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5. Alpha-1 deficiency in severe asthma patients

Author

Zappa, M., primary, Grossi, S., additional, Pignatti, P., additional, Pini, L., additional, Centis, R., additional, Migliori, G.B., additional, Ardesi, F., additional, Sotgiu, G., additional, Corsico, A. G., additional, Spanevello, A., additional, and Visca, D., additional

Published
2024
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6. Outcome of treatment of MDR-TB or drug-resistant patients treated with bedaquiline and delamanid: Results from a large global cohort

Author

Koirala, S., Borisov, S., Danila, E., Mariandyshev, A., Shrestha, B., Lukhele, N., Dalcolmo, M., Shakya, S.R., Miliauskas, S., Kuksa, L., Manga, S., Aleksa, A., Denholm, J.T., Khadka, H.B., Skrahina, A., Diktanas, S., Ferrarese, M., Bruchfeld, J., Koleva, A., Piubello, A., Koirala, G.S., Udwadia, Z.F., Palmero, D.J., Munoz-Torrico, M., GC, R., Gualano, G., Grecu, V.I., Motta, I., Papavasileiou, A., Li, Y., Hoefsloot, W., Kunst, H., Mazza-Stalder, J., Payen, M.-C., Akkerman, O.W., Bernal, E., Manfrin, V., Matteelli, A., Mustafa Hamdan, H., Nieto Marcos, M., Cadiñanos Loidi, J., Cebrian Gallardo, J.J., Duarte, R., Escobar Salinas, N., Gomez Rosso, R., Laniado-Laborín, R., Martínez Robles, E., Quirós Fernandez, S., Rendon, A., Solovic, I., Tadolini, M., Viggiani, P., Belilovski, E., Boeree, M.J., Cai, Q., Davidavičienė, E., Forsman, L.D., De Los Rios, J., Drakšienė, J., Duga, A., Elamin, S.E., Filippov, A., Garcia, A., Gaudiesiute, I., Gavazova, B., Gayoso, R., Gruslys, V., Jonsson, J., Khimova, E., Madonsela, G., Magis-Escurra, C., Marchese, V., Matei, M., Moschos, C., Nakčerienė, B., Nicod, L., Palmieri, F., Pontarelli, A., Šmite, A., Souleymane, M.B., Vescovo, M., Zablockis, R., Zhurkin, D., Alffenaar, J.-W., Caminero, J.A., Codecasa, L.R., García-García, J.-M., Esposito, S., Saderi, L., Spanevello, A., Visca, D., Tiberi, S., Pontali, E., Centis, R., D'Ambrosio, L., van den Boom, M., Sotgiu, G., and Migliori, G.B.

Published
2021
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15. Clinical standards for the management of adverse effects during treatment for TB.

Author

Singh, K.P., Carvalho, A.C.C., Centis, R., Ambrosio, L.D., Migliori, G.B., Mpagama, S.G., Nguyen, B.C., Aarnoutse, R.E., Aleksa, A., Altena, R. van, Bhavani, P.K., Bolhuis, M.S., Borisov, S., Boveneind-Vrubleuskaya, N. Van't, Bruchfeld, J., Caminero, J.A., Carvalho, I., Cho, J.G., Davies Forsman, L., Dedicoat, M., Dheda, K., Dooley, K., Furin, J., García-García, J.M., Garcia-Prats, A., Hesseling, A.C., Heysell, S.K., Hu, Y., Kim, H.Y., Manga, S., Marais, B.J., Margineanu, I., Märtson, A.G., Munoz Torrico, M., Nataprawira, H.M., Nunes, E., Ong, C.W.M., Otto-Knapp, R., Palmero, D.J., Peloquin, C.A., Rendon, A., Rossato Silva, D., Ruslami, R., Saktiawati, A.M.I., Santoso, P., Schaaf, H.S., Seaworth, B., Simonsson, U.S.H., Singla, R., Skrahina, A., Solovic, I., Srivastava, S., Stocker, S.L., Sturkenboom, M.G.G., Svensson, E.M., Tadolini, M., Thomas, T.A., Tiberi, S., Trubiano, J., Udwadia, Z.F., Verhage, A.R., Vu, D.H., Akkerman, O.W., Alffenaar, J.W.C., Denholm, J.T., Singh, K.P., Carvalho, A.C.C., Centis, R., Ambrosio, L.D., Migliori, G.B., Mpagama, S.G., Nguyen, B.C., Aarnoutse, R.E., Aleksa, A., Altena, R. van, Bhavani, P.K., Bolhuis, M.S., Borisov, S., Boveneind-Vrubleuskaya, N. Van't, Bruchfeld, J., Caminero, J.A., Carvalho, I., Cho, J.G., Davies Forsman, L., Dedicoat, M., Dheda, K., Dooley, K., Furin, J., García-García, J.M., Garcia-Prats, A., Hesseling, A.C., Heysell, S.K., Hu, Y., Kim, H.Y., Manga, S., Marais, B.J., Margineanu, I., Märtson, A.G., Munoz Torrico, M., Nataprawira, H.M., Nunes, E., Ong, C.W.M., Otto-Knapp, R., Palmero, D.J., Peloquin, C.A., Rendon, A., Rossato Silva, D., Ruslami, R., Saktiawati, A.M.I., Santoso, P., Schaaf, H.S., Seaworth, B., Simonsson, U.S.H., Singla, R., Skrahina, A., Solovic, I., Srivastava, S., Stocker, S.L., Sturkenboom, M.G.G., Svensson, E.M., Tadolini, M., Thomas, T.A., Tiberi, S., Trubiano, J., Udwadia, Z.F., Verhage, A.R., Vu, D.H., Akkerman, O.W., Alffenaar, J.W.C., and Denholm, J.T.

Abstract

Item does not contain fulltext, BACKGROUND: Adverse effects (AE) to TB treatment cause morbidity, mortality and treatment interruption. The aim of these clinical standards is to encourage best practise for the diagnosis and management of AE.METHODS: 65/81 invited experts participated in a Delphi process using a 5-point Likert scale to score draft standards.RESULTS: We identified eight clinical standards. Each person commencing treatment for TB should: Standard 1, be counselled regarding AE before and during treatment; Standard 2, be evaluated for factors that might increase AE risk with regular review to actively identify and manage these; Standard 3, when AE occur, carefully assessed and possible allergic or hypersensitivity reactions considered; Standard 4, receive appropriate care to minimise morbidity and mortality associated with AE; Standard 5, be restarted on TB drugs after a serious AE according to a standardised protocol that includes active drug safety monitoring. In addition: Standard 6, healthcare workers should be trained on AE including how to counsel people undertaking TB treatment, as well as active AE monitoring and management; Standard 7, there should be active AE monitoring and reporting for all new TB drugs and regimens; and Standard 8, knowledge gaps identified from active AE monitoring should be systematically addressed through clinical research.CONCLUSION: These standards provide a person-centred, consensus-based approach to minimise the impact of AE during TB treatment.

Published
2023

20. Management of childhood MDR-TB in Europe and Central Asia : report of a Regional WHO meeting

Author

Gröschel, M.I., van den Boom, M., Dixit, A., Skrahina, A., Dodd, P.J., Migliori, G.B., Seddon, J.A., and Farhat, M.R.

Abstract

BACKGROUND: As the WHO European Region has the highest proportion of multidrug-resistant TB (MDR-TB) among total incident TB cases, many children and adolescents are at risk of MDR-TB infection and disease.\ud \ud \ud \ud METHODS: We performed an electronic survey of clinicians and TB programme personnel who attended the 2020 Regional Consultation on child and adolescent TB organised by the WHO Regional Office. We characterised access to diagnostics and drugs, and practices in the prevention and management of child and adolescent MDR-TB.\ud \ud \ud \ud RESULTS: Children and adolescents are inconsistently represented in national guidelines and budgets; child-friendly drug formulations for MDR-TB treatment are insufficiently available in 57% of countries, and 32% of countries reported paediatric drug stock-outs. The novel drugs, bedaquiline and delamanid, are accessible by respectively 80% and 60% of respondent countries. Respondents were asked how many children were diagnosed with MDR-TB in 2019, and a comparison of this number to modelled estimates of incidence (to identify the case detection gap) and WHO notifications (to identify the case reporting gap) showed substantial differences in both comparisons.\ud \ud \ud \ud CONCLUSIONS: Better representation of this patient group in guidelines and budgets, greater access to drugs and improved reporting are essential to reach TB elimination in this Region.

Published
2022

21. Clinical standards for the dosing and management of TB drugs

Author

Alffenaar, J.W.C., Stocker, S.L., Forsman, L.D., Garcia-Prats, A., Heysell, S.K., Aarnoutse, R.E., Akkerman, O.W., Aleksa, A., Altena, R. van, Oñata, W.A. de, Bhavani, P.K., Boveneind-Vrubleuskaya, N. Van't, Carvalho, A.C.C., Centis, R., Chakaya, J.M., Cirillo, D.M., Cho, J.G., Ambrosio, L.D., Dalcolmo, M.P., Denti, P., Dheda, K., Fox, G.J., Hesseling, A.C., Kim, H.Y., Köser, C.U., Marais, B.J., Margineanu, I., Märtson, A.G., Torrico, M.M., Nataprawira, H.M., Ong, C.W.M., Otto-Knapp, R., Peloquin, C.A., Silva, D.R., Ruslami, R., Santoso, P., Savic, R.M., Singla, R., Svensson, E.M., Skrahina, A., Soolingen, D. van, Srivastava, S., Tadolini, M., Tiberi, S., Thomas, T.A., Udwadia, Z.F., Vu, D.H., Zhang, W., Mpagama, S.G., Schön, T., Migliori, G.B., Alffenaar, J.W.C., Stocker, S.L., Forsman, L.D., Garcia-Prats, A., Heysell, S.K., Aarnoutse, R.E., Akkerman, O.W., Aleksa, A., Altena, R. van, Oñata, W.A. de, Bhavani, P.K., Boveneind-Vrubleuskaya, N. Van't, Carvalho, A.C.C., Centis, R., Chakaya, J.M., Cirillo, D.M., Cho, J.G., Ambrosio, L.D., Dalcolmo, M.P., Denti, P., Dheda, K., Fox, G.J., Hesseling, A.C., Kim, H.Y., Köser, C.U., Marais, B.J., Margineanu, I., Märtson, A.G., Torrico, M.M., Nataprawira, H.M., Ong, C.W.M., Otto-Knapp, R., Peloquin, C.A., Silva, D.R., Ruslami, R., Santoso, P., Savic, R.M., Singla, R., Svensson, E.M., Skrahina, A., Soolingen, D. van, Srivastava, S., Tadolini, M., Tiberi, S., Thomas, T.A., Udwadia, Z.F., Vu, D.H., Zhang, W., Mpagama, S.G., Schön, T., and Migliori, G.B.

Abstract

Item does not contain fulltext, BACKGROUND: Optimal drug dosing is important to ensure adequate response to treatment, prevent development of drug resistance and reduce drug toxicity. The aim of these clinical standards is to provide guidance on 'best practice´ for dosing and management of TB drugs.METHODS: A panel of 57 global experts in the fields of microbiology, pharmacology and TB care were identified; 51 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all participants.RESULTS: Six clinical standards were defined: Standard 1, defining the most appropriate initial dose for TB treatment; Standard 2, identifying patients who may be at risk of sub-optimal drug exposure; Standard 3, identifying patients at risk of developing drug-related toxicity and how best to manage this risk; Standard 4, identifying patients who can benefit from therapeutic drug monitoring (TDM); Standard 5, highlighting education and counselling that should be provided to people initiating TB treatment; and Standard 6, providing essential education for healthcare professionals. In addition, consensus research priorities were identified.CONCLUSION: This is the first consensus-based Clinical Standards for the dosing and management of TB drugs to guide clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment to improve patient care.

Published
2022

22. Radio and X-Ray Observations of the Luminous Fast Blue Optical Transient AT 2020xnd

Author

Bright, J. S., Margutti, Raffaella, Matthews, David, Brethauer, D., Coppejans, D. L., Wieringa, M.H., Metzger, B. D., Demarchi, L., Laskar, T., Romero, Charles, Alexander, Kate D., Horesh, Assaf, Migliori, G.B., Chornock, Ryan, Berger, E., Bietenholz, M., Devlin, Joe, Dicker, Simon R., Jacobson-Galan, W. V., Mason, B., Milisavljevic, D., Motta, Sara E., Mroczkowski, Tony, Ramirez-Ruiz, Jorge Enrico, Rhodes, L., Sarazin, C., Sfaradi, Itai, Sievers, Jonathan, Bright, J. S., Margutti, Raffaella, Matthews, David, Brethauer, D., Coppejans, D. L., Wieringa, M.H., Metzger, B. D., Demarchi, L., Laskar, T., Romero, Charles, Alexander, Kate D., Horesh, Assaf, Migliori, G.B., Chornock, Ryan, Berger, E., Bietenholz, M., Devlin, Joe, Dicker, Simon R., Jacobson-Galan, W. V., Mason, B., Milisavljevic, D., Motta, Sara E., Mroczkowski, Tony, Ramirez-Ruiz, Jorge Enrico, Rhodes, L., Sarazin, C., Sfaradi, Itai, and Sievers, Jonathan

Published
2022

27. Epidemic and pandemic viral infections: impact on tuberculosis and the lung: A consensus by the World Association for Infectious Diseases and Immunological Disorders (WAidid), Global Tuberculosis Network (GTN), and members of the European Society of Clinical Microbiology and Infectious Diseases Study Group for Mycobacterial Infections (ESGMYC)

Author

Ong, C.W.M., Migliori, G.B., Raviglione, M., MacGregor-Skinner, G., Sotgiu, G., Alffenaar, J.W.C., Tiberi, S., Adlhoch, C., Alonzi, T., Archuleta, S., Brusin, S., Cambau, E., Capobianchi, M.R., Castilletti, C., Centis, R., Cirillo, D.M., D'Ambrosio, L., Delogu, G., Esposito, S.M.R., Figueroa, J., Friedland, J.S., Ho, B.C.H., Ippolito, G., Jankovic, M., Kim, H.Y., Klintz, S. Rosales, Ködmön, C., Lalle, E., Leo, Y.S., Leung, C.C., Märtson, A.G., Melazzini, M.G., Fard, S. Najafi, Penttinen, P., Petrone, L., Petruccioli, E., Pontali, E., Saderi, L., Santin, M., Spanevello, A., Crevel, R. van, Werf, M.J. van der, Visca, D., Viveiros, M., Zellweger, J.P., Zumla, A., Goletti, D., Ong, C.W.M., Migliori, G.B., Raviglione, M., MacGregor-Skinner, G., Sotgiu, G., Alffenaar, J.W.C., Tiberi, S., Adlhoch, C., Alonzi, T., Archuleta, S., Brusin, S., Cambau, E., Capobianchi, M.R., Castilletti, C., Centis, R., Cirillo, D.M., D'Ambrosio, L., Delogu, G., Esposito, S.M.R., Figueroa, J., Friedland, J.S., Ho, B.C.H., Ippolito, G., Jankovic, M., Kim, H.Y., Klintz, S. Rosales, Ködmön, C., Lalle, E., Leo, Y.S., Leung, C.C., Märtson, A.G., Melazzini, M.G., Fard, S. Najafi, Penttinen, P., Petrone, L., Petruccioli, E., Pontali, E., Saderi, L., Santin, M., Spanevello, A., Crevel, R. van, Werf, M.J. van der, Visca, D., Viveiros, M., Zellweger, J.P., Zumla, A., and Goletti, D.

Abstract

Contains fulltext : 225854.pdf (Publisher’s version ) (Open Access), Major epidemics, including some that qualify as pandemics, such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), HIV, influenza A (H1N1)pdm/09 and most recently COVID-19, affect the lung. Tuberculosis (TB) remains the top infectious disease killer, but apart from syndemic TB/HIV little is known regarding the interaction of viral epidemics and pandemics with TB. The aim of this consensus-based document is to describe the effects of viral infections resulting in epidemics and pandemics that affect the lung (MERS, SARS, HIV, influenza A (H1N1)pdm/09 and COVID-19) and their interactions with TB. A search of the scientific literature was performed. A writing committee of international experts including the European Centre for Disease Prevention and Control Public Health Emergency (ECDC PHE) team, the World Association for Infectious Diseases and Immunological Disorders (WAidid), the Global Tuberculosis Network (GTN), and members of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycobacterial Infections (ESGMYC) was established. Consensus was achieved after multiple rounds of revisions between the writing committee and a larger expert group. A Delphi process involving the core group of authors (excluding the ECDC PHE team) identified the areas requiring review/consensus, followed by a second round to refine the definitive consensus elements. The epidemiology and immunology of these viral infections and their interactions with TB are discussed with implications for diagnosis, treatment and prevention of airborne infections (infection control, viral containment and workplace safety). This consensus document represents a rapid and comprehensive summary on what is known on the topic.

Published
2020

28. MDR/XDR-TB management of patients and contacts: Challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network

Author

Migliori, G.B., Tiberi, S., Zumla, A., Petersen, Eskild, Chakaya, J.M., Wejse, C., Munoz-Torrico, M., Duarte, R., Alffenaar, J.W.C., Schaaf, H.S., Marais, B.J., Cirillo, D.M., Alagna, R., Rendon, A., Pontali, E., Piubello, A., Figueroa, J., Ferlazzo, G., Garcia-Basteiro, A., Centis, R., Visca, D., Boeree, M.J., Magis-Escurra, C., D'Ambrosio, L., Sotgiu, G., Migliori, G.B., Tiberi, S., Zumla, A., Petersen, Eskild, Chakaya, J.M., Wejse, C., Munoz-Torrico, M., Duarte, R., Alffenaar, J.W.C., Schaaf, H.S., Marais, B.J., Cirillo, D.M., Alagna, R., Rendon, A., Pontali, E., Piubello, A., Figueroa, J., Ferlazzo, G., Garcia-Basteiro, A., Centis, R., Visca, D., Boeree, M.J., Magis-Escurra, C., D'Ambrosio, L., and Sotgiu, G.

Abstract

Contains fulltext : 219865.pdf (publisher's version ) (Open Access), The continuous flow of new research articles on MDR-TB diagnosis, treatment, prevention and rehabilitation requires frequent update of existing guidelines. This review is aimed at providing clinicians and public health staff with an updated and easy-to-consult document arising from consensus of Global Tuberculosis Network (GTN) experts. The core published documents and guidelines have been reviewed, including the recently published MDR-TB WHO rapid advice and ATS/CDC/ERS/IDSA guidelines. After a rapid review of epidemiology and risk factors, the clinical priorities on MDR-TB diagnosis (including whole genome sequencing and drug-susceptibility testing interpretations) and treatment (treatment design and management, TB in children) are discussed. Furthermore, the review comprehensively describes the latest information on contact tracing and LTBI management in MDR-TB contacts, while providing guidance on post-treatment functional evaluation and rehabilitation of TB sequelae, infection control and other public health priorities.

Published
2020

30. Surveillance of adverse events in the treatment of drug-resistant tuberculosis: first global report

Author

Borisov, S., Danila, E., Maryandyshev, A., Dalcolmo, M., Miliauskas, S., Kuksa, L., Manga, S., Skrahina, A., Diktanas, S., Codecasa, L.R., Aleksa, A., Bruchfeld, J., Koleva, A., Piubello, A., Udwadia, Z.F., Akkerman, O.W., Belilovski, E., Bernal, E., Boeree, M.J., Loidi, J., Cai, Q., Gallardo, J.J. Cebrian, Dara, M., Davidaviciene, E., Forsman, L.D., Rios, J. De Los, Denholm, J., Draksiene, J., Duarte, R., Elamin, S.E., Salinas, N. Escobar, Ferrarese, M., Filippov, A., Garcia, A., Garcia-Garcia, J.M., Gaudiesiute, I., Gavazova, B., Gayoso, R., Rosso, R., Gruslys, V., Gualano, G., Hoefsloot, W., Jonsson, J., Khimova, E., Kunst, H., Laniado-Laborin, R., Li, Y, Magis-Escurra, C., Manfrin, V., Marchese, V., Robles, E. Martinez, Matteelli, A., Mazza-Stalder, J., Moschos, C., Munoz-Torrico, M., Hamdan, H. Mustafa, Nakceriene, B., Nicod, L., Marcos, M., Palmero, D.J., Palmieri, F., Papavasileiou, A., Payen, M.C., Pontarelli, A., Quiros, S., Rendon, A., Saderi, L., Smite, A., Solovic, I., Souleymane, M.B., Tadolini, M., Boom, M. van den, Vescovo, M., Viggiani, P., Yedilbayev, A., Zablockis, R., Zhurkin, D., Zignol, M., Visca, D., Spanevello, A., Caminero, J.A., Alffenaar, J.W.C., Tiberi, S., Centis, R., D'Ambrosio, L., Pontali, E., Sotgiu, G., Migliori, G.B., Borisov, S., Danila, E., Maryandyshev, A., Dalcolmo, M., Miliauskas, S., Kuksa, L., Manga, S., Skrahina, A., Diktanas, S., Codecasa, L.R., Aleksa, A., Bruchfeld, J., Koleva, A., Piubello, A., Udwadia, Z.F., Akkerman, O.W., Belilovski, E., Bernal, E., Boeree, M.J., Loidi, J., Cai, Q., Gallardo, J.J. Cebrian, Dara, M., Davidaviciene, E., Forsman, L.D., Rios, J. De Los, Denholm, J., Draksiene, J., Duarte, R., Elamin, S.E., Salinas, N. Escobar, Ferrarese, M., Filippov, A., Garcia, A., Garcia-Garcia, J.M., Gaudiesiute, I., Gavazova, B., Gayoso, R., Rosso, R., Gruslys, V., Gualano, G., Hoefsloot, W., Jonsson, J., Khimova, E., Kunst, H., Laniado-Laborin, R., Li, Y, Magis-Escurra, C., Manfrin, V., Marchese, V., Robles, E. Martinez, Matteelli, A., Mazza-Stalder, J., Moschos, C., Munoz-Torrico, M., Hamdan, H. Mustafa, Nakceriene, B., Nicod, L., Marcos, M., Palmero, D.J., Palmieri, F., Papavasileiou, A., Payen, M.C., Pontarelli, A., Quiros, S., Rendon, A., Saderi, L., Smite, A., Solovic, I., Souleymane, M.B., Tadolini, M., Boom, M. van den, Vescovo, M., Viggiani, P., Yedilbayev, A., Zablockis, R., Zhurkin, D., Zignol, M., Visca, D., Spanevello, A., Caminero, J.A., Alffenaar, J.W.C., Tiberi, S., Centis, R., D'Ambrosio, L., Pontali, E., Sotgiu, G., and Migliori, G.B.

Abstract

Item does not contain fulltext, The World Health Organization (WHO) recommends that countries implement pharmacovigilance and collect information on active drug safety monitoring (aDSM) and management of adverse events.The aim of this prospective study was to evaluate the frequency and severity of adverse events to anti-tuberculosis (TB) drugs in a cohort of consecutive TB patients treated with new (i.e. bedaquiline, delamanid) and repurposed (i.e. clofazimine, linezolid) drugs, based on the WHO aDSM project. Adverse events were collected prospectively after attribution to a specific drug together with demographic, bacteriological, radiological and clinical information at diagnosis and during therapy. This interim analysis included patients who completed or were still on treatment at time of data collection.Globally, 45 centres from 26 countries/regions reported 658 patients (68.7% male, 4.4% HIV co-infected) treated as follows: 87.7% with bedaquiline, 18.4% with delamanid (6.1% with both), 81.5% with linezolid and 32.4% with clofazimine. Overall, 504 adverse event episodes were reported: 447 (88.7%) were classified as minor (grade 1-2) and 57 (11.3%) as serious (grade 3-5). The majority of the 57 serious adverse events reported by 55 patients (51 out of 57, 89.5%) ultimately resolved. Among patients reporting serious adverse events, some drugs held responsible were discontinued: bedaquiline in 0.35% (two out of 577), delamanid in 0.8% (one out of 121), linezolid in 1.9% (10 out of 536) and clofazimine in 1.4% (three out of 213) of patients. Serious adverse events were reported in 6.9% (nine out of 131) of patients treated with amikacin, 0.4% (one out of 221) with ethionamide/prothionamide, 2.8% (15 out of 536) with linezolid and 1.8% (eight out of 498) with cycloserine/terizidone.The aDSM study provided valuable information, but implementation needs scaling-up to support patient-centred care.

Published
2019

31. Surveillance of adverse events in the treatment of drug-resistant tuberculosis: A global feasibility study

Author

Akkerman, O., Aleksa, A., Alffenaar, J.W.C., Al-Marzouqi, N.H., Arias-Guillen, M., Belilovski, E., Bernal, E., Boeree, M.J., Borisov, S.E., Bruchfeld, J., Loidi, J., Cai, Q., Caminero, J.A., Gallardo, J.J. Cebrian, Centis, R., Codecasa, L.R., D'Ambrosio, L., Dalcolmo, M., Danila, E., Dara, M., Davidaviciene, E., Forsman, L. Davies, Jefe, J. De Los Rios, Denholm, J., Duarte, R., Elamin, S.E., Ferrarese, M., Filippov, A., Ganatra, S., Garcia, A., Garcia-Garcia, J.M., Gayoso, R., Montoya, A.M. Giraldo, Rosso, R.G. Gomez, Gualano, G., Hoefsloot, W., Ilievska-Poposka, B., Jonsson, J., Khimova, E., Kuksa, L., Kunst, H., Laniado-Laborin, R., Li, Y., Magis-Escurra, C., Manfrin, V., Manga, S., Marchese, V., Robles, E. Martinez, Maryandyshev, A., Matteelli, A., Migliori, G.B., Mullerpattan, J.B., Munoz-Torrico, M., Hamdan, H. Mustafa, Marcos, M., Noordin, N.M., Palmero, D.J., Palmieri, F., Payen, M.C., Piubello, A., Pontali, E., Pontarelli, A., Quiros, S., Rendon, A., Skrahina, A., Smite, A., Solovic, I., Sotgiu, G., Souleymane, M.B., Spanevello, A., Stosic, M., Tadolini, M., Tiberi, S., Udwadia, Z.F., Boom, M. van den, Vescovo, M., Viggiani, P., Visca, D., Zhurkin, D., Zignol, M., Akkerman, O., Aleksa, A., Alffenaar, J.W.C., Al-Marzouqi, N.H., Arias-Guillen, M., Belilovski, E., Bernal, E., Boeree, M.J., Borisov, S.E., Bruchfeld, J., Loidi, J., Cai, Q., Caminero, J.A., Gallardo, J.J. Cebrian, Centis, R., Codecasa, L.R., D'Ambrosio, L., Dalcolmo, M., Danila, E., Dara, M., Davidaviciene, E., Forsman, L. Davies, Jefe, J. De Los Rios, Denholm, J., Duarte, R., Elamin, S.E., Ferrarese, M., Filippov, A., Ganatra, S., Garcia, A., Garcia-Garcia, J.M., Gayoso, R., Montoya, A.M. Giraldo, Rosso, R.G. Gomez, Gualano, G., Hoefsloot, W., Ilievska-Poposka, B., Jonsson, J., Khimova, E., Kuksa, L., Kunst, H., Laniado-Laborin, R., Li, Y., Magis-Escurra, C., Manfrin, V., Manga, S., Marchese, V., Robles, E. Martinez, Maryandyshev, A., Matteelli, A., Migliori, G.B., Mullerpattan, J.B., Munoz-Torrico, M., Hamdan, H. Mustafa, Marcos, M., Noordin, N.M., Palmero, D.J., Palmieri, F., Payen, M.C., Piubello, A., Pontali, E., Pontarelli, A., Quiros, S., Rendon, A., Skrahina, A., Smite, A., Solovic, I., Sotgiu, G., Souleymane, M.B., Spanevello, A., Stosic, M., Tadolini, M., Tiberi, S., Udwadia, Z.F., Boom, M. van den, Vescovo, M., Viggiani, P., Visca, D., Zhurkin, D., and Zignol, M.

Abstract

Contains fulltext : 207083.pdf (publisher's version ) (Open Access), The World Health Organization launched a global initiative, known as aDSM (active TB drug safety monitoring and management) to better describe the safety profile of new treatment regimens for drug-resistant tuberculosis (TB) in real-world settings. However, comprehensive surveillance is difficult to implement in several countries. The aim of the aDSM project is to demonstrate the feasibility of implementing national aDSM registers and to describe the type and the frequency of adverse events (AEs) associated with exposure to the new anti-TB drugs. Following a pilot study carried out in 2016, official involvement of TB reference centres/countries into the project was sought and cases treated with bedaquiline- and/or delamanid-containing regimens were consecutively recruited. AEs were prospectively collected ensuring potential attribution of the AE to a specific drug based on its known safety profile. A total of 309 cases were fully reported from 41 centres in 27 countries (65% males; 268 treated with bedaquiline, 20 with delamanid, and 21 with both drugs) out of an estimated 781 cases the participating countries had committed to report by the first quarter of 2019.

Published
2019

32. Determinants of child nutrition and mortality in north-west Uganda

Author

Vella, V., Tomkins, A., Borghesi, A., Migliori, G.B., Adriko, B.C., and Crevatin, E.

Subjects
Malnutrition in children -- Risk factors, Children -- Patient outcomes, Uganda -- Health aspects
Abstract

An anthropometric survey of children aged 0-59 months in north-west Uganda in February-March 1987 indicated a high prevalence of stunting but little wasting. Use of unprotected water supplies in the [...]

Published
1992

34. Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis

Author

Ahmad, N., Ahuja, S.D., Akkerman, O.W., Alffenaar, J.C., Anderson, L.F., Baghaei, P., Bang, D., Barry, P.M., Bastos, M.L., Behera, D., Benedetti, A., Bisson, G.P., Boeree, M.J., Bonnet, M., Brode, S.K., Brust, J.C.M., Cai, Y., Caumes, E., Cegielski, J.P., Centis, R., Chan, P.C., Chan, E.D., Chang, K.C., Charles, M., Cirule, A., Dalcolmo, M.P., D'Ambrosio, L., Vries, G. de, Dheda, K., Esmail, A., Flood, J., Fox, G.J., Frechet-Jachym, M., Fregona, G., Gayoso, R., Gegia, M., Gler, M.T., Gu, S., Guglielmetti, L., Holtz, T.H., Hughes, J., Isaakidis, P., Jarlsberg, L., Kempker, R.R., Keshavjee, S., Khan, F.A., Kipiani, M., Koenig, S.P., Koh, W.J., Kritski, A., Kuksa, L., Kvasnovsky, C.L., Kwak, N., Lan, Z., Lange, C de, Laniado-Laborin, R., Lee, M., Leimane, V., Leung, C.C., Leung, E.C., Li, P.Z., Lowenthal, P., Maciel, E.L., Marks, S.M., Mase, S., Mbuagbaw, L., Migliori, G.B., Milanov, V., Miller, A.C., Mitnick, C.D., Modongo, C., Mohr, E., Monedero, I., Nahid, P., Ndjeka, N., O'Donnell, M.R., Padayatchi, N., Palmero, D., Pape, J.W., Podewils, L.J., Reynolds, I., Riekstina, V., Robert, J., Rodriguez, M., Seaworth, B., Seung, K.J., Schnippel, K., Shim, T.S., Singla, R., Smith, S.E., Sotgiu, G., Sukhbaatar, G., Tabarsi, P., Tiberi, S., Trajman, A., Trieu, L., Udwadia, Z.F., Werf, T.S. van der, Veziris, N., Zignol, M., Menzies, D., Ahmad, N., Ahuja, S.D., Akkerman, O.W., Alffenaar, J.C., Anderson, L.F., Baghaei, P., Bang, D., Barry, P.M., Bastos, M.L., Behera, D., Benedetti, A., Bisson, G.P., Boeree, M.J., Bonnet, M., Brode, S.K., Brust, J.C.M., Cai, Y., Caumes, E., Cegielski, J.P., Centis, R., Chan, P.C., Chan, E.D., Chang, K.C., Charles, M., Cirule, A., Dalcolmo, M.P., D'Ambrosio, L., Vries, G. de, Dheda, K., Esmail, A., Flood, J., Fox, G.J., Frechet-Jachym, M., Fregona, G., Gayoso, R., Gegia, M., Gler, M.T., Gu, S., Guglielmetti, L., Holtz, T.H., Hughes, J., Isaakidis, P., Jarlsberg, L., Kempker, R.R., Keshavjee, S., Khan, F.A., Kipiani, M., Koenig, S.P., Koh, W.J., Kritski, A., Kuksa, L., Kvasnovsky, C.L., Kwak, N., Lan, Z., Lange, C de, Laniado-Laborin, R., Lee, M., Leimane, V., Leung, C.C., Leung, E.C., Li, P.Z., Lowenthal, P., Maciel, E.L., Marks, S.M., Mase, S., Mbuagbaw, L., Migliori, G.B., Milanov, V., Miller, A.C., Mitnick, C.D., Modongo, C., Mohr, E., Monedero, I., Nahid, P., Ndjeka, N., O'Donnell, M.R., Padayatchi, N., Palmero, D., Pape, J.W., Podewils, L.J., Reynolds, I., Riekstina, V., Robert, J., Rodriguez, M., Seaworth, B., Seung, K.J., Schnippel, K., Shim, T.S., Singla, R., Smith, S.E., Sotgiu, G., Sukhbaatar, G., Tabarsi, P., Tiberi, S., Trajman, A., Trieu, L., Udwadia, Z.F., Werf, T.S. van der, Veziris, N., Zignol, M., and Menzies, D.

Abstract

Item does not contain fulltext, BACKGROUND: Treatment outcomes for multidrug-resistant tuberculosis remain poor. We aimed to estimate the association of treatment success and death with the use of individual drugs, and the optimal number and duration of treatment with those drugs in patients with multidrug-resistant tuberculosis. METHODS: In this individual patient data meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library to identify potentially eligible observational and experimental studies published between Jan 1, 2009, and April 30, 2016. We also searched reference lists from all systematic reviews of treatment of multidrug-resistant tuberculosis published since 2009. To be eligible, studies had to report original results, with end of treatment outcomes (treatment completion [success], failure, or relapse) in cohorts of at least 25 adults (aged >18 years). We used anonymised individual patient data from eligible studies, provided by study investigators, regarding clinical characteristics, treatment, and outcomes. Using propensity score-matched generalised mixed effects logistic, or linear regression, we calculated adjusted odds ratios and adjusted risk differences for success or death during treatment, for specific drugs currently used to treat multidrug-resistant tuberculosis, as well as the number of drugs used and treatment duration. FINDINGS: Of 12 030 patients from 25 countries in 50 studies, 7346 (61%) had treatment success, 1017 (8%) had failure or relapse, and 1729 (14%) died. Compared with failure or relapse, treatment success was positively associated with the use of linezolid (adjusted risk difference 0.15, 95% CI 0.11 to 0.18), levofloxacin (0.15, 0.13 to 0.18), carbapenems (0.14, 0.06 to 0.21), moxifloxacin (0.11, 0.08 to 0.14), bedaquiline (0.10, 0.05 to 0.14), and clofazimine (0.06, 0.01 to 0.10). There was a significant association between reduced mortality and use of linezolid (-0.20, -0.23 to -0.16), levofloxacin (-0.06, -0.09 to -0.04), moxifloxacin (-0.07,

Published
2018

35. Treatment Outcomes of Patients With Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis According to Drug Susceptibility Testing to First- and Second-line Drugs: An Individual Patient Data Meta-analysis

Author

Bastos, Mayara L., Hussain, Hamidah, Weyer, Karin, Garcia-Garcia, Lourdes, Leimane, Vaira, Leung, Chi Chiu, Narita, Masahiro, Penã, Jose M., Ponce-de-Leon, Alfredo, Seung, Kwonjune J., Shean, Karen, Sifuentes-Osornio, José, Van der Walt, Martie, Van der Werf, Tjip S., Yew, Wing Wai, Menzies, Dick, Ahuja, S., Ashkin, D., Avendaño, M., Banerjee, R., Bauer, M., Becerra, M., Benedetti, A., Burgos, M., Centis, R., Chan, E.D., Chiang, C.Y., Cobelens, F., Cox, H., D'Ambrosio, L., de Lange, W.C.M., DeRiemer, K., Enarson, D., Falzon, D., Flanagan, K., Flood, J., Gandhi, N., Garcia-Garcia, L., Granich, R.M., Hollm-Delgado, M.G., Holtz, T.H., Hopewell, P., Iseman, M., Jarlsberg, L.G., Keshavjee, S., Kim, H.R., Koh, W.J., Lancaster, J., Lange, C., Leimane, V., Leung, C.C., Li, J., Menzies, D., Migliori, G.B., Mitnick, C.M., Narita, M., Nathanson, E., Odendaal, R., O'Riordan, P., Pai, M., Palmero, D., Park, S.K., Pasvol, G., Pena, J., Pérez-Guzmán, C., Ponce-de-Leon, A., Quelapio, M.I.D., Quy, H.T., Riekstina, V., Robert, J., Royce, S., Salim, M., Schaaf, H.S., Seung, K.J., Shah, L., Shean, K., Shim, T.S., Shin, S.S., Shiraishi, Y., Sifuentes-Osornio, J., Sotgiu, G., Strand, M.J., Sung, S.W., Tabarsi, P., Tupasi, T.E., Vargas, M.H., van Altena, R., van der Walt, M., van der Werf, T.S., Viiklepp, P., Westenhouse, J., Yew, W.W., and Yim, J.J.

Abstract

The clinical validity of drug susceptibility testing (DST) for pyrazinamide, ethambutol, and second-line antituberculosis drugs is uncertain. In an individual patient data meta-analysis of 8955 patients with confirmed multidrug-resistant tuberculosis, DST results for these drugs were associated with treatment outcomes

Published
2017

36. Treatment Outcomes of Patients With Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis According to Drug Susceptibility Testing to First- and Second-line Drugs

Author

Bastos, Mayara L., Hussain, Hamidah, Weyer, Karin, Garcia-Garcia, Lourdes, Leimane, Vaira, Leung, Chi Chiu, Narita, Masahiro, Penã, Jose M., Ponce-de-Leon, Alfredo, Seung, Kwonjune J., Shean, Karen, Sifuentes-Osornio, José, Van der Walt, Martie, Van der Werf, Tjip S., Yew, Wing Wai, Menzies, Dick, Ahuja, S., Ashkin, D., Avendaño, M., Banerjee, R., Bauer, M., Becerra, M., Benedetti, A., Burgos, M., Centis, R., Chan, E.D., Chiang, C.Y., Cobelens, F., Cox, H., D'Ambrosio, L., de Lange, W.C.M., DeRiemer, K., Enarson, D., Falzon, D., Flanagan, K., Flood, J., Gandhi, N., Garcia-Garcia, L., Granich, R.M., Hollm-Delgado, M.G., Holtz, T.H., Hopewell, P., Iseman, M., Jarlsberg, L.G., Keshavjee, S., Kim, H.R., Koh, W.J., Lancaster, J., Lange, C., Leimane, V., Leung, C.C., Li, J., Menzies, D., Migliori, G.B., Mitnick, C.M., Narita, M., Nathanson, E., Odendaal, R., O'Riordan, P., Pai, M., Palmero, D., Park, S.K., Pasvol, G., Pena, J., Pérez-Guzmán, C., Ponce-de-Leon, A., Quelapio, M.I.D., Quy, H.T., Riekstina, V., Robert, J., Royce, S., Salim, M., Schaaf, H.S., Seung, K.J., Shah, L., Shean, K., Shim, T.S., Shin, S.S., Shiraishi, Y., Sifuentes-Osornio, J., Sotgiu, G., Strand, M.J., Sung, S.W., Tabarsi, P., Tupasi, T.E., Vargas, M.H., van Altena, R., van der Walt, M., van der Werf, T.S., Viiklepp, P., Westenhouse, J., Yew, W.W., Yim, J.J., and Microbes in Health and Disease (MHD)

Subjects
Microbiology (medical), Drug, Adult, Male, medicine.medical_specialty, Tuberculosis, media_common.quotation_subject, Extensively Drug-Resistant Tuberculosis, PULMONARY TUBERCULOSIS, CITY, CALIFORNIA, Antitubercular Agents, drug susceptibility test, Microbial Sensitivity Tests, treatment outcomes, Pharmacology, THERAPY, Young Adult, Pharmacotherapy, Risk Factors, Internal medicine, Tuberculosis, Multidrug-Resistant, medicine, Odds Ratio, STANDARDIZED REGIMENS, MANAGEMENT, PROGRAM, Humans, COHORT, Articles and Commentaries, Ethambutol, media_common, business.industry, multidrug resistant, Extensively drug-resistant tuberculosis, Odds ratio, Pyrazinamide, Middle Aged, medicine.disease, Multiple drug resistance, meta-analysis, Infectious Diseases, Treatment Outcome, tuberculosis, Female, business, FOLLOW-UP, medicine.drug
Abstract

Background. Individualized treatment for multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis depends upon reliable and valid drug susceptibility testing (DST) for pyrazinamide, ethambutol, and second-line tuberculosis drugs. However, the reliability of these tests is uncertain, due to unresolved methodological issues. We estimated the association of DST results for pyrazinamide, ethambutol, and second-line drugs with treatment outcomes in patients with MDR tuberculosis and XDR tuberculosis.Methods. We conducted an analysis of individual patient data assembled from 31 previously published cohort studies of patients with MDR and XDR tuberculosis. We used data on patients' clinical characteristics including DST results, treatment received, outcomes, and laboratory methods in each center.Results. DST methods and treatment regimens used in different centers varied considerably. Among 8955 analyzed patients, in vitro susceptibility to individual drugs was consistently and significantly associated with higher odds of treatment success (compared with resistance to the drug), if that drug was used in the treatment regimen. Various adjusted and sensitivity analyses suggest that this was not explained by confounding. The adjusted odds of treatment success for ethambutol, pyrazinamide, and the group 4 drugs ranged from 1.7 to 2.3, whereas for second-line injectables and fluoroquinolones, odds ranged from 2.4 to 4.6.Conclusions. DST for ethambutol, pyrazinamide, and second-line tuberculosis drugs appears to provide clinically useful information to guide selection of treatment regimens for MDR and XDR tuberculosis.

Published
2014

38. Team approach to manage difficult-to-treat TB cases: Experiences in Europe and beyond

Author

D’Ambrosio, L., primary, Bothamley, G., additional, Caminero Luna, J.A., additional, Duarte, R., additional, Guglielmetti, L., additional, Muñoz Torrico, M., additional, Payen, M.C., additional, Saavedra Herrera, N., additional, Salazar Lezama, M.A., additional, Skrahina, A., additional, Tadolini, M., additional, Tiberi, S., additional, Veziris, N., additional, and Migliori, G.B., additional

Published
2018
Full Text
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39. Point of care diagnostics for tuberculosis

Author

García-Basteiro, A.L., primary, DiNardo, A., additional, Saavedra, B., additional, Silva, D.R., additional, Palmero, D., additional, Gegia, M., additional, Migliori, G.B., additional, Duarte, R., additional, Mambuque, E., additional, Centis, R., additional, Cuevas, L.E., additional, Izco, S., additional, and Theron, G., additional

Published
2018
Full Text
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41. Safety and tolerability of clarithromycin in the treatment of multidrug-resistant tuberculosis

Author

Paardt, A.L. Van der, Akkerman, O.W., Gualano, G., Palmieri, F., Forsman, L.D., Aleksa, A., Tiberi, S., Lange, W.C. de, Bolhuis, M.S., Skrahina, A., Soolingen, D. van, Kosterink, J.G.W., Migliori, G.B., Werf, T.S. van der, Alffenaar, J.C., Paardt, A.L. Van der, Akkerman, O.W., Gualano, G., Palmieri, F., Forsman, L.D., Aleksa, A., Tiberi, S., Lange, W.C. de, Bolhuis, M.S., Skrahina, A., Soolingen, D. van, Kosterink, J.G.W., Migliori, G.B., Werf, T.S. van der, and Alffenaar, J.C.

Abstract

Item does not contain fulltext

Published
2017

43. Comparison of bacteriological conversion and treatment outcomes among MDR-TB patients with and without diabetes in Mexico: Preliminary data

Author

Muñoz-Torrico, M., primary, Caminero Luna, J., additional, Migliori, G.B., additional, D’Ambrosio, L., additional, Carrillo-Alduenda, J.L., additional, Villareal-Velarde, H., additional, Torres-Cruz, A., additional, Flores-Ergara, H., additional, Martínez-Mendoza, D., additional, García-Sancho, C., additional, Centis, R., additional, Salazar-Lezama, M.Á., additional, and Pérez-Padilla, R., additional

Published
2017
Full Text
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44. Cost-comparison of different management policies for tuberculosis patients in Italy

Author

Migliori, G.B., Ambrosetti, M., Besozzi, G., Farris, B., Nutini, S., Saini, L., Casali, L., Nardini, S., Bugiani, M., Neri, M., and Raviglioni, M.C.

Abstract

Although in developing countries the treatment of tuberculosis (TB) cases is among the most cost-effective health interventions, few studies have evaluated the cost-effectiveness of TB control in low-prevalence countries. The aim of the present study was to carry out an economic analysis in Italy that takes into account both the perspective of the resource-allocating authority (i.e. the Ministry of Health) and the broader social perspective, including a cost description based on current outcomes applied to a representative sample of TB patients nationwide (admission and directly observed treatment (DOT) during the initial intensive phase of treatment); a cost-comparison analysis of two alternative programmes: current policy based on available data (scenario 1) and an hypothetical policy oriented more towards outpatient care (scenario 2) (both scenarios included the option of including or not including DOT outside hospital admission, and incentives) were compared in terms of cost per case treated successfully. Indirect costs (such as loss of productivity) were included in considerations of the broader social perspective. The study was designed as a prospective monitoring activity based on the supervised collection of forms from a representative sample of Italian TB units. Individual data were collected and analysed to obtain a complete economic profile of the patients enrolled and to evaluate the effectiveness of the intervention. A separate analysis was done for each scenario to determine the end-point at different levels of cure rate (50-90%). The mean length of treatment was 6.6 months (i.e. patients hospitalized during the intensive phase; length of stay was significantly higher in smear-positive patients and in human immunodeficiency virus (HIV) seropositive patients). Roughly six direct smear and culture examinations were performed during hospital admission and three during ambulatory treatment. The cost of a single bed day was US$ 186.90, whereas that of a single outpatient visit ranged, according to the different options, from US$ 2.50 to US$ 11. Scenario 2 was consistently less costly than scenario 1. The cost per case cured for smear-positive cases was US$ 16 703 in scenario 1 and US$ 5946 in scenario 2. The difference in cost between the cheapest option (no DOT) and the more expensive option (DOT, additional staff, incentives) ranged from US$ 1407 (scenario 1, smear-negative and extrapulmonary cases) to US$ 1814 (scenario 2, smear-positive cases). The additional cost to society including indirect costs ranged from US$ 1800 to US$ 4200. The possible savings at the national level were in the order of US$ 50 million per year. In conclusion, cost-comparison analysis showed that a relatively minor change in policy can result in significant savings and that the adoption of DOT will represent a relatively modest economic burden, although the real gain in effectiveness resulting from DOT in Italy requires further evaluation., Introduction The competition of health programmes for limited economic resources within national health systems has spawned an abundance of studies on economic evaluation in health care. Economic evaluation is the [...]

Published
1999

45. Cost-effectiveness analysis of tuberculosis control policies in Ivanovo Oblast, Russian Federation

Author

Migliori, G.B., Khomenko, A.G., Punga, V.V., Ambrosetti, M., Danilova, I., Ribka, L.N., Grzemska, M., Sawert, H., and Raviglione, M.C.

Subjects
Tuberculosis -- Russia, Cost benefit analysis -- Reports, Russia -- Health aspects
Abstract

Many of the current tuberculosis control programmes in the Russian Federation are based on costly strategies which are underfunded and use long, individualized treatment regimens. This article compares, using a cost-effectiveness analysis, the new WHO strategy implemented in the Ivanovo Oblast (case-finding among symptomatic patients (SCF) and shorter regimens) and the old strategy (active screening of the asymptomatic population (ACF) and longer regimens). The cost per case cured was calculated at different levels of cure rate (45-95%) using three scenarios to describe the new WHO strategy (use of WHO-recommended regimens and three options at increasing rates of admission) and a fourth scenario to describe the old strategy (ail patients admitted for the whole treatment and longer regimens). The cost per case detected was determined by calculating the following: yield of the new and old strategy (number of examinations necessary to diagnose one case); cost of the diagnostic process; multiplying yield per cost according to the three scenarios describing the new WHO strategy and a fourth scenario describing the old strategy. In the Ivanovo Oblast the cost per case cured, at 85% cure rate level, ranged from US$1197 (new strategy, scenario 1 without food) to US$ 6293 (old strategy, scenario 4) the cost per case detected ranged from US$ 1581 (new strategy, scenario 1) to US$ 4000 (old strategy, scenario 4). Significant savings can result from shifting towards the new WHO strategy. Decision-makers and health administrators should be responsible for re-investing the financial and human resources mobilized by the adoption of cost-effective strategies within the TB control programme., Introduction In 1995 the Russian Federation reported over 85 000 new tuberculosis (TB) cases (57.4 cases per 100 000 population), a 69% increase over a minimum-ever incidence of 34 cases [...]

Published
1998

46. Survey of BCG vaccination policy in Europe: 1994-96

Author

Trnka, L., Dankova, D., Zitova, J., Cimprichova, L., Migliori, G.B., Clancy, L., and Zellweger, J.P.

Subjects
BCG vaccines -- Health aspects, Vaccination -- Social aspects, Europe -- Social policy
Abstract

A retrospective survey, based on a standardized questionnaire sent to qualified public health experts in tuberculosis in 50 European countries, was carried out to evaluate the following: concordance between national vaccination programmes and WHO recommendations on BCG vaccination for prevention of tuberculosis; relation between BCG vaccination and revaccination policy and the tuberculosis epidemiological situation; and differences in BCG vaccination policy between Western and Central-Eastern European countries. The results obtained (from 41 (82%) of the 50 countries) revealed that BCG vaccination programmes met WHO recommendations in 44% of European countries. Mass primary vaccination and general revaccination were extremely common in countries where the prevalence of tuberculosis was high. A highly significant difference was found between Western and Central-Eastern European countries in terms of their adhesion to WHO recommendations. Within Central-Eastern Europe no difference was found between countries that had or had not been part of the former Soviet Union. The implementation of WHO recommendations into national tuberculosis programmes must be intensified, based on the available body of evidence. Preventive methods whose cost-effectiveness has not been properly established should be discouraged., Introduction Bacillus Calmette-Guerin (BCG) vaccine has been used in Europe to prevent tuberculosis (TB) in humans since 1921. At that time no other method of preventing TB in children was [...]

Published
1998

49. Drug resistance beyond XDR-TB: results from a large individual patient data meta-analysis

Author

Migliori, G.B., Sotgiu, G., Gandhi, N. R., Falzon, D., DeRiemer, K., Centis, R., Hollm-Delgado, M.G., Palmero, D., Pérez-Guzmán, C., Vargas, M.H., D'Ambrosio, L., Spanevello, A., Bauer, M., Chan, E.D., Schaaf, H.S., Keshavjee, S., Holtz, T.H., and Menzies, D.

Subjects
Article
Abstract

The broadest pattern of tuberculosis drug resistance for which a consensus definition exists is extensively drug-resistant tuberculosis (XDR-TB). It is not known if additional drug resistance portends worsened patient outcomes. This study compares treatment outcomes of XDR-TB patients with and without additional resistance to explore the need for a new definition.

Published
2012

50. Tuberculosis diagnostics and biomarkers: needs, challenges, recent advances, and opportunities

Author

McNerney, R., Maeurer, M., Abubakar, I., Marais, B., McHugh, T.D., Ford, N., Weyer, K., Lawn, S., Grobusch, M.P., Memish, Z., Squire, S.B., Pantaleo, G., Chakaya, J., Casenghi, M., Migliori, G.B., Mwaba, P., Zijenah, L., Hoelscher, M., Cox, H., Swaminathan, S., Kim, P.S., Schito, M., Harari, A., Bates, M., Schwank, S., O'Grady, J., Pletschette, M., Ditui, L., Atun, R., and Zumla, A.

Abstract

Tuberculosis is unique among the major infectious diseases in that it lacks accurate rapid point-of-care diagnostic tests. Failure to control the spread of tuberculosis is largely due to our inability to detect and treat all infectious cases of pulmonary tuberculosis in a timely fashion, allowing continued Mycobacterium tuberculosis transmission within communities. Currently recommended gold-standard diagnostic tests for tuberculosis are laboratory based, and multiple investigations may be necessary over a period of weeks or months before a diagnosis is made. Several new diagnostic tests have recently become available for detecting active tuberculosis disease, screening for latent M. tuberculosis infection, and identifying drug-resistant strains of M. tuberculosis. However, progress toward a robust point-of-care test has been limited, and novel biomarker discovery remains challenging. In the absence of effective prevention strategies, high rates of early case detection and subsequent cure are required for global tuberculosis control. Early case detection is dependent on test accuracy, accessibility, cost, and complexity, but also depends on the political will and funder investment to deliver optimal, sustainable care to those worst affected by the tuberculosis and human immunodeficiency virus epidemics. This review highlights unanswered questions, challenges, recent advances, unresolved operational and technical issues, needs, and opportunities related to tuberculosis diagnostics.

Published
2012

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