Molecular Epidemiology of <i>Mycobacterium tuberculosis</i>among Pulmonary Tuberculosis Patients in Ilorin, Nigeria

Background: Tuberculosis (TB) is an infectious disease and it is a public health concern due to the endemic nature of the disease. Nigeria’s health systems still rely heavily on out-dated tuberculosis diagnostic tests;including sputum smear microscopy and chest radiography. This necessitated the urgent need to explore a more reliable, effective method that can rapidly enhance simultaneous detection of Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance. Aims: We evaluated the prevalence of MTB and rifampicin resistance and the influence of socio-demographic factors. Methods: A longitudinal, descriptive study that employs the Xpert MTB/RIF automated molecular method for rapid detection of rifampicin resistance. Secondary data were collected from the medical record from March 2017 to December 2018. Primary data were collected by direct clinical observations and analysis with gene expert machine from January 2019-March 2019. Results: Study populations were 1893 subjects pooled as secondary data at the Gene Expert laboratory, with a mean age of 44.92 years and were categorized based on sex, 1125 (59.4%) males and 768 (40.6%) females respectively. The MTB detected were 117 (15.7%) for males while 76 (9.9%) were positive for females. 948 (84.3%) were negative for males and 692 (90.1%) negative for females. Also, the categories for age were grouped into three but the older age groups (29 - 54) and (55 - 80) were more vulnerable to MTB having a p = 0.506 which is statistically non-significant;only 14 (5.5%) have RIF while 239 (94.5%) do not have RIF resistance strains. Logistic regression analysis of MTB detected showed a significant association (p < 0.05) for sex and a non-significant association (p > 0.05) for age. The prevalence rate for RIF Resistance is 5.53%, there is a statistical difference p = 0.001 between RIF Resistance and MTB in Ilorin. Conclusion: The utilization of validated molecular technique for MTB strain identification has shown stronger epidemiological impetus for an improved care management outcome specifically in resources limited areas.

Epidemiology of tuberculosis in Eastern Sudan

Objective:To investigate the epidemiological factors of tubereulosis(TB)in eastern Sudan.Methods:The socio-demographic and clinical data was retrieved from the database at Kassala hospital during the year of 2011.The medical file of consequent patients who was discharged from the same ward in the hospital was reviewed to act as control for the TB patients.Results:A total of 670 patients were registered at Kassala hospital with clinical,laboratory and radiological evidence proven TB.Pulmonary TB accounted for 73.4%while extra-pulmonary TB was reported in 26.6%of all TB patients.The mean age(SD)was not significantly different between the cases and controls(670 in each arm).TB patients were those who had less education,and the infection more likely common among male patients.Conclusions:Intervention from outside the health field in particular awareness of associated risk factors and improvement of the educational level potentially will strengthen TB control.

Trends in Tuberculosis Epidemiology among Children in the Democratic Republic of Congo

Setting: The epidemiology of tuberculosis (TB) among children in the Democratic Republic of Congo (DRC) is not well known. Objective: This study aimed to describe the trends in TB epidemiology among children in the DRC and to compare these trends in children and adults. Design: Data from the National TB program, the WHO Global TB Report, and a demographic survey of health in the DRC were retrospectively analyzed. The study period was from 1995 to 2014. The notification rate, absolute incidence and incidence rate of TB per 100,000 population were reported. Results: In 2014, 12,785 (12.6% of adult cases) TB cases were reported in children and 101,303 in adults. Among children, 3438 (26.89%) had PTB+;2828 (22.11%) had PTB–;and 6519 (50.98%) had extrapulmonary TB (EPTB). Children under 5 years had a lower reported prevalence of TB (184 cases). The incidence rate per 100,000 population was 10 in children and 181 in adults. The TB incidence decreased between 2010 (11.47) and 2014 (10.46). The proportion of children in overall cases of PTB+ was 4% to 5% in all districts. Conclusion: Caring for childhood TB remains a challenge in the DRC. Improved diagnostic procedures and effective training of providers who care for childhood TB are needed.

Epidemiology of extra pulmonary tuberculosis in Eastern Sudan

Objective: To investigate the epidemiological factors associated with extra pulmonary tuberculosis(EPTB) in Kassala, Eastern Sudan.Methods: Patients infected with TB(pulmonary and extra-pulmonary) documented at the hospital were interviewed with a structured questionnaire used to gather socio-demographic information. The diagnosis of EPTB cases was based on presence of tuberculous granulomas in the histological samples, positive PCR to DNA of mycobacterium tuberculosis, radiological i ndings and l uid analysis suggestive of EPTB and clinical diagnosis with adequate response to anti-tuberculous therapy.Results: A total of 985 patients with TB were enrolled in the study, including 761(77.3%) with PTB and 224(22.7%) with EPTB. The mean age(SD) of patients with PTB and EPTB was 33.2(15.4) and 34.7(14.6) years respectively. The prevalence of EPTB was at(22.7%), with TB lymphadenitis 79(35.3%), marking the frequent form of EPTB followed by peritoneal TB 27(12.05%). While residence and occupation were not associated with EPTB, those with lower level of education(OR = 0.3; coni dence intervals(CI) = 0.2-0.5; P < 0.001), female(OR = 8.7, CI = 4.9-15.1, P < 0.001), non vaccination(OR=70.3, CI = 34.2-144.3, P < 0.001), and non smoker(OR = 0.1; CI = 0.06-0.20; P < 0.001), were associated with high prevalence of EPTB. Conclusions: Around one quarter of patients with TB in this study were more likely to have EPTB. Therefore, ef ective strategic plans regarding diagnostic procedures and control measures are needed to reduce the burden of the disease in Sudan.

Profile of Extra-Pulmonary Tuberculosis in Internal Medicine

Introduction: Tuberculosis is an infectious disease that mainly affects the lung. Extrapulmonary localizations are a reason for hospitalization in our health facilities. The objective of this study was to describe the epidemiological, clinical, paraclinical and evolutionary aspects of extra pulmonary tuberculosis (EPT) at the Abass Ndao Hospital Center. Patients and Methods: This was a descriptive cross-sectional study conducted over a period of 11 years (January 1, 2010 to December 30, 2021). All patients with extrapulmonary tuberculosis hospitalized in the department of internal medicine during the recruitment period were included. Results: Fifty-two (52) patients were collected. The year 2019 recorded the most cases 23.08% (n = 20). The mean age of the patients was 40.56 ± 18.24 years. The age group 20 - 34 years 42.31% (n = 22) was the most represented. Females were in the majority 61.54% (n = 32) with a sex ratio (M/F) was 0.63. Housewives were in the majority 40.38% (n = 21). 60.87% of the cases (n = 14) came from a health facility. 38.46% of the cases had been infected. 21.74% (n = 9) were smokers. The reasons for consultation were dominated by fever (67.44%), AEG (62.79%) and cough (41.86%). Eighteen patients (40.91%) had fever. The mean time to consultation was 77.37 ± 90.3 days with extremes of 3 and 365 days. The median was 45 days. More than half of the patients 61.90% (n = 26) had anemia. Positive retroviral serology was noted in 21.43% of cases. All patients had a CRP greater than 6. More than half of the patients 51.92% (n = 27) had multifocal tuberculosis. The peritoneum 44.23% (n = 23) was the main organ affected. The average hospital stay was 9.8 ± 4.9 days with extremes of 1 and 19 days. All patients had received the protocol in force at the national level. Death was noted in 4 patients (9.52%). Conclusion: EPT is characterized in our context by a notorious diagnostic difficulty due to the multiplicity of clinical presentations, the complexity of explorations, and the problems of differential diagnosis notably with other granulomatosis, systemic lupus and cancers. This difficulty is reflected in the low rate of diagnosis with a paraclinical argument of certainty and in the long diagnostic delays.

The Epidemiological Characteristics of Beijing Lineage Mycobacterium tuberculosis from a National Referral Center in China

Our study was to investigate the epidemiological characteristics of M.tuberculosis from a national tuberculosis referral center in China. All strains isolated from TB patients, were genotyped by the RD105 deletion, 8 and 51 SNP loci and VNTR. The high differentiation SNPs of modern Beijing strains were analyzed for protein function and structure. 413 M. tuberculosis were included. Of 379 Beijing lineage M. tuberculosis, ＇modern＇ and ＇ancient＇ strains respectively represented 85.5% （324/379） and 14.5% （55/379）. Rv2494 （V48A） and Rv0245 （Sl03F） were confirmed as high differentiation SNPs associated with modern strains. In a word, Modern Beijing lineage M.tuberculosis was dominant and the structural models suggested that modern sub-lineage may more easily survive in ＇extreme＇ host condition.

Epidemiological perspective of drug resistant extrapulmonary tuberculosis

Tuberculosis(TB) remains one of the leading infectious diseases causing significant morbidity and mortality worldwide. Although, pulmonary TB is the most common presentation and is the main transmissible form of the disease, extrapulmonary TBalso significantly contributes to the burden of disease and can cause severe complications and disabilities. At present, the most serious issue with TB control programme is emergence of multi and extensively drug resistant Mycobacterium tuberculosis strain worldwide. As the number of drug resistant pulmonary TB is increasing around the world, the number of drug resistant TB with extrapulmonary manifestations are also on rise. However, there is surprisingly scant information in medical literatures on prevalence and impact of extrapulmonary drug-resistant TB. Here, we appraise the recent epidemiological studies that underpin the status and impact of drug resistance in TB cases with extrapulmonary manifestations.

Pulmonary and Extra-Pulmonary Tuberculosis: Epidemiological and Diagnostic Aspects at Sominé DOLO Hospital in Mopti

Despite the efforts made to fight the tuberculosis, Mycobacterium tuberculosis still remains a public health problem, particularly for low-income countries. According to the World Health Organization data, our country, Mali has detected only half of the 10,385 cases of tuberculosis expected for 2014 for a population of 17,309,000 inhabitants. The objective of this present work was to describe the different clinical aspects and the epidemiology of tuberculosis at Hospital Sominé Dolo in Mopti. We performed a retro-prospective and descriptive of tuberculosis cases diagnosed in our department of medicine between May 2016 and August 2018. A total of 96 tuberculosis cases were recorded, i.e. 4.6% and 1.0% for hospitalizations and consultations patterns, respectively. The median of age was 41 with extremes from 5 to 80 years. The age group [31 - 40 years] was the most affected with 20.8%. Men and women were affected in identical proportions, i.e. 50%. Pulmonary locations were the most frequent with 55.2%. Pleural tuberculosis was far the most frequent of the extra-pulmonary forms with 24.0% followed by the peritoneal and bone localization with 6.3% each. The majority of patients were followed on an outpatient basis, i.e. 90.6%. The disease lethality was 7.3%. Our data show that the cases of extra-pulmonary tuberculosis are in an increasing proportion and their diagnosis confirmation remains difficult in our context.

Pleural Fluid Alkaline Phosphate Levels to Differentiate between Tuberculosis and Malignant Pleural Effusion a Tertiary Care Experience

Introduction: Pleural effusion (PF) is a common clinical presentation in several diseases. Tuberculosis is one of the most frequent causes of exudative pleural effusions in immunocompetent patients. Tuberculosis is the leading cause of morbidity and mortality from an infectious disease in developing countries. Pakistan is ranked fifth in the world in terms of tuberculosis high-burden countries. Various pleural fluid parameters have been used to identify the cause of pleural effusion. It has been discovered that tuberculous pleural effusions had a greater alkaline phosphatase (ALP) concentration than transudative effusions. This study used pleural fluid alkaline phosphatase levels to distinguish between tuberculous pleural effusion and malignant pleural effusion because there is little information from tuberculosis-high burden nations like Pakistan. Study Design: A descriptive cross-sectional study conducted at the Jinnah Postgraduate Medical Center in Karachi between October 2016 and October 2017. Material and Methods: The study comprised all patients who were admitted to the department of chest medicine at Jinnah post graduate medical centre (JPMC) of either gender between the ages of 18 and 70 who had exudative lymphocytic pleural effusions lasting two weeks or more included in the study. Non probability consecutive sampling was used to collect data. Patients who have tonsillitis, pharyngitis, pneumonia, asthma, Chronic obstructive pulmonary disease (COPD), or a history of hemoptysis, Bleeding disorders like, platelet function disorder, thrombocytopenia, Liver cirrhosis and Pregnant women were excluded. Parents’ informed consent was obtained after being informed of the study’s protocol, hazards, and advantages. Each patient had their level of pleural fluid alkaline phosphate (PALP) assessed. In order to evaluate the patient’s pleural effusion, a pre-made questionnaire was used. All the collected data were entered into the SPSS 20. An independent sample t-test was used to recognize alkaline phosphate levels association with pleural fluid secondary to tuberculosis or malignancy. Results: In this Descriptive Cross-Sectional Study, the total of 156 patients with age Mean ± SD of was 41.96 ± 17.05 years. The majority of patients 110 (70.5%) were male and 46 (29.5%) were female. Advanced age was associated with raised pleural fluid alkaline phosphatase. The difference of pleural fluid alkaline phosphate level between tuberculous v/s malignant group was found to be (38.03 ± 45.97) v/s (82.77 ± 61.80) respectively with P-value (P = 0.0001). Conclusion: Malignant pleural effusions had elevated PALP when compared to tuberculous pleural effusions in exudative lymphocytic pleural effusions;better differences are seen in older ages and shorter disease durations.

Viral hepatitis prevalence in patients with active and latent tuberculosis

AIM: To assess the prevalence of hepatitis B virus(HBV) and hepatitis C virus(HCV) infection and association with drug induced liver injury(DILI) in patients undergoing anti-tuberculosis(TB) therapy.METHODS: Four hundred and twenty nine patients with newly diagnosed TB- either active disease or latent infection- who were due to commence antiTB therapy between September 2008 and May 2011 were included. These patients were prospectively tested for serological markers of HBV, HCV and human immunodeficiency virus(HIV) infections- hepatitis B core antigen(HBc Ag), hepatitis B surface antigen(HBs Ag), hepatitis B e antigen, Ig G and Ig M antibody to HBc Ag(anti-HBc), HCV Ig G antibody and HIV antibody using a combination of enzyme-linked immunosorbent assay, Western blot assay and polymerase chain reaction techniques. Patients were reviewed at least monthly during the TB treatment initiation phase. Liver function tests were measured prior to commencement of antiTB therapy and 2-4 wk later. Liver function tests were also performed at any time the patient had significant nausea, vomiting, rash, or felt non-specifically unwell. Fisher's exact test was used to measure significance in comparisons of proportions between groups. A P value of less than 0.05 was considered statistically significant.RESULTS: Of the 429 patients, 270(62.9%) had active TB disease and 159(37.1%) had latent TB infection. 61(14.2%) patients had isolated anti-HBc positivity, 11(2.6%) were also HBs Ag positive and 7(1.6%) were HCV-antibody positive. 16/270 patients with active TB disease compared to 2/159 patients with latent TB infection had markers of chronic viral hepatitis(HBs Ag or HCV antibody positive; P = 0.023). Similarly the proportion of HBs Ag positive patients were significantly greater in the active vs latent TB infection group(10/43 vs 1/29, P = 0.04). The prevalence of chronic HBV or HCV was significantly higher than the estimated United Kingdom prevalence of 0.3% for each. We found no association between DILI and presence of serological markers of HBV or HCV. Three(5.3%) patients with serological markers of HBV or HCV infection had DILI compared to 25(9.5%) patients without; P = 0.04.CONCLUSION: Viral hepatitis screening should be considered in TB patients. DILI risk was not increased in patients with HBV/HCV.

Risk factors of treatment default and death among tuberculosis patients in a resource-limited setting

Objective:To evaluate the rates,timing and determinants of default and death among adult tuberculosis patients in Nigeria.Methods:Routine surveillance data were used.A retrospective cohort study of adult tuberculosis patients treated during 2011 and 2012 in two large health facilities in Ebonyi State.Nigeria was conducted.Multivariable logistic regression analyses were used to tdentify independent predictors for treatment default and death.Results:Of 1668 treated patients,the default rate was 157(9.4%),whilst 165(9.9%) died.Also,35.7%(56) of the treatment defaults and 151(91.5%) of deaths occurred during the intensive phase of treatment.Risk of default increased with increasing age(adjusted odds ratio(aOR) 1.2;95%confidence interval(CI)1.1-1.9).smear-negative TB case(aOR 2.3:CI 1.5-3.6).extrapulmonary TB case(aOR 2.7:CI 1.3-5.2).and patients who received the longer treatment regimen(aOR 1,6;1.1-2.2).Risk of death was highest in extrapulmonary TB(aOR 3.0:CI 1.4-6.1) and smear-negative TB cases(aOR 2.4:CI1.7-3.51.rural residents(aOR 1.7:CI 1.2-2.6),HIV co-infected(aOR 2.5:CI 1.7-3.6),not receiving antiretroviral therapy(aOR 1.6:CI 1.1-2.9),and not receiving cotrimoxazole prophylaxis(aOR 1.7:CI 1.2—2.6).Conclusions:Targeted interventions to improve treatment adherence for patients with the highest risk of default or death are urgently needed.This needs to he urgently addressed by the National Tuberculosis Programme.

Pulmonary Tuberculosis in Morocco: A Two Year Retrospective Study

OBJECTIVES: To determine the epidemiological features of pulmonary tuberculosis in the region of Gharb-Chrarda-Beni-Hssen in Morocco. METHODS: This is a retrospective study of pulmonary tuberculosis cases, diagnosed and treated at the regional diagnostic center of tuberculosis and respiratory diseases (RDCTRD) in Kenitra between January 2010 and December 2011. RESULTS: During the study period, there were 456 cases diagnosed with pulmonary tuberculosis at the RDCTRD, accounting for 51.3% of all tuberculosis cases reported during this period. More than two-thirds were men (69%), with a male-female ratio of 2.22 and 3.3% of cases were children under the age of 15 years. The average age of the patients was 37.07 ± 0.78 years. The average body weight at diagnosis of tuberculosis was 56.20 ± 0.55 kg for all patients. According to the results, 89% of pulmonary tuberculosis cases were microscopically positive. The majority of patients (80.3%) showed signs of tuberculous impregnation. Nearly three-quarters of these cases (71%) were smokers, 21% were cannabis addicts and 7% were alcoholics. Among the 427 cases for whom the outcome was known, 3 (0.7%) of them died. CONCLUSION: Tuberculosis can be controlled by preventing transmission and infection, by stopping the progression from latent infection to active tuberculosis, and by treating active disease.

Socio-Demographic Characteristics and Risk Factors Contributing Pulmonary Tuberculosis Infection and Recent Transmission

Host factors, environmental factors, genetic diversity and distinct phylogeographic distribution of Mycobacterium tuberculosis (MTB) contribute to regional differences in drug resistance. Bangladesh remains among the top 20 high Multi drug resistant tuberculosis (MDR-TB) burden countries of the world. This cross sectional study was conducted to identify the socio demographic characteristics and the risk factors contributing Pulmonary tuberculosis (PTB) infection. These characteristics and risk factors were further investigated among the clustered isolates. Total 60 culture isolates consist of 40 RR and 20 rifampicin sensitive (RS) isolates were enrolled in this study. Laboratory works were done in National Tuberculosis Reference Laboratory (NTRL) and Department of Microbiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. All 60 samples were confirmed as MTB by MPT 64 antigen detection. Two samples were excluded for possible cross contamination and two for failing to give PCR product for most of the locus. So, finally 56 samples were further analyzed for results. Four isolates were distributed within two clusters which were belonged to Beijing lineage. Socio demographic data and risk factors analysis of this study found significant male predominance (p = 0.04) with history of smoking (p = 0.01) and previous anti-TB treatment (p = 0.012) as the significant risk factors for RR TB.

Spontaneous Pneumothorax Complicating Miliary Tuberculosis: About a Case at the “Centre Medical Principal De La Gendarmerie Nationale Du Mali”

Introduction: Spontaneous pneumothorax is a rare but serious complication of tuberculosis. Miliary tuberculosis (MT) is a severe form of tuberculosis secondary to hematogenous spread of Mycobacterium tuberculosis. Objective: To report a case of MT complicated by pneumothorax. Methodology: This was a 25-year-old patient, farmer, followed up at the Pneumo-phtisiology department of the CHU du Point G for MT whose condition was improving after the introduction of anti-tuberculosis chemotherapy. He consulted again after experiencing chest pain. Clinical and imaging revealed a Spontaneous pneumothorax complicating MT. The treatment combined anti-tuberculosis chemotherapy, chest drainage and respiratory physiotherapy. Outcome was favorable with improvement of clinical and radiological signs. Conclusion: Pneumothorax complicating MT requires a reflective diagnostic approach and rapid management to improve its prognosis.

Tuberculosis in Children: Epidemio-Clinical Aspects in the Paediatric Department of the Gabriel TouréUniversity Hospital Center

Introduction: Globally, tuberculosis is the leading cause of death from a single infectious agent ahead of HIV/AIDS. Approximately 10 million people contracted TB in 2017, 10% of whom were children aged 0 - 15 years, or about 1 million with 250,000 deaths in 2016 (including children with HIV-associated TB). The signs of TB in children are not always specific and diagnosis remains difficult unlike in adults. According to a study conducted in 2011 in the paediatric department of the CHU-Gabriel Touré, only seventeen cases of all forms of tuberculosis were found, or approximately 0.2% of hospitalised children. The objective of our study was to investigate the epidemiological and clinical aspects of tuberculosis in children. Materials and Method: This was a prospective, cross-sectional and descriptive study that took place from 24 October 2017 to 23 October 2018, or 12 months in children aged 0-15 years. Data were collected from an individual medical record opened for each patient and an individual survey form established for each child. Results: During the study period, 40,434 children were consulted. Tuberculosis was suspected in 91 children, with a frequency of 0.22%. The age range of 1 to 4 years was 36.3% with a median age of 72 months. The sex ratio was 1.8. Chronic cough with 84.6% and malnutrition with 24.17% were the most frequent symptoms. Chest X-ray revealed bilateral pulmonary lesions in 52.7% and mediastinal adenopathy in 12.1%. TST was positive in 10.9% of patients, microscopy in 26.4%, Gene Xpert in 18.7%, and culture in 16.5%. The biological diagnosis of tuberculosis was retained in 48.4% of the patients, the pulmonary form represented 93.2%. The therapeutic regime (2RHZE/4RH) was used in 81.6% of cases and the evolution was favourable in 65.9% of patients. Conclusion: The diagnosis of tuberculosis in children remains difficult in our context. The clinical signs are not always specific, and further studies are needed to further elucidate this disease.

Toward tuberculosis elimination by understanding epidemiologic characteristics and risk factors in Hainan Province, China

Background The disease burden of tuberculosis(TB)was heavy in Hainan Province,China,and the information on transmission patterns was limited with few studies.This atudy aims to further explore the epidemiological charac-teristics and influencing factors of TB in Hainan Province,and thereby contribute valuable scientific evidences for TB elimination in Hainan Province.Methods The TB notification data in Hainan Province from 2013 to 2022 were collected from the Chinese National Disease Control Information System Tuberculosis Surveillance System,along with socio-economic data.The spatial-temporal and population distributions were analyzed,and spatial autocorrelation analysis was conducted to explore TB notification rate clustering.In addition,the epidemiological characteristics of the cases among in-country migrants were described,and the delay pattern in seeking medical care was investigated.Finally,a geographically and tem-porally weighted regression(GTWR)model was adopted to analyze the relationship between TB notification rate and socio-economic indicators.The tailored control suggestions in different regions for TB elimination was provided by understanding epidemiological characteristics and risk factors obtained by GTWR.Results From 2013 to 2022,64,042 cases of TB were notified in Hainan Province.The estimated annual percent-age change of TB notification rate in Hainan Province from 2013 to 2020 was-6.88%[95%confidence interval(CI):-5.30%,-3.69%],with higher rates in central and southern regions.The majority of patients were males(76.33%)and farmers(67.80%).Cases among in-country migrants primarily originated from Sichuan(369 cases),Heilongjiang(267 cases),Hunan(236 cases),Guangdong(174 cases),and Guangxi(139 cases),accounting for 53%.The majority(98.83%)of TB cases were notified through passive case finding approaches,with delay in seeking care.The GTWR analysis showed that gross domestic product per capita,the number of medical institutions and health personnel per 10,oo0 people were main factors affecting the high TB notification rates in some regions in Hainan Province.Dif-ferent regional tailored measures such as more TB specialized hospitals were proposed based on the characteristics of each region.Conclusions The notification rate of TB in Hainan Province has been declining overall but still remained high in central and southern regions.Particular attention should be paid to the prevalence of TB among males,farmers,and outof-province migrant populations.The notification rate was also influenced by economic development and medical conditions,indicating the need of more TB specialized hospitals,active surveillance and other tailored prevention and control measures to promote the progress of TB elimination in Hainan Province.

Epidemiological characteristics of tuberculosis incidence and its macro-influence factors in Chinese mainland during 2014-2021

Background Tuberculosis(TB)remains a pressing public health issue,posing a significant threat to individuals'well-being and lives.This study delves into the TB incidence in Chinese mainland during 2014-2021,aiming to gain deeper insights into their epidemiological characteristics and explore macro-level factors to enhance control and prevention.Methods TB incidence data in Chinese mainland from 2014 to 2021 were sourced from the National Notifiable Disease Reporting System(NNDRS).A two-stage distributed lag nonlinear model(DLNM)was constructed to evaluate the lag and non-linearity of daily average temperature(℃,Atemp),average relative humidity(%,ARH),average wind speed(m/s,AWS),sunshine duration(h,SD)and precipitation(mm,PRE)on the TB incidence.A spatial panel data model was used to assess the impact of demographic,medical and health resource,and economic factors on TB incidence.Results A total of 6,587,439 TB cases were reported in Chinese mainland during 2014-2021,with an average annual incidence rate of 59.17/100,000.The TB incidence decreased from 67.05/100,000 in 2014 to 46.40/100,000 in 2021,notably declining from 2018 to 2021(APC=-8.87%,95%CI:-11.97,-6.85%).TB incidence rates were higher among males,farmers,and individuals aged 65 years and older.Spatiotemporal analysis revealed a significant cluster in Xinjiang,Qinghai,and Xizang from March 2017 to June 2019(RR=3.94,P<0.001).From 2014 to 2021,the proportion of etiologically confirmed cases increased from 31.31%to 56.98%,and the time interval from TB onset to diagnosis shortened from 26 days(IQR:10-56 days)to 19 days(IQR:7-44 days).Specific meteorological conditions,including low temperature(<16.69℃),high relative humidity(>71.73%),low sunshine duration(<6.18 h)increased the risk of TB incidence,while extreme low wind speed(<2.79 m/s)decreased the risk.The spatial Durbin model showed positive associations between TB incidence rates and sex ratio(β=1.98),number of beds in medical and health institutions per 10,000 population(β=0.90),and total health expenses(β=0.55).There were negative associations between TB incidence rates and population(β=-1.14),population density(β=-0.19),urbanization rate(β=-0.62),number of medical and health institutions(β=-0.23),and number of health technicians per 10,000 population(β=-0.70).Conclusions Significant progress has been made in TB control and prevention in China,but challenges persist among some populations and areas.Varied relationships were observed between TB incidence and factors from meteorological,demographic,medical and health resource,and economic aspects.These findings underscore the importance of ongoing efforts to strengthen TB control and implement digital/intelligent surveillance for early risk detection and comprehensive interventions.

Recent transmission of Mycobacterium tuberculosis in China： the implication of molecular epidemiology for tuberculosis control

Tuberculosis （TB） has remained an ongoing concern in China. The national scale-up of the Directly Observed Treatment, Short Course （DOTS） program has accelerated the fight against TB in China. Nevertheless, many challenges still remain, including the spread of drug-resistant strains, high disease burden in rural areas, and enormous rural-to-urban migrations. Whether incident active TB represents recent transmission or endogenous reactivation has helped to prioritize the strategies for TB control. Evidence from molecular epidemiology studies has delineated the recent transmission of Mycobacterium tuberculosis （M. tuberculosis） strains in many settings. However, the transmission patterns of TB in most areas of China are still not clear. Studies carried out to date could not capture the real burden of recent transmission of the disease in China because of the retrospective study design, incomplete sampling, and use of low-resolution genotyping methods. We reviewed the implementations of molecular epidemiology of TB in China, the estimated disease burden due to recent transmission of M. tuberculosis strains, the primary transmission of drug-resistant TB, and the evaluation of a feasible genotyping method of M. tuberculosis strains in circulation.

Molecular epidemiology of Mycobacterium tuberculosis in Gansu province of China

Background Mycobacterial interspersed repetitive units-variable number tandem repeat （MIRU-VNTR） and Beijing family typing based on detecting the deletion of RD105 sequence are two common genotyping methods used to study the molecular epidemiologic characteristics of Mycobacterium （M.） tuberculosis. We collected 218 strains of M. tuberculosis between 2004 and 2006 in the Linxia Hui Autonomous Prefecture of Gansu province in Northwest China. Methods MIRU-VNTR analysis and Beijing family typing based on detecting the deletion of RD105 sequence were used to type the 218 strains, and their typing power was evaluated to look for practical and efficient genotyping methods suitable for the region. Results The MIRU typing yielded 115 distinct genotypes, including 98 unique isolates and 17 different clusters containing 120 isolates （55.05%）; the cluster rate was 47.25%. By detecting the deletion of RD105 sequence, 188 of 218 （86.23%） isolates belonged to Beijing family. Combination of Beijing family typing and MIRU typing yielded 118 distinct patterns, including 101 unique isolates and 17 clusters containing 117 isolates （54.13%）. The largest cluster contained 58 strains with MIRU genotype of 223325173533 which contained 50 strains belonging to Beijing family and 8 strains belonging to non-Beijing family. Conclusions The Beijing family strains occupied a large proportion and the Beijing family MIRU genotype 223325173533 is a dominant strain in Linxia of Gansu. Combining detecting the deletion of RD105 and MIRU typing together provides a simple, fast, and effective method which is low in cost and might be practical and suitable for M. tuberculosis aenotvDina in China.

Epidemiology of tuberculosis in Sabah, Malaysia, 2012–2018

Background Tuberculosis(TB)is of high public health importance in Malaysia.Sabah State,located on the island of Borneo,has previously reported a particularly high burden of disease and faces unique contextual challenges compared with peninsular Malaysia.The aim of this study is to describe the epidemiology of TB in Sabah to identify risk groups and hotspots of TB transmission.Methods We conducted a retrospective review of TB cases notified in Sabah,Malaysia,between 2012 and 2018.Using data from the state’s‘myTB’notification database,we calculated the case notification rate and described trends in the epidemiology,diagnostic practices and treatment outcomes of TB in Sabah within this period.The Chi-squared test was used for determining the difference between two proportions.Results Between 2012 and 2018 there were 33193 cases of TB reported in Sabah(128 cases per 100000 population).We identified several geographic hotspots,including districts with>200 cases per 100000 population per year.TB rates increased with age and were highest in older males.Children<15 years accounted for only 4.6%of cases.Moderate or advanced disease on chest X-ray and sputum smear positivity was high(58 and 81%of cases respectively),suggesting frequent late diagnosis.Multi-drug resistant(MDR)TB prevalence was low(0.3%of TB cases),however,rapid diagnostic test coverage was low(1.2%)and only 18%of all cases had a positive culture result.Treatment success was 83%(range:81–85%)in those with drug-sensitive TB and 36%(range:25–45%)in cases of MDR-TB.Conclusion Between 2012 and 2018,TB notifications in Sabah State equated to 20%of Malaysia’s total TB notifications,despite Sabah representing only 10%of Malaysia’s population.We found hotspots of TB in urbanised population hubs and points of migration,as well as evidence of late presentation and diagnosis.Ensuring universal health coverage and expansion of GeneXpert®coverage is recommended to reduce barriers to care and early diagnosis and treatment for TB.