana Healthcare Provider and Hospital Administrator Multi-Drug Resistant Organism Survey
2013 Indiana Healthcare Provider and Hospital Administrator Multi-Drug Resistant Organism Survey Antibiotic resistance is a global issue that has significant impact in the field of infectious diseases.
More informationTuberculousmeningitis: what is the best treatment regimen?
Tuberculousmeningitis: what is the best treatment regimen? H S Schaaf Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University
More informationPregnancy and Tuberculosis. Information for clinicians
Pregnancy and Tuberculosis Information for clinicians When to suspect Tuberculosis (TB)? Who is at risk of TB during pregnancy? Recent research suggests that new mothers are at an increased risk of TB
More informationGuidelines on targeted tuberculin testing and treatment of latent tuberculosis infection
Guidelines on targeted tuberculin testing and treatment of latent tuberculosis infection Tuberculosis and Chest Service (Last update on 31March 2015) Internal guidelines of the Tuberculosis & Chest Service
More informationApril King-Todd 2014 National TB Conference Atlanta, Georgia June 10, 2014
An Outbreak of TB Among the Homeless: The Aftermath in a High Incidence County April King-Todd, RN, MPH Los Angeles County Department of Public Health Tuberculosis Control Program National TB Nurses Coalition
More informationA Logistic Regression Model to Predict High Risk Patients to Fail in Tuberculosis Treatment Course Completion
A Logistic Regression Model to Predict High Risk Patients to Fail in Tuberculosis Treatment Course Completion Sharareh R. Niakan Kalhori, Mahshid Nasehi, Xiao-Jun Zeng Abstract One of the world health
More informationCompetency 1 Describe the role of epidemiology in public health
The Northwest Center for Public Health Practice (NWCPHP) has developed competency-based epidemiology training materials for public health professionals in practice. Epidemiology is broadly accepted as
More informationMANAGEMENT OF TUBERCULOSIS
MANAGEMENT OF TUBERCULOSIS Dean B. Ellithorpe, M.D. Clinical Professor of Medicine Section of Pulmonary Diseases, Critical Care and Environmental Medicine Tulane University School of Medicine INTRODUCTION
More informationAMBULATORY TREATMENT AND PUBLIC HEALTH MEASURES FOR A PATIENT WITH UNCOMPLICATED PULMONARY TUBERCULOSIS
AMBULATORY TREATMENT AND PUBLIC HEALTH MEASURES FOR A PATIENT WITH UNCOMPLICATED PULMONARY TUBERCULOSIS AN INFORMATION PAPER January 2013 AMBRX_1301 This information paper is an update of Chapter 17 of
More informationClinical description 2 Laboratory test for diagnosis 3. Incubation period 4 Mode of transmission 4 Period of communicability 4
Tuberculosis Contents Epidemiology in New Zealand 2 Case definition 2 Clinical description 2 Laboratory test for diagnosis 3 Case classification 3 Spread of infection 4 Incubation period 4 Mode of transmission
More informationTB at Edendale Hospital: Operational Guidelines for Doctors and Nurses. Dr. Michael Clark Medical Officer Edendale Hospital
TB at Edendale Hospital: Operational Guidelines for Doctors and Nurses Dr. Michael Clark Medical Officer Edendale Hospital The Burden What? Tuberculosis (TB) HIV/TB co-infection Drug resistance Where?
More informationDevelopment of a Web-based Information Service Platform for Protected Crop Pests
Development of a Web-based Information Service Platform for Protected Crop Pests Chong Huang 1, Haiguang Wang 1 1 Department of Plant Pathology, China Agricultural University, Beijing, P. R. China 100193
More informationMaria Dalbey RN. BSN, MA, MBA March 17 th, 2015
Maria Dalbey RN. BSN, MA, MBA March 17 th, 2015 2 Objectives Participants will be able to : Understand the Pathogenesis of Tuberculosis (TB) Identify the Goals of Public Health for TB Identify Hierarchy
More informationU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention Division of Tuberculosis Elimination Public
More information2015 CMB Request for Proposals (RFP) Innovations in e-learning for Health Professional Education
2015 CMB Request for Proposals (RFP) Innovations in e-learning for Health Professional Education Invitation for Proposals The China Medical Board ( 美 国 中 华 医 学 基 金 会 ) invites eligible Chinese universities
More informationannex 2 country profiles
Annex 2 Country profiles Afghanistan High TB burden Estimates of TB burden a 213 Rate (per 1 population) 13 (8.4 16) 42 (27 53) Mortality (HIV+TB only).82 (.65.1).27 (.21.33) (includes HIV+TB) 1 (54 17)
More informationThe Status Quo and Prospect of Chinese Autistic Education Ms. Leilei Zhan Senior Editor, Jiangsu Education Journal House
CHINA The Status Quo and Prospect of Chinese Autistic Education Ms. Leilei Zhan Senior Editor, Jiangsu Education Journal House I. The prevalence rate of autism in mainland China So far, China has not conducted
More informationTargeted Testing for Tuberculosis Infection
Targeted Testing for Tuberculosis Infection CONTENTS Introduction... 3.2 Purpose... 3.2 Policy... 3.2 When to Conduct Targeted Testing... 3.3 Approaches to increasing targeted testing and treatment for
More informationRecognised as a world leader and a prominent clinical researcher in South Africa
Expert Talks Prof. Peter Donald Emeritus professor in Pediatrics and Child Health at the Faculty of Health Sciences of the University of Stellenbosch and Tygerberg Children's Hospital, South frica n internationally
More informationTuberculosis And Diabetes. Dr. hanan abuelrus Prof.of internal medicine Assiut University
Tuberculosis And Diabetes Dr. hanan abuelrus Prof.of internal medicine Assiut University TUBERCULOSIS FACTS More than 9 million people fall sick with tuberculosis (TB) every year. Over 1.5 million die
More informationNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Age Differences in Viral Suppression, Antiretroviral Therapy Use, and Adherence Among HIV-positive Men Who Have Sex With Men Receiving
More informationRecent Advances in The Treatment of Mycobacterium Tuberculosis
Recent Advances in The Treatment of Mycobacterium Tuberculosis Dr Mohd Arif Mohd Zim Senior Lecturer & Respiratory Physician Faculty of Medicine, Universiti Teknologi MARA mohdarif035@salam.uitm.edu.my
More informationPrinciples of Systematic Review: Focus on Alcoholism Treatment
Principles of Systematic Review: Focus on Alcoholism Treatment Manit Srisurapanont, M.D. Professor of Psychiatry Department of Psychiatry, Faculty of Medicine, Chiang Mai University For Symposium 1A: Systematic
More informationSelf-Study Modules on Tuberculosis
Self-Study Modules on Tuberculosis Epidemiology of Tuberculosis U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for HIV/AIDS, Viral Hepatitis, STD,
More informationDIRECTLY OBSERVED TREATMENT SHORT-COURSE (DOTS)
DIRECTLY OBSERVED TREATMENT SHORT-COURSE (DOTS) Protocol for Tuberculosis Demonstration Projects in Russia U.S. Centers for Disease Control and Prevention and U.S. Agency for International Development
More informationHeat-sensitive moxibustion for lumbar disc herniation: a meta-analysis of randomized controlled trials
Online Submissions:http://www.journaltcm.com J Tradit Chin Med 2012 September 15; 32(3): 322-328 info@journaltcm.com ISSN 0255-2922 2012 JTCM. All rights reserved. EVIDENCE-BASED STUDY for lumbar disc
More informationLack of Weight Gain and Relapse Risk in a Large Tuberculosis Treatment Trial
Lack of Weight Gain and Relapse Risk in a Large Tuberculosis Treatment Trial Awal Khan, Timothy R. Sterling, Randall Reves, Andrew Vernon, C. Robert Horsburgh, and the Tuberculosis Trials Consortium Centers
More informationProtocol for the Control of Tuberculosis
Protocol QH-HSDPTL-040-1:2015 Effective Date: 11 November 2015 Review Date: 11 November 2018 Supersedes: Protocol QH-HSDPTL-040-1:2013 QH-HSDPTL-040-2:2013 QH-HSDPTL-040-3:2013 Health Service Directive
More informationExtent and origin of resistance to antituberculosis drugs in the Netherlands, 1993 to 2011
Research articles Extent and origin of resistance to antituberculosis drugs in the Netherlands, 1993 to 2011 C Ruesen (carolienruesen@gmail.com) 1, A B van Gageldonk-Lafeber 1, G de Vries 1,2, C G Erkens
More informationPatient Education CONTENTS. Introduction... 12.2
CONTENTS Introduction... 12.2 Purpose... 12.2 General Guidelines... 12.3 Language and Comprehension Barriers... 12.4 Education Topics... 12.5 Medical Diagnosis... 12.5 Contact Investigation... 12.6 Isolation...
More information