Compliance among infants exposed to hepatitis B virus in a post-vaccination serological testing program in four provinces in China

Background:Mother to child transmission of hepatitis B virus(HBV)remains the most common form of HBV infection in China.Prevention of HBV vertical transmission involves timely administration of the complete hepatitis B vaccine(HepB)series and hepatitis B immunoglobulin.Post-vaccination serological testing(PVST)is utilized to determine an infant's outcome after HBV exposure and completion of HepB series.We aim to determine the frequency of compliance with a PVST testing cascade for HBV infected mothers and analyze factors associated with infant lost to follow up(LTFU).Methods:We conducted a retrospeaive cohort review of previously collected data in Fujian,Jiangxi,Zhejiang and Chongqing provinces in China from 1 June 2016-31 December 2017.The study population included all HBV-exposed infants and their mothers.SAS software was used for statistical analyses.Bivariate and multivariate regression analyses(presented in odds ratio[OR]with 95%confidence intervals[CI])were used to compare the proportional differences of factors associated with PVST not being completed.Results:Among enrolled 8474 target infants,40%of them transferred out of the study provinces without further information and 4988 were eligible for PVST.We found 20%(994)of infants were not compliant with the testing cascade:55%of LTFU occurred because parents refused venous blood sample collection or failure of sample collection in the field,16%transferred out after 6 months of age,and 10%of families chose to have independent,confidential PVST completed without reporting results.High PVST noncompliance rates were more likely to be from Fujian(aOR=17.0,95%CI:9.7-29.9),Zhejiang(aOR=5.7,95%Cl:3.2-10.1)and Jiangxi(aOR=1.9,95%CI:1.0-3.4),and from HBV e antigen positive mother(aOR=1.2,95%CI:1.1-1.4).Conclusions:This study found that the LTFU rate reached 20%in PVST program,which was a significant problem.We recommend implementing a national elearonic information system for tracking HBV at risk mother-infant pairs;encourage further research in developing a less invasive means of completing PVST,and take effective measures nationally to reduce HBV stigma.Without reducing the loss to follow up rate among infants eligible for PVST,elimination of vertical HBV transmission will be impossible.

Serological surveillance for SARS-CoV-2 antibodies among students,faculty and staff within a large university system during the pandemic

BACKGROUND At the end of December 2019,the world faced severe acute respiratory syndrome-coronavirus 2(SARS-CoV-2),which led to the outbreak of coronavirus disease 2019(COVID-19),associated with respiratory issues.This virus has shown significant challenges,especially for senior citizens,patients with other underlying illnesses,or those with a sedentary lifestyle.Serological tests conducted early on have helped identify how the virus is transmitted and how to curb its spread.The study hypothesis was that the rapid serological test for SARS-CoV-2 antibodies could indicate the immunoreactive profile during the COVID-19 pandemic in a university population.AIM To conduct active surveillance for serological expression of anti-SARS-CoV-2 antibodies in individuals within a university setting during the COVID-19 pandemic.METHODS This sectional study by convenience sampling was conducted in a large university in Niteroi-RJ,Brazil,from March 2021 to July 2021.The study population consisted of students,faculty,and administrative staff employed by the university.A total of 3433 faculty members,60703 students,and 3812 administrative staff were invited to participate.Data were gathered through rapid serological tests to detect immunoglobulin(Ig)M and IgG against SARS-CoV-2.Theχ²or Fisher's exact test was used to conduct statistical analysis.A 0.20 significance level was adopted for variable selection in a multiple logistic regression model to evaluate associations.RESULTS A total of 1648 individuals were enrolled in the study.The proportion of COVID-19 positivity was 164/1648(9.8%).The adjusted logistic model indicate a positive association between the expression of IgM or IgG and age[odds ratio(OR)=1.16,95%CI:1.02-1.31](P<0.0024),individuals who had been in contact with a COVID-19-positive case(OR=3.49,95%CI:2.34-5.37)(P<0.001),those who had received the COVID-19 vaccine(OR=2.33,95%CI:1.61-3.35)(P<0.001)and social isolation(OR=0.59,95%CI:0.41-0.84)(P<0.004).The likelihood of showing a positive result increased by 16%with every ten-year increment.Conversely,adherence to social distancing measures decreased the likelihood by 41%.CONCLUSION These findings evidenced that the population became more exposed to the virus as individuals discontinued social distancing practices,thereby increasing the risk of infection for themselves.

Real-world utility of serological tests in patients with suspected scrub typhus in the Republic of Korea:A single-center,retrospective,observational study

Objective:Serological tests are widely used for scrub typhus diagnosis;however,their limitations are evident.This study aims to assess their practical value in clinical settings.Methods:We analyzed the data of adult patients with suspected scrub typhus who visited a tertiary care hospital in the Republic of Korea from September to December from 2019 to 2021.The included patients had an acute fever and at least one of the following ten secondary findings:myalgia,skin rash,eschar,headache,thrombocytopenia,increased liver enzyme levels,lymphadenopathy,hepatomegaly,splenomegaly,and pleural effusion.The diagnoses were grouped as scrub typhus or other diseases by two infectious disease physicians.Results:Among 136 patients who met the eligibility criteria,109 had scrub typhus and 27 had different diseases.Single and paired total antibodies using immunofluorescence assay(IFA),and total antibodies using immunochromatography-based rapid diagnostic testing(ICT)were measured in 98%,22%,and 75%of all patients,respectively.Confirmation using paired samples for scrub typhus was established at a median of 11[interquartile range(IQR)10-16]days following the first visit.Among the 82 admitted patients,the median admission time was 9(IQR 7-13)days.According to IFA,58(55%)patients with scrub typhus had total immunoglobulin titers≥1:320,while 23(85%)patients with other disease had titers<1:320.Positive ICT results were observed in 64(74%)patients with scrub typhus and 10(67%)patients with other diseases showed negative ICT results.Conclusions:Serological testing for scrub typhus is currently insufficient for decision-making in clinical practice.

Serological survey on canine coronavirus antibodies in giant pandas by virus neutralization test

In order to survey the infectious situation of canine coronavirus (CCV) in giant panda population, a virus neutralization test detecting specific antibodies against CCV in giant panda抯 sera was established by using two-fold dilutions of serum and 100 TCID50 of the virus. The 62 sera samples of giant pandas, which were gathered from zoos and reserve region of Sichuan Province, China were detected. The neutralization antibody titer of 1:4 was recognized as the positive criterion, 8 sera samples were detected to be positive, and the positive rate was 12.9%. The titers of neutralizing antibody ranged from 1:8 to 1:32. It was the first comprehensive investigation on neutralization antibodies against CCV in giant panda population in China. The results of study showed that the infection of CCV in giant panda population was universal, which has posed a threat to the health of giant panda. Therefore, it is incumbent on us to study safe and effective vaccines to protect giant panda against CCV infection.

Serological Investigation into the Infected Genotypes of Patients with Japanese Encephalitis in the Coastal Provinces of China

Objective Genotypes(G)1,3,and 5 of the Japanese encephalitis virus(JEV)have been isolated in China,but the dominant genotype circulating in Chinese coastal areas remains unknown.We searched for G5 JEV-infected cases and attempted to elucidate which JEV genotype was most closely related to human Japanese encephalitis(JE)in the coastal provinces of China.Methods In this study,we collected serum specimens from patients with JE in three coastal provinces of China(Guangdong,Zhejiang,and Shandong)from 2018 to 2020 and conducted JEV cross-neutralization tests against G1,G3,and G5.Results Acute serum specimens from clinically reported JE cases were obtained for laboratory confirmation from hospitals in Shandong(92 patients),Zhejiang(192 patients),and Guangdong(77 patients),China,from 2018 to 2020.Seventy of the 361 serum specimens were laboratory-confirmed to be infected with JEV.Two cases were confirmed to be infected with G1 JEV,32 with G3 JEV,and two with G5 JEV.Conclusion G3 was the primary infection genotype among JE cases with a definite infection genotype,and the infection caused by G5 JEV was confirmed serologically in China.

Study on the Application Value of Liver Function and Serological Index Levels in the Diagnosis of Fatty Liver

Objective:To explore the application value of liver function and serological index detection in diagnosing fatty liver.Methods:Ninety patients with fatty liver disease(disease group)and ninety healthy subjects(healthy group)were selected as the subjects of this study.They all underwent liver function index testing and serological index testing.Test results were compared,and the diagnostic accuracy of single and combined tests was evaluated.Results:Liver function indicators of patients in the disease group were higher than those in the healthy group,with severe patients exhibiting higher levels than moderate patients and mild patients(P<0.05).Serological indicators in patients in the disease group were higher than those in the healthy group,with severe patients showing higher levels than moderate patients and mild patients(P<0.05).The diagnostic accuracy of liver function index testing was higher than that of serological index testing,and the accuracy of combined testing was higher than that of single testing(P<0.05).Conclusion:In diagnosing fatty liver,combining liver function testing and serological testing enables the initial diagnosis of the disease and facilitates the accurate assessment of its severity.

Role of serological rapid antibody test in the management of possible COVID-19 cases

Although the detection of viral particles by reverse transcription polymerase chain reaction(RT-PCR)is the gold standard diagnostic test for coronavirus disease 2019(COVID-19),the false-negative results constitute a big challenge.AIM To examine a group of patients diagnosed and treated as possible COVID-19 pneumonia whose multiple nasopharyngeal swab samples were negative for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)by RT-PCR but then serological immunoglobulin M/immunoglobulin G(IgM/IgG)antibody against SARS-CoV-2 were detected by rapid antibody test.METHODS Eighty possible COVID-19 patients who had at least two negative consecutive COVID-19 RT-PCR test and were subjected to serological rapid antibody test were evaluated in this study.RESULTS The specific serological total IgM/IgG antibody against SARS-CoV-2 was detected in twenty-two patients.The mean age of this patient group was 63.2±13.1-yearsold with a male/female ratio of 11/11.Cough was the most common symptom(90.9%).The most common presenting chest computed tomography findings were bilateral ground glass opacities(77.2%)and alveolar consolidations(50.1%).The mean duration of time from appearance of first symptoms to hospital admission,to hospital admission,to treatment duration and to serological positivity were 8.6 d,11.2 d,7.9 d,and 24 d,respectively.Compared with reference laboratory values,serologically positive patients have shown increased levels of acute phase reactants,such as C-reactive protein,ferritin,and procalcitonin and higher inflammatory markers,such as erythrocyte sedimentation rate,lactate dehydrogenase enzyme,and fibrin end-products,such as D-dimer.A left shift on white blood cell differential was observed with increased neutrophil counts and decreased lymphocytes.CONCLUSION Our study demonstrated the feasibility of a COVID-19 diagnosis based on rapid antibody test in the cases of patients whose RT-PCR samples were negative.Detection of antibodies against SARS-CoV-2 with rapid antibody test should be included in the diagnostic algorithm in patients with possible COVID-19 pneumonia.

Correction to“Performance of a serological IgM and IgG qualitative test for COVID-19 diagnosis:An experimental study in Brazil”

Correction to“Freire de Melo F,Martins Oliveira Diniz L,Nélio Januário J,Fernando Gonçalves Ferreira J,Dórea RSDM,de Brito BB,Marques HS,Lemos FFB,Silva Luz M,Rocha Pinheiro SL,de Magalhães Queiroz DM.Performance of a serological IgM and IgG qualitative test for COVID-19 diagnosis:An experimental study in Brazil.World J Exp Med 2022;12(5):100-103[PMID:36196438 DOI:10.5493/wjem.v12.i5.100]”.In this article,we identified an issue with the“Acknowledgments”section.Here,we then provide a recognition section for our supporting institutions.

Performance of a serological IgM and IgG qualitative test for COVID-19 diagnosis:An experimental study in Brazil

Qualitative antibody tests are an easy,point-of-care diagnostic method that is useful in diagnosing coronavirus disease 2019,especially in situations where reverse transcription-polymerase chain reaction is negative.However,some factors are able to affect its sensitivity and accuracy,which may contribute to these tests not being used as a first-line diagnostic tool.

Cost effectiveness analysis of population-based serology screening and ^(13)C-Urea breath test for Helicobacter pylori to prevent gastric cancer:A markov model

AIM:To compare the costs and effectiveness of no screening and no eradication therapy, the population- based Helicobacter pylori (H pylori) serology screening with eradication therapy and 13C-Urea breath test (UBT) with eradication therapy. METHODS:A Markov model simulation was carried out in all 237 900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years (QALYs) gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses. RESULTS:Compared to no screening, the incremental cost-effectiveness ratio (ICER) was $16 166 per life year saved or $13 571 per QALY gained for the serology screening, and $38 792 per life year saved and $32 525 per QALY gained for the UBT. The ICER was $477 079 per life year saved or $390 337 per QALY gained for the UBT compared to the serology screening. The cost- effectiveness of serology screening over the UBT was robust to most parameters in the model. CONCLUSION:The population-based serologyscreening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.

Serological Survey of Zika Virus in Humans and Animals in Dejiang Prefecture, Guizhou Province,China

Objective The current outbreak of Zika virus(ZIKV)poses a severe threat to human health.Two ZIKV strains were isolated from mosquitoes collected from the Dejiang prefecture in China in 2016,which was the first isolation of ZIKV in nature in China.Methods In this study,serum samples were collected from 366 healthy individuals and 104 animals from Dejiang prefecture in 2017,and the plaque reduction neutralization test(PRNT)was used to evaluate the seroprevalence of ZIKV.Results None of the 366 residents from whom the samples were collected were seropositive for ZIKV.None of the 11 pigs from whom the samples were collected were seropositive for ZIKV,while 1 of 63(1.59%)chickens and 2 of 30(6.67%)sheep were seropositive for ZIKV.Conclusions The extremely low seropositivity rate of ZIKV antibodies in animals in the Dejiang prefecture,Guizhou province in this study indicates that ZIKV can infect animals;however,there is a low risk of ZIKV circulating in the local population.

Serological Detection of Tomato Pepino mosaic virus in Morocco

Pepino mosaic virus （PepMV）, monopartite RNA virus, 6,500 pb, belonging to Flexiviridae and Potexvirus group, is highly infectious and easily transmissible. Its economic impact is major for the tomato producer＇s countries. Prevention, based on early virus detection is the only effective control measure. Monoclonal antibodies appeared to be very useful tool. The authors used for the production of monoclonal antibodies hybridomas technique, by fusing spleen cells of immunized BALB/c mice to PepMV and SP2/O cancerous cells. The aim of this work is to produce hybridomas producers of Mab that could be used for ELISA in Morocco. At the same time, these efforts will serve to decrease expenses of producers concerning phytosanitory control. We obtained 16 hybridomas lines producers of Mab specific for PepMV. They were tested for efficiencies in ELISA and two lines were retained for production of Mab on large scale （1B 11-G 10 and 5A l-G5）. Isotyping of these two lines showed that they are belonging to IgG 1 class and easily purified by affinity chromatography in agarose column by protein A. The conjugation of these two antibodies to alkaline phosphatase has been verified by DAS-ELISA. These antibodies will enable to diagnose the disease from infected tomato plants, integrating several serological tests to control it and target the actions of struggles.

Comparative Study of Serologic Results Obtained by HI Test of Avian Influenza and Newcastle Disease Performed in Four Mexican Laboratories

In the poultry industry, it is common to evaluate the humoral immune response associated to the vaccination calendar used for the different zootechnical purposes. When the vaccine against avian influenza and Newcastle disease currently used in a farm is going to be changed, an important parameter observed to choose a product over the others is based on the antibody titers reached by the application of the new vaccine. This study aimed to compare the serologic results obtained by hemagglutination inhibition （HI） test of avian influenza and Newcastle disease reported in four different national laboratories. One-day-old Ross broiler chickens were kept in Horsfall-Bauer isolation units and were vaccinated subcutaneously for the prevention of avian influenza and Newcastle disease. Then, serum of all the birds was extracted at three, six and seven weeks old and sent to four different national diagnostic laboratories, where HI test was performed for avian influenza and Newcastle disease. The treatments were designed in 4 × 3 factorial. Data showed significant statistical differences between laboratory results （up to six logarithms for influenza at six and seven weeks）. This study confirms that the results of the HI test can vary from one laboratory to another, thus it is important to consider this, when the vaccines against avian influenza and Newcastle disease are evaluated at field.

Multiplex Rapid Test with Acceptable Diagnosis Performance as a Solution to Increase Diagnosis of Hepatitis B and C Viruses in Pregnant Women in an Area of High Prevalence of Both Hepatitis Viruses Associated with HIV

Background and Objective: HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) are very widespread in the world, however, less than 20% of the people affected are diagnosed and treated. This study aimed to determine the prevalence of HIV, HCV and HBV co-infections in pregnant women at Bangui Community University Hospital and the cost of screening. Methods: A cross-sectional study involving consenting pregnant women who came for antenatal care was performed. HIV, HCV antibodies and HBV antigens were detected using Exacto Triplex? HIV/HCV/HBsAg rapid test, cross-validated by ELISA tests. Sociodemographic and professional data, the modes of transmission and prevention of HIV and both hepatitis viruses were collected in a standard sheet and analyzed using the Epi-Info software version 7. Results: Pregnant women aged 15 to 24 were the most affected (45.3%);high school girls (46.0%), and pregnant women living in cohabitation (65.3%) were the most represented. Twenty-five (16.7%) worked in the formal sector, 12.7% were unemployed housewives and the remainder in the informal sector. The prevalence of HIV, HBV, and HCV viruses was 11.8%, 21.9% and 22.2%, respectively. The prevalence of co-infections was 8.6% for HIV-HBV, 10.2% for HIV-HCV, 14.7% for HBV-HCV and 6.5% for HIV-HBV-HCV. All positive results and 10% of negative results by the rapid test were confirmed by ELISA tests. The serology of the three viruses costs 39,000 FCFA (60 Euros) by ELISA compared to 10,000 FCFA (15.00 Euros) with Exacto Triplex? HIV/HCV/AgHBs (BioSynex, Strasbourg, France). Conclusion: The low level of education and awareness of hepatitis are barriers to development and indicate the importance of improving the literacy rate of women in the Central African Republic (CAR). Likewise, the high prevalence of the three viruses shows the need for the urgent establishment of a national program to combat viral hepatitis in the CAR.

联合指标对缺血性卒中中医辨证分型的诊断价值评价

目的探究联合指标对缺血性卒中不同证型的诊断价值,为西医及基层医生对于缺血性卒中中医辨证分型提供客观依据。方法以2021年8月至2022年4月收集到的589名缺血性卒中患者为研究对象,参照相关标准将其分为风痰上扰证、肝阳暴亢证、气虚血瘀证、阴虚风动证、痰热内闭清窍证、痰湿蒙塞清窍证6种证型,利用工作者特征(ROC)曲线分析疾病史、血清指标等对不同证型诊断的价值。结果UA、高血压、饮酒联合诊断风痰上扰诊断价值较高,AUC为0.865(95%CI:0.800~0.929),灵敏度100%,特异度66.6%;UA、心率、PLT、失眠、高血压联合诊断肝阳暴亢诊断价值较高,AUC为0.734(95%CI:0.674~0.774),灵敏度81.7%,特异度58.3%;UA、PLT、(离)退休联合诊断痰热内闭清窍诊断价值较高,AUC为0.587(95%CI:0.529~0.645),灵敏度94.1%,特异度22.6%;心率、RBC、(离)退休、高血压联合诊断气虚血瘀诊断价值较高,AUC为0.700(95%CI:0.656~0.745),灵敏度57.2%,特异度75.9%;UA、PLT、高血压、失眠、饮酒、颈内动脉斑块、糖尿病联合诊断阴虚风动诊断价值较高,AUC为0.893(95%CI:0.853~0.933),灵敏度89.3%,特异度80.0%;UA、高血压联合诊断痰湿蒙塞清窍诊断价值较高,AUC为0.622(95%CI:0.538~0.705),灵敏度71.7%,特异度51.2%。结论UA、高血压贯穿疾病始终,联合指标对缺血性卒中不同证型诊断价值不同,可作为辨证分型的参考。

维生素B12缺乏症相关的口腔临床特点分析

目的:分析维生素B12缺乏相关的口腔临床特点及血液学特点,以便早期诊断及治疗。方法:回顾性分析2021年1月~2023年11月16例维生素B12缺乏患者的口腔症状、临床体征、既往病史,并分析血常规、血清维生素B12和叶酸水平等辅助检查结果。结果:维生素B12缺乏患者多以口腔刺激痛、烧灼感及口腔溃疡为主诉。临床检查多以口腔黏膜充血红斑、多发性小溃疡为主要表现。有胃切除史患者更容易患贫血,没有胃切除史患者维生素B12缺乏早于血液学检查的变化。结论:特殊人群患者如果出现多发性复发性口腔溃疡、萎缩性舌炎、黏膜充血红斑等病损时,应警惕维生素B12缺乏的可能性,应建议进一步检查血清维生素B12水平,以便该疾病的早发现、早诊断、早治疗。

Syphilis Serologic Follow-up After Regular Treatment

Objective： To understand the changes in syphilis serology after regular treatment. Methods： Patients with clinical evidence and credible medical history of syphilis were treated regularly. Their serologic tests were followed for two years. Results： At the end of half a year, 22.95% of patients had a negative USR but 26.23% remained positive even after 2 years. More than 3% of patients had a negative FTA-ABS result. These patients tended to be under 40 with a disease course of less than 2 years. Conclusion： The resolution rate was high for patients who were young, had a shorter course of disease and reacted strongly to the infection. In patients older than 40 with a long course of disease, the resolution rate was low.

Analysis of Clinical Characteristics and Diagnostic Value of Fungal Serology in Patients with Invasive Candidiasis

Objective: To evaluate the diagnostic value of (1 - 3)-β-D glucan and mannan assay for invasive candidiasis. Methods: A retrospective study was conducted on 32 cases in the disease group (18 proven invasive candidiasis and 14 probable invasive candidiasis) and 48 cases in the control group. The subjects were recruited from January 2018 to March 2019 in Clinical Laboratory of Hainan General Hospital. All subjects were detected by (1 - 3)-β-D glucan and mannan assay. Results: The mean concentration of (1 - 3)-β-D glucan in the disease group was 97.45 (43.23, 224.35) pg/ml and it was significantly higher than the mean concentration of the control group which was 49.85(41.91, 56.07) pg/ml (P = 0.005). The mean concentration of mannan in the disease group and the control group were 161.36 (34.96, 224.49) pg/ml and 25.80 (25.00, 29.31) pg/ml, respectively, which were significantly different (P < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of (1 - 3)-β-D glucan assay were 59.38%, 89.58%, 79.17%, 76.79%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of mannan assay were 65.63%, 95.83%, 91.30%, 80.70%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of combination of two types of assays were 81.25%, 85.42%, 78.79% and 87.23%, respectively. Conclusions: Combination of (1 - 3)-β-D glucan and mannan assay can improve diagnostic specificity and it has essential clinical diagnostic value for invasive candidiasis.

Comparison of Sputum Smear Microscopy and Rapid Tuberculosisantibody Detection Test Kits for Diagnosis of Pulmonary Tuberculosis in Abia State, Nigeria

The SSM （sputum smear microscopy） and five immunochromatographic tuberculosis antibody detection tests （DiaSpot TB, Spodex TB, SD Rapid TB, Clinotech TB Screen and Precious One-step TB） were compared for diagnosis of active TB at the Leprosy and Tuberculosis Referral Hospital, Uzuakoli, Abia State, Nigeria. Sputum specimens from 150 study participants （male/female ratio, 0.81） were cultured on Lowenstein-Jensen slopes and direct smears were stained by Ziehl-Neelsen technique and examined by light microscopy. Sera were tested for anti-TB antibodies using the rapid TB tests. A total of 91 participants were culture positive, 79 （86.8%） for M. tuberculosis and 12 （13.2%） for nontuberculous mycobacteria. The sensitivity of SSM was 50% （95% CI： 39.0-61.0） and specificity was 92.3% （95% CI： 86.4-98.2） in those culture positive for M. tuberculosis. The sensitivity and specificity of the Rapid TB tests ranged from 24.1-39.2% and 78.4-87.8%, respectively. None of the five rapid TB tests had acceptable level of accuracy for diagnosis of active TB. The sensitivity of SSM though moderate is inadequate for long term TB control in this setting.