Search

Objective: to identify Brazilian micro-regions with under-reported tuberculosis cases, from 2012 to 2014., Methods: this was an ecological study using data from the Notifiable Health Conditions Information System (SINAN). The indirect estimator of the proportion of notified cases (EIPCN) was calculated as the mean between the proportion of cases that adhered to treatment and the proportion of those who underwent sputum smear microscopy. Negative Binomial Regression was used to investigate evidence of under-reporting in the micro-regions selected through EIPCN., Results: under-reporting was suspected in 89 (17.5%) micro-regions with EIPCN below 83%. The EIPCN rate ratio in the regression model was 0.996 (95%CI 0.988;1.003) considering all the data and equal to 0.987 (95%CI 0.974;0.999) excluding the 89 micro-regions with suspected under-reporting., Conclusion: evidence of tuberculosis case under-reporting was found in micro-regions where basic indicators of surveillance system quality had poor performance.

Objective to describe the completeness of tuberculosis (TB) case records in Santa Catarina, Brazil, from 2007 to 2016. Methods this was a descriptive study using Notifiable Health Conditions Information System data; completeness, consistency of notification form records and timely notification were analyzed in order to assess data quality. Results completeness of notification form mandatory fields was considered good; essential fields were less complete, in particular the 'Schooling' field; low completeness of follow-up sputum smear microscopy and failure to update culture tests and HIV serology tests demonstrate weaknesses in follow-up records. Conclusion the tuberculosis surveillance system data were considered adequate for guiding tuberculosis prevention and control actions; record monitoring and periodical evaluation, as well as adoption of strategies to improve follow-up report completeness are recommended.

Background: In Asia, over 50% of patients with symptoms of tuberculosis (TB) access health care from private providers. These patients are usually not notified to the National TB Control Programs, which contributes to low notification rates in many countries., Methods: From January 1, 2011 to December 31, 2012, Karachi's Indus Hospital - a private sector partner to the National TB Programme - engaged 80 private family clinics in its catchment area in active case finding using health worker incentives to increase notification of TB disease. The costs incurred were estimated from the perspective of patients, health facility and the program providing TB services. A Markov decision tree model was developed to calculate the cost-effectiveness of the active case finding as compared to case detection through the routine passive TB centers. Pakistan has a large private health sector, which can be mobilized for TB screening using an incentivized active case finding strategy. Currently, TB screening is largely performed in specialist public TB centers through passive case finding. Active and passive case finding strategies are assumed to operate independently from each other., Results: The incentive-based active case finding program costed USD 223 per patient treated. In contrast, the center based non-incentive arm was 23.4% cheaper, costing USD 171 per patient treated. Cost-effectiveness analysis showed that the incentive-based active case finding program was more effective and less expensive per DALY averted when compared to the baseline passive case finding as it averts an additional 0.01966 DALYs and saved 15.74 US$ per patient treated., Conclusion: Both screening strategies appear to be cost-effective in an urban Pakistan context. Incentive driven active case findings of TB in the private sector costs less and averts more DALYs per health seeker than passive case finding, when both alternatives are compared to a common baseline situation of no screening.

Existing high-priority target product profiles (TPPs) of the World Health Organization (WHO) establish important needs for tuberculosis (TB) diagnostic development. Building on this earlier work, this guidance series aims to provide study guidance for performing accuracy studies of novel diagnostic products that may meet the 4 high-priority WHO TPPs and thus enable adequate evidence generation to inform a WHO evidence review process. Diagnostic accuracy studies represent a fundamental step in the validation of all tests. Unfortunately, such studies often have limitations in design, execution, and reporting, leading to low certainty of the evidence about true test performance, which can delay or impede policy and scale-up decisions. This introductory paper outlines the following: (1) the purpose of this series of papers on study guidance; (2) WHO evidence needs and process for the development of policy guidelines for new TB diagnostic tests; and (3) study design considerations, ie, general diagnostic study considerations, intended use of test and role in the clinical pathway, choice of population and setting, index-test specific issues, suitable reference standard and comparators, study flow and specimen issues, and finally key issues beyond accuracy that should be considered. The other 4 papers in this series will provide more detailed guidance for each of the 4 WHO high-priority TPPs. By increasing the clarity around the clinical evaluation needs for tests that have the potential to meet the TPP specifications, we hope to support harmonized evidence generation and enable the WHO review process towards meeting the WHO End TB Strategy targets for reducing the incidence and mortality associated with TB., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Objectives: A well-functioning disease surveillance system is essential for effective control of diseases. Therefore, conducting evaluation studies on the performance of disease surveillance systems is necessary. This study was conducted to evaluate the performance of the Iranian syndrome-based surveillance system for tuberculosis (TB) in rural areas of Fars, the third largest province located in southern Iran., Study Design: This was an evaluation study., Methods: Two independent sources of information (data from a population-based survey and data from the surveillance system) were used in this evaluation. A group of trained female nurses used a specially designed interview-administered questionnaire to obtain data on the health status of family members from mothers or other adult women in rural houses. Subsequently, the nurses obtained data from individuals who reported a history of TB during a specified period and defined whether the patients presented themselves to a rural or urban health centre or clinic., Results: A total of 48,771 individuals participated in this study. Of 156 cases who reported a history of TB, 137 (87.82%) presented themselves to at least one medical care provider seeking diagnosis and treatment services. Of patients who visited a health or medical centre, only 18 (13.14%) were reported to the highest level of the surveillance system. Accordingly, the rates of underascertainment and underreporting of the Iranian surveillance system for TB were 12.18% and 86.86%, respectively. Moreover, underascertainment was significantly higher for men (19.40%) than for women (6.74%). The mean time between the date at which TB was noticed and the date of diagnosis was 56.24 days, which was longer for men (79.29 days) than for women (40.10 days). The highest and lowest levels of underreporting were observed for private general practitioners (100%) and the health centres run by the government (87%), respectively., Conclusion: The quality of the communicable disease surveillance system for TB in Iran is facing important challenges, including underascertainment, underreporting and timeliness, in addition to different types of bias. Informing the general population and health workforce about TB and the importance of timely diagnosis is a good approach to improve the performance of Iran's national communicable disease surveillance system., (Copyright © 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objective: To analyze the discourses of health professionals about the obstacles in the process of detection and reporting of tuberculosis cases in Mozambique., Method: Qualitative exploratory study with a theoretical-methodological approach of Discourse Analysis of French matrix. The study was conducted in Mozambique in 2014 at three levels: central, provincial and district. The study included 15 health professionals, 4 physicians, 6 technicians and 5 nursing professionals, who worked in the National Tuberculosis Control Program, with more than 1 year of experience., Result: The following discursive blocks emerged: Detection of tuberculosis cases in laboratories; Underreporting of tuberculosis cases; Obstacles to detect cases of tuberculosis: long distances and lack of transport; and Reporting of cases for decision making., Final Considerations: The discourses analyzed point to the ideological affiliation that includes the lack of investment policies in the health sector and the political commitment as basic obstacles in the detection and reporting of tuberculosis cases.

Background: Knowledge of the HIV status in patients with tuberculosis (TB) and vice versa is crucial for proper individual patient management, while knowledge of the prevalence of co-infection guides preventive and therapeutic strategies. The aim of the study was to assess if national disease databases on TB and HIV are adequate sources to provide this information., Methods: A two way capture-recapture analysis to assess the completeness of the registers, and to obtain the prevalence of TB-HIV co-infection in the Netherlands in the years 2002-2012., Results: HIV testing was performed in less than 50% of the patients with TB. Of the 932 TB-HIV infected patients, just 293 (31.4%) were registered in both registers. Under-reporting of TB-HIV co-infection ranged from 50% to 70% in the national TB register, and from 31% to 37% in the HIV database. Prevalence of TB-HIV co-infection in the Netherlands in 2012 was 7.1% (95% CI 6.0% to 8.3%), which was more than double of the prevalence estimated from the national TB database., Conclusions: TB-HIV co-infection is markedly under-reported in national disease databases. There is an urgent need for improved registration and preferably a routine data exchange between the two surveillance systems., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Introduction: Tuberculosis (TB) is a notifiable disease and health care providers are required to notify every TB case to local authorities. We conducted a pilot study to determine the usefulness and feasibility of mobile interface in TB notification (MITUN) voice based system for notification of TB cases by private medical practitioners., Methodology: The study was conducted during September 2013 to October 2014 in three zones of Chennai, an urban setting in South India. Private clinics wherein services are provided by single private medical practitioners were approached. The steps involved in MITUN included: Registration of the practitioners and notification of TB cases by them through voice interactions. Pre and post-intervention questionnaires were administered to collect information on TB notification practices and feasibility of MITUN after an implementation period of 6 months., Results: A total of 266 private medical practitioners were approached for the study. Of them, 184 (69%) participated in the study; of whom 11 (6%) practitioners used MITUN for TB notification. Reasons for not using MITUN include lack of time, referral of patients to government facility, issues related to patient confidentiality and technical problems. Suggestions for making mobile phone based TB notification process user-friendly included reducing call duration, including only crucial questions and using missed call or SMS options., Conclusion: The performance (feasibility and usefulness) of MITUN voice based system for TB notification in the present format was sub-optimal. Perceived problems, logistical and practical issues preclude scale-up of notification of TB by private practitioners.

The control of HIV / Tuberculosis (TB) co -infection remains a challenge for public health. Notification is mandatory for both diseases and the National Case Registry Database (Sinan) is responsible for the collection and processing of individual forms of reporting and monitoring. The adequate fulfillment of these fields chips (completeness) is essential to follow the dynamics of the disease and set priorities for intervention. The aim of this study was to evaluate the completeness of the notification forms of tuberculosis in the priority municipalities of Bahia (Camaçari , Feira de Santana , Ilhéus , Itabuna, Jequié, Lauro de Freitas , Porto Seguro , Teixeira de Freitas , Paulo Afonso, Barreiras and Salvador) to control the disease in individuals with HIV/AIDS using tabulations obtained from the Sinan in the period from 2001 to 2010. The results showed that despite the completeness of the field HIV be above 50 %, more than half the cases were met as "undone" or "being processed" in all municipalities assessed in the period. The low completeness of reporting forms may compromise the quality of surveillance of TB cases. The results suggest the need for greater availability of HIV testing in these individuals.

Background: Involving all relevant healthcare providers in tuberculosis (TB) management through public-private mix (PPM) approaches is a vital element in the World Health Organization's (WHO) Stop TB Strategy. The control of TB in Zambia is mainly done in the public health sector, despite the high overall incidence rates., Aim: We conducted a survey to determine the extent of private-sector capacity, participation, practices and adherence to national guidelines in the control of TB., Setting: This survey was done in the year 2012 in 157 facilities in three provinces of Zambia where approximately 85% of the country's private health facilities are found., Methods: We used a structured questionnaire to interview the heads of private health facilities to assess the participation of the private health sector in TB diagnosis, management and prevention activities., Results: Out of 157 facilities surveyed, 40.5% were from the Copperbelt, 4.4% from Central province and 55.1% from Lusaka province. Only 23.8% of the facilities were able to provide full diagnosis and management of TB patients. Although 47.4% of the facilities reported that they do notify their cases to the National TB control programme, the majority (62.7%) of these facilities did not show evidence of notifications., Conclusion: Our results show that the majority of the facilities that diagnose and manage TB in the private sector do not report their TB activities to the National TB Control Programme (NTP). There is a need for the NTP to improve collaboration with the private sector with respect to TB control activities and PPM for Directly Observed Treatment, Short Course (DOTS).

Tuberculosis (TB) remains a major cause of morbidity and mortality, and Viet Nam ranks 12 among the 22 high-TB burden countries. This study analyses surveillance data of the National Tuberculosis Control Programme in Viet Nam for the six-year period 2007 to 2012. During the study period, 598,877 TB cases (all forms) were notified, and 313,225 (52.3%) were new smear-positive cases. The case notification rate of new smear-positive cases was decreased, from 65 per 100,000 population in 2007 to 57 per 100,000 population in 2012; this decrease was observed for males and females in all age groups except males aged 0-14 and females aged 15-24 years. The male-to-female ratio of new smear-positive TB cases increased from 2.85 in 2007 to 3.02 in 2012. The average annual cure rate of new smear-positive cases was 90.3%. The high male-to-female ratio for new smear-positive TB cases in this notification data was lower than that from the 2007 TB prevalence survey in Viet Nam, suggesting a lower case detection for males. The decrease in new smear-positive case notification rates may reflect a decline in TB incidence in Viet Nam as several programmatic improvements have been made, although further research is required to increase case detection among young males and children.

The aim of this study was to evaluate the completeness of tuberculosis reporting forms in the greater metropolitan areas of five Brazilian capitals where the incidence of tuberculosis was high in 2010 - Salvador, Rio de Janeiro, Cuiabá, Porto Alegre, and Belém - using tabulations obtained from the Sistema Nacional de Informação de Agravos de Notificação (National Case Registry Database). The degree of completeness was highest in Porto Alegre and Cuiabá, whereas it was lowest in Rio de Janeiro, where there are more reported cases of tuberculosis than in any other Brazilian capital. A low degree of completeness of these forms can affect the quality of the Brazilian National Tuberculosis Control Program, which will have negative consequences for health care and decision-making processes.

Objective: To identify factors associated with under-reporting of tuberculosis (TB) in the private sector in Korea., Design: A cross-sectional study of 37,820 cases in whom treatment was initiated between January and December 2008 using data from the Nationwide Medical Records Survey of Patients with TB. Adjusted odds ratios (aOR) for under-reporting with respect to socio-demographic and clinical factors were estimated., Results: Among the 37,820 identified cases, 21,611 (57.1%) were reported to the Korean TB Surveillance System. Factors associated with under-reporting on univariate analysis included young children, foreign-born persons, non-multidrug-resistant TB, persons prescribed fewer than four anti-tuberculosis drugs, non-performance of or negative result on sputum smear and extra-pulmonary TB (particularly abdominal or genitourinary TB). For pulmonary TB, cases with no sputum smear results vs. smear-positive patients (aOR 2.23, P < 0.001) and those prescribed <4 drugs vs. those who were prescribed ≥4 drugs (aOR 1.60, P < 0.001) were strongly related to under-reporting on multivariate analysis., Conclusion: The extent of under-reporting was greater among young children, persons who had not received sputum smear testing and those who had been prescribed fewer than four drugs. Furthermore, TB diagnostic investigations were often inadequate. Education on reporting requirements, including the importance of following guidelines on TB management, and a stricter enforcement of the existing TB Prevention Law, are needed.

Unlabelled: Tuberculosis (TB) is a notifiable disease by the Communicable Disease Control Law in Taiwan. Several measures have been undertaken to improve reporting of TB but the completeness and timeliness of TB notification in Taiwan has not yet been systemically evaluated., Methods: To assess completeness and timeliness of TB notification, potential TB cases diagnosed by health care facilities in the year 2005-2007 were identified using the reimbursement database of national health insurance (NHI), which has 99% population coverage in Taiwan. Potential TB patients required notification were defined as those who have TB-related ICD-9 codes (010-018) in the NHI reimbursement database in 2005-2007, who were not diagnosed with TB in previous year, and who have been prescribed with 2 or more types of anti-TB drugs. Each potential TB case was matched to the national TB registry maintained at Taiwan Centers for Disease Control (CDC) by using national identity number or, if non-citizen, passport number to determine whether the patients had been notified to local public health authorities and Taiwan CDC. The difference in the number of days between date of anti-tuberculosis treatment and date of notification was calculated to determine the timeliness of TB reporting., Results: Of the 57,405 TB patients who were prescribed with 2 or more anti-tuberculosis drugs, 55,291 (96.3%) were notified to National TB Registry and 2,114 (3.7%) were not. Of the 55,291 notified cases, 45,250 (81.8%) were notified within 7 days of anti-tuberculosis treatment (timely reporting) and 10,041(18.2%) after 7 days (delayed reporting). Factors significantly associated with failure of notification are younger age, previously notified cases, foreigner, those who visited clinics and those who visited health care facilities only once or twice in 6 months., Conclusion: A small proportion of TB cases were not notified and a substantial proportion of notified TB cases had delayed reporting, findings with implication for strengthening surveillance of tuberculosis in Taiwan. Countries where the completeness and timeliness of TB notification has not yet been evaluated should take similar action to strengthen surveillance of TB.

Background: Cooperation between different public and private health institutes involved in tuberculosis (TB) control has proven to enhance TB control in different settings. In China, such a mechanism has not been set up yet between Centers for Disease Control (CDCs) and university hospitals despite an increased TB incidence among students. This study aims to improve arrival of TB suspects identified by universities at the CDCs in order to manage them under standardized, directly observed treatment-short course (DOTS) conditions according to the National Tuberculosis Programme (NTP) guidelines., Methods: Five matched pairs of universities were randomly assigned to the control and intervention group. After a baseline survey, a cooperation mechanism between local CDCs and university hospitals was set up in the intervention group. The effects on referral of TB suspects to the local CDC, tracing by the local CDC, and arrival at the local CDCs were assessed. Differences were tested by means of the chi-square test., Results: During the baseline survey, the referral, tracing and arrival rates were between 37% and 46%. After implementation of the cooperation mechanism, these rates had not changed in the control group but increased significantly in the intervention group: the referral, tracing and arrival rates were 97%, 95%, and 93%, respectively., Conclusions: It is feasible and effective to set up cooperation between CDCs and university hospitals to increase the number of TB suspects examined by CDCs and increase the number of TB patients treated under DOTS conditions. These public-public mix (PPM) activities should be expanded to cover all other university hospitals in China.

Objective: To analyze underreporting of deaths and hospital admissions from tuberculosis to the Information System for Notifiable Diseases (SINAN)., Methods: Cases with tuberculosis as basic or associated cause of death were selected from the Brazilian Mortality Information System (SIM) and hospital admissions for tuberculosis as main or secondary cause from the Hospital Information System of the Brazilian Unified Health System (SIH-SUS), for residents in the municipality of Rio de Janeiro in 2004. Probabilistic record linkage was carried out between the SIM and SIH-SUS databases and the SINAN for the years 2002 to 2004., Results: Out of the 542 deaths from tuberculosis in the period, 234 (43.2%) were not registered in the SINAN for the two previous years. As for the 1,079 admissions, 238 (22.1%) failed to be notified. Seventy-one deaths were related to these admissions: 47 were registered out of the SIH-SUS by death, 24 occurred after discharge and seven remained unnotified in the SINAN. The elderly were 1.6 times (95%CI 1.074;2.516) less likely to be notified than younger patients, and those with at least a college education were 3.6 times (95%CI 1.384;11.022) less likely to be notified than those with no formal education. Patients under 15 were 4.8 times (95%CI 2.757;8.452) less likely to be notified than those aged between 15 and 59 years. Some regional health administration divisions showed a percentage of unnotified deaths of over 50% and this percentage ranged from 37.8% to 12.7% for hospital admissions., Conclusions: The data suggest problems in the detection of cases and point to obstacles in adequate and timely treatment, as well as to quality flaws in the information system, with differences among regions in the municipality.

Setting: Tuberculosis (TB) case registers in Cambodia, two provinces in China and in Viet Nam., Objective: To determine completeness and consistency of information for quarterly reports on case finding and treatment outcome., Methods: A representative sample of TB case registers was selected in Cambodia, in two provinces in China and in Viet Nam. Quarterly reports were reproduced from double-entered, validated data to determine completeness and consistency., Results: The dataset comprised 37,635 patient records in 2 calendar years. Only 0.2%, 3.6% and 1.1% of cases, respectively, in Cambodia, the two China provinces, and Viet Nam did not allow classification for the quarterly report on case finding. If the treatment outcome was reported as cured, it was correct in 99.9%, 85.7%, and 98.5% of the respective three jurisdictions: errors were mostly due to misclassification of completion as cure. Under-reporting of failures was more frequent than over-reporting in Cambodia and Viet Nam, while in the two provinces in China 84% of reported failures did not actually meet the bacteriological criterion., Conclusions: This evaluation demonstrates that recording essential information is exemplary in all three countries. It will be essential to carefully supervise the ability of staff to correctly define TB treatment outcome results in all three countries.

Setting: Despite the low incidence of tuberculosis (TB) in the United States military, there is uncertainty in the overall reporting and estimates of incidence., Objective: To assess TB reporting in the active component US military., Design: TB notification in the US military was compared with three other data sources: laboratory, hospitalization and pharmacy records. Sensitivity and positive predictive value were estimated for all data sources using a gold standard of either a reportable medical event (RME) reported as confirmed or a positive laboratory result for Mycobacterium tuberculosis. Uncorrected and capture-recapture (CR) methods were used to estimate underreporting and completeness of data sources., Results: Completeness of reporting of pulmonary TB cases was estimated as 72.4% uncorrected or 58.3% with CR. Even after correction for possible underreporting, the incidence of active pulmonary TB was only 0.87 per 100,000 person-years between 2004 and 2006., Conclusion: The rate of active TB in the US military is low. Like civilian surveillance, US military RME surveillance may substantially underreport TB incidence rates. Expanding surveillance to include data sources such as hospitalizations and pharmacy records will increase the number of TB diagnoses at the cost of including many false-positives.

In 1999 the Enhanced Tuberculosis Surveillance (ETS) system was introduced in the United Kingdom to strengthen surveillance of tuberculosis (TB). The aim of this study was to assess the use of record-linkage and capture-recapture methodology for estimating the completeness of TB reporting in England between 1999 and 2002. Due to the size of the TB data sources sophisticated record-linkage software was required and the proportion of false-positive cases among unlinked hospital-derived TB records was estimated through a population mixture model. This study showed that record-linkage of TB data sources and cross-validation with additional TB-related datasets improved data quality as well as case ascertainment. Since the introduction of ETS observed completeness of notification in England has increased and the results were consistent with expected levels of under-notification. Completeness of notification estimated by a log-linear capture-recapture model was highly inconsistent with prior estimates and the validity of this methodology was further examined.

Objective: The tuberculosis recording and reporting information system (TB R&R), one of the five pillars of the DOTS strategy, has undergone a revision to comply with the new elements of the Stop TB Strategy and to ensure standardisation of essential TB information., Design: An expert group on TB R&R, including the main technical partners, held a series of consultations with the Stop TB Working Groups and countries. Draft revised forms were field tested by countries with the participation of technical partners. A survey was conducted by the World Health Organization (WHO) in 105 countries., Result: The main changes in the TB R&R are the inclusion of TB-HIV activities (the leading reason for change at the country level), smear examinations and culture for settings performing this test routinely and the management of patient drug kits. The revised forms help monitor contributions from all care providers and community workers. The package of forms is presented in three sets: 1) essential data, 2) setting with routine culture and 3) additional data., Conclusion: The revised R&R forms were endorsed by the WHO, the KNCV Tuberculosis Foundation, the International Union Against Tuberculosis and Lung Disease and the US Centers for Disease Control and Prevention in 2007. They are now available in English, French and Spanish, and are adopted in most countries.

Setting: The World Health Organization (WHO) European Region, which includes 52 countries., Objective: To assess an epidemiological data collection tool implemented in 2004 for recording human immunodeficiency virus (HIV) status among tuberculosis (TB) patients., Design: Based on WHO estimates, the reported number of TB patients with HIV was compared with the number expected. The analysis included all forms of TB and was restricted to adults, wherever possible. The numbers of TB patients detected from HIV/acquired immune-deficiency syndrome (AIDS) programmes (NAPs) were also assessed., Results: In 2003, 20 (38%) National TB Programmes (NTPs) reported 4602 (35%) HIV-infected TB cases of 13117 expected; in 2004, 23 (44%) NTPs reported 5902 (42%) cases of 13901 expected. In 2003, 47 (90%) NAPs reported 3575 (27%) TB cases as a new AIDS diagnosis, while in 2004, 40 (77%) NAPs reported 3901 (28%) TB cases. Those countries that did report, reported on average 60-65% of expected cases, irrespective of the kind of programme and the year., Conclusion: Most NTPs did not report TB cases with HIV infection. Overall, the number of cases reported in countries that reported data from either NTPs or NAPs was significantly lower than expected. Improved surveillance requires concerted efforts from both NTPs and NAPs.

Objective: To assess the quality of tuberculosis surveillance in Brazil., Methods: Local data from 2001 to 2003 were assessed according to the quality of detection and follow-up of the cases in the region, the quality of the information produced by the notification system, and the load of morbidity of tuberculosis. Cities were classified into four groups, according to tuberculosis epidemiologic stage and the quality of tuberculosis surveillance., Results: In the study period, about 8% of the Brazilian cities presented over 10% of the cases of tuberculosis notified by the health care services of another city. In about 950 cities, the frequency of patients with pulmonary tuberculosis undergoing sputum examination was lower than 90%. In the North region, Amazonas, Pará and Amapá presented more cities classified in the groups of poor tuberculosis surveillance. In the Northeast, Pernambuco, Ceará and Bahia presented the poorest surveillance. The South and Midwest regions presented greater number of cities with better tuberculosis surveillance., Conclusions: One third of the Brazilian cities present poor tuberculosis surveillance. This picture is not homogeneous in Brazil, and the regions with highest tuberculosis incidence have a great number of cities with apparently insufficient control measures.

Background: The Centers for Disease Control and Prevention (CDC) convened a workgroup to revise the tuberculosis (TB) case report in the United States of America (U.S.). The group proposed substantial revisions. Study objectives were to systematically assess the validity and completeness of reported TB case surveillance data in California and to inform TB case report revision process., Methods: A sample of 594 cases was retrospectively selected from the cohort of all TB cases reported during 6/1/96-5/31/97 to the State TB Registry. Cases, stratified by treatment outcome, were randomly sampled within each outcome category. Data for 53 variables were abstracted from each case's public health medical record and compared to data recorded on the TB case report. Using the medical record as the "gold standard," estimates were developed for 1) concordance, sensitivity, and positive predictive value of reported data for categorical variables; 2) the absolute mean difference between the two information source for date variables; and 3) the completeness of data on the case report and in medical record., Results: At least 90% of the values for 35 (79.5%) categorical variables submitted on the TB case report form were identical to values in the medical record. Concordance between data on the case report and medical record was lower for the remaining nine (20.5%) categorical variables: status of abnormal chest x-ray (46.8%); directly observed therapy (48.6%); smear result for tissue or body fluid other than sputum (49.2%); type(s) of tissue or body fluid for smears and cultures other than sputum (76.4% and 73.9% respectively); provider type (73.4%); occupation (84.4%); sputum culture conversion (85.4%); and sputum smear result (89.6%). Case report data were more complete than data in the medical record; 2.9% versus 9.8% of data were missing/unknown, respectively., Conclusion: For most variables examined on the TB case report, data validity was excellent, indicating a robust surveillance system. However, lower data quality was noted for a small number of variables primarily impacting treatment adherence, including assessment and planning; advocacy; allocation and garnering of resources; and research. The study provides compelling evidence supporting the CDC workgroup's proposed revisions to the TB case report.

The Infectious Disease Control Act enacted in Germany in 1.1.2001 led to a duty of notification also for institutes of pathologic-anatomical diagnostics. All reports within 45 months after enacting concerning diseases and agents being subject to registration were evaluated. Among the notifiable diseases with fatal outcome ( section sign 6) belonged 3 cases of Meningococcus sepsis, 13 of tuberculosis und 5 cases of Creutzfeldt-Jacob disease. During lifetime 54% of tuberculosis cases remained undetected. Notifiable agents ( section sign 7.1) concerned 92 times Mycobacterium-tuberculosis-complex, twice Influenza Virus and one case of Cryptosporidiosis and Giardia lamblia each. Six Echinococcus granulosus cysts were reported ( section sign 7.2). Notification needs exact diagnosis of infectious diseases and agents being subject of registration. By this pathologists participate in the control of infectious diseases.

Prompt laboratory reporting of tuberculosis (TB) test results is necessary for TB control. To understand the extent of and factors contributing to laboratory reporting delays and the impact of reporting delays on initiation of treatment of TB patients, we analyzed data from 300 consecutive culture-positive TB cases reported in four California counties in 1998. Laboratory reporting to the specimen submitter was delayed for 26.9% of smear-positive patients and 46.8% of smear-negative patients. Delays were associated with the type of laboratory that performed the testing and with delayed transport of specimens. Referral laboratories (public health and commercial) had longer median reporting time frames than hospital and health maintenance organization laboratories. Among patients whose treatment was not started until specimens were collected, those with delayed laboratory reporting were more likely to have delayed treatment than patients with no laboratory reporting delays (odds ratio [OR] of 3.9 and 95% confidence interval [CI] of 1.6 to 9.7 for smear-positive patients and OR of 13.1 and CI of 5.3 to 32.2 for smear-negative patients). This relation remained after adjustment in a multivariate model for other factors associated with treatment delays (adjusted OR of 25.64 and CI of 7.81 to 83.33 for smear-negative patients). These findings emphasize the need to reduce times of specimen transfer between institutions and to ensure rapid communication among laboratories, health care providers, and health departments serving TB patients.

Objective: Epidemiological surveillance of tuberculosis (TB) in Australia is dependent on the accuracy of the notification data. We have investigated the specificity of TB notification for the diagnosis of this disease., Method: We used data from notifications to the NSW Department of Health to identify members of a cohort of refugees who were screened between 1984 and 1993 and subsequently developed TB during that period. We reviewed notification data and, in most instances, case notes and x-ray films, to independently confirm or refute the diagnosis of TB., Results: Two hundred and fifty members of the cohort were identified in the notification database. After excluding refugees on treatment prior to arrival in Australia, and those who were notified as 'quiescent' and 'atypical' cases, there were 189 cases notified as active TB. There was evidence to support the diagnosis of active TB in 125 cases (66%) and evidence that subjects did not have active disease in 60 cases (32%). We could not determine the status of the remaining four notified cases., Conclusion: This study has shown that, in a population of refugees subject to screening, nearly one-third of cases notified as active tuberculosis from the study population were actually not active tuberculosis cases., Implications: The use of the TB notification database may result in overestimation of the incidence of TB in population groups who are subject to active screening.

The aim of this study was to evaluate completeness of tuberculosis notification in Bichat Claude-Bernard University Hospital and to evaluate whether misclassification of atypical mycobacterial infection could have contributed to the inaccuracy of tuberculosis notification. Data from Microbiology Laboratory of the hospital and statutory notifications were compared. From 1 January 1994 to 31 December 1995, 299 tuberculosis cases were diagnosed in the Microbiology Laboratory and 316 cases were notified as tuberculosis. Notification rate for laboratory-documented tuberculosis was 57.5%, was significantly higher in cases with positive acid fast bacilli smear (75%) than without this feature (45%) and was similar in HIV-positive (59.4%) and HIV-negative (63.5%) patients. Among notified cases, diagnosis was established by laboratory proofs in only 54.4% and by clinical signs in 45.6%. Three cases with positive smear and culture growing atypical mycobacteria were wrongly notified. Notification of laboratory-documented tuberculosis was higher than that observed in a previous study in the same hospital, suggesting that the rise of tuberculosis incidence reported in our country could be partially artificial. Nevertheless, extent of notification remains insufficient and needs to be improved by combining microbiological data with current system of notification.

Setting: Notification rates and mortality are the main indicators in the epidemiology of tuberculosis. While errors in case notification are known to be considerable, the quality of the data on deaths is largely unknown., Objective: To validate the quality of data on deaths from active tuberculosis., Design: We compared deaths from active tuberculosis in Statistics Norway with the National Tuberculosis Register (NTR) and cases found by autopsy in two Norwegian counties in 1977-1989. We also assessed the diagnostic classification and inclusion criteria for tuberculosis., Results: 110 patients were entered into the study. We excluded 30 of 106 patients in Statistics Norway, primarily because of inactive tuberculosis (16) or minimal lesions (7). We found an additional 20 patients in the NTR and 14 more from autopsy reports. These missing cases were registered in Statistics Norway with a different diagnosis (28), inactive tuberculosis (4) or not found (2). Nineteen of them were diagnosed with tuberculosis by autopsy and five by cultures reported after death. We altered the diagnostic classification of underlying cause in 14% and found tuberculosis to be the underlying cause in 65 patients., Conclusion: The mortality rate from active tuberculosis in Statistics Norway was fairly correct, but one-third were under-reported and one-third over-reported. The mortality rate includes only half of all the deaths from active tuberculosis. All the cases in which active tuberculosis is mentioned on the death certificate are a clearer indication of tuberculosis deaths.

The purpose of this study was to establish the extent of undernotification of tuberculosis in AIDS patients resident in 2 inner London local authorities. For residents of the 2 authorities, statutory notifications of tuberculosis between 1986 and 1992 were compared, using soundex codes of surnames, sex and year of birth, with AIDS cases reported to the Public Health Laboratory Service (PHLS) AIDS Centre during the same period where TB had been recorded on the AIDS report form. In 36 of 613 AIDS cases reported as residents of the 2 authorities tuberculosis was recorded on the AIDS report form. Matching revealed that only 2 (6%) of these cases had been notified to the local authority. These results highlight the need to resolve the dilemma between concerns about patient confidentiality and the statutory requirement to notify tuberculosis so that clinical management of contacts can be undertaken and the true impact of HIV infection on the incidence of tuberculosis in the UK can be elucidated.