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Objectives. We examined trends in tuberculosis (TB) cases and case rates among US- and foreign-born children and adolescents and analyzed the potential effect of changes to overseas screening of applicants for immigration to the United States. Methods. We analyzed TB case data from the National Tuberculosis Surveillance System for 1994 to 2007. Results. Foreign-born children and adolescents accounted for 31% of 18659 reported TB cases in persons younger than age 18 years from 1994 to 2007. TB rates declined 44% among foreign-born children and adolescents (20.3 per 10000 to 11.4 per 100000 population) and 48% (2.1 per 100000 to 1.1 per 100000) among those who were born in the United States. Rates were nearly 20 times as high among foreign-born as among US-born adolescents. Among foreign-born children and adolescents with known month of US entry (88%), more than 20% were diagnosed with TB within 3 months of entry. Conclusions. Marked disparities in TB morbidity persist between foreign- and US-born children and adolescents. These disparities and the high proportion of TB cases diagnosed shortly after US entry suggest a need for enhanced pre- and postimmigration screening. (Am J Public Health. 2010;100:1724-1729. doi:10.2105/AJPH.2009.181289)

The study attempts to compare the unique cases and epidemiology of extensively (XDR-TB) as against multidrug-resistant TB and drug-susceptible TB cases. The results conclude that the number of cases of XDR-TB has declined considerably. Cases still continue to be reported each year.

Objective To conduct a comprehensive assessment of the case-mix of patients admitted to tuberculosis hospitals and the reasons for their admission in four Russian regions: Ivanovo, Orel, Samara and Vladimir. We also sought to quantify the extent to which efficiency could be improved by reducing hospitalization rates and re-profiling hospital beds available in the tuberculosis-control system. Methods We used a standard questionnaire to determine how beds were being used and who was using the beds in tuberculosis facilities in four Russian regions. Data were collected to determine how 4306 tuberculosis beds were utilized as well as on the socioeconomic and demographic indicators, clinical parameters and reasons for hospitalization for 3352 patients. Findings Of the 3352 patients surveyed about 70% were male; the average age was 40; and rates of unemployment, disability and alcohol misuse were high. About one-third of beds were occupied by smear-positive or culture-positive tuberculosis patients; 20% were occupied by tuberculosis patients who were smear-negative and/or culture-negative; 20% were occupied by patients who no longer had tuberculosis; and 20% were unoccupied. If clinical and public health admission criteria were applied then < 50% of admissions would be justified and < 50% of the current number of beds would be required. Up to 85% of admissions and beds were deemed to be necessary when social problems and poor access to outpatient care were considered along with clinical and public health admission criteria. Conclusion Much of the Russian Federation&apos;s large tuberculosis hospital infrastructure is unnecessary when clinical and public health criteria are used, but the large hospital infrastructure within the tuberculosis-control system has an important social support function. Improving the efficiency of the system will require the reform of health-system norms and regulations as they relate to resource allocation and clinical care and implementation of lower-cost approaches to case management for patients with social problems. Additionally, closer attention will need to be paid to the management of staff numbers in the tuberculosis system. Keywords Tuberculosis, Pulmonary/therapy; Hospitals, Special/utilization; Hospital costs; Hospital bed capacity; Bed occupancy; Hospitalization; Inpatients; Efficiency, Organizational; Health care surveys; Cross-sectional studies; Russian Federation (source: MESH, NLM). Efficacite des systemes de sante en Federation de Russie :la lutte antituberculeuse Objectif Conduire une evaluation globale d&apos;un eventail de cas hospitalises dans des etablissements specialises dans la tuberculose et des raisons de leur admission dans quatre regions russes : Ivanovo, Orel, Samara et Vladimir. Nous avons egalement cherche a determiner dans quelle mesure I&apos;efficacite pourrait etre amelioree en reduisant les taux d&apos;hospitalisation et en restructurant les lits d&apos;hopitaux disponibles dans le systeme de lutte antituberculeuse. Methodes Nous avons utilise un questionnaire type pour determiner de quelle facon les lits etaient utilises et qui les utilisait dans les etablissements spedalises dans la tuberculose de quatre regions russes. Les donnees ont ete recueillies afin de determiner comment 4306 lits affectes a la tuberculose etaient utilises et egalement concernant les indicateurs socio-economiques et demographiques, les parametres cliniques et les raisons de I&apos;hospitalisation de 3352 malades. Resultats Sur les 3352 patients etudies, environ 70 % etaient des hommes; I&apos;age moyen etait de 40 ans et les taux de chomage, d&apos;incapacite et d&apos;alcoolisme etaient eleves. Pres du tiers des lits etaient occupes par des patients tuberculeux a frottis positif ou a culture positive ; 20 % etaient occupes par des patients tuberculeux a frottis negatif et/ou culture negative ; 20 % etaient occupes par des patients qui n&apos;avaient plus la tuberculose ; et 20 % etaient inoccupes. Si des critres d&apos;admission cliniques et de sante publique etaient appliques, moins de 50 % des admissions seraient justifiees et moins de 50 % du nombre actuel de lits s&apos;avereraient necessaires. Jusqu&apos;a 85 % des hospitalisations et des lits ont ete juges necessaires Iorsque les problemes sociaux et d&apos;acces aux soins ambulatoires etaient pris en compre au meme titre que les criteres cliniques et de sante publique. Conclusion Lorsque I&apos;on utilise des criteres cliniques et de sante publique, une grande partie de I&apos;importante infrastructure hospitalieres consacree a la tuberculose en Federation de Russie est superflue, mais cette infrastructure du systeme de lutte antituberculeuse joue un role de soutien social non negligeable. Il faudra, pour ameliorer I&apos;efficacite de la lutte antituberculeuse, entreprendre une reforme des normes et des reglementations du systeme de sante qui ont trait a I&apos;allocation des ressources et aux soins cliniques et mettre en oeuvre des methodes moins couteuses de prise en charge des cas pour les patients presentant des problemes sociaux. En outre, une attention accrue devra etre portee a la gestion des effectifs dans le systeme de lutte antituberculeuse. Mots cles Tuberculose pulmonaire/therapeutique; Hopital specialise/utilisation; Couts hopital; Capacite lits hopital; Occupation lit hopital; Hospitalisation; Malade hospitalise; Efficacite fonctionnement; Enquete systeme de sante; Etude section efficace; Federation de Russie (source: MESH, INSERM). Eficiencia de los sistemas de salud en la Federacion de Rusia: control de la tuberculosis Objetivo Realizar una evaluacion integral de los casos de pacientes ingresados en hospitales de tuberculosis y de las razones de su ingreso en cuatro regiones de Rusia: Ivanovo, Orel, Samara y Vladimir. Decidimos ademas determinar en que medida podia mejorarse la eficiencia reduciendo las tasas de hospitalizacion y reclasificando las camas de hospital disponibles en el sistema de control de la tuberculosis. Metodos Utilizamos un cuestionario estandar para determinar como estaban utilizandose las camas y quienes las ocupaban en los centros de tuberculosis de las cuatro regiones rusas mencionadas. Se reunieron datos para determinar como se utilizaban 4306 camas de tuberculosis, asi como sobre los indicadores socioeconomicos y demograficos, los parametros clinicos y los motivos de hospitalizacion de 3352 pacientes. Resultados De los 3352 enfermos encuestados, alrededor del 70% eran hombres; su edad media era de 40 anos; y las tasas de desempleo, discapacidad y consumo abusivo de alcohol eran altas. En torno a una tercera parte de las camas estaban ocupadas por enfermos de tuberculosis con baciloscopia positiva o cultivo positivo; el 20% lo estaban por tuberculosos con baciloscopia negativa y/o cultivo negativo; un 20% estaban ocupadas por pacientes que ya no sufrian tuberculosis; y el 20% estaban libres. Aplicando criterios de admision clinicos y de salud publica, menos del 50% de los ingresos estarian justificados, y se necesitaria menos del 50% del numero actual de camas. Cuando se tuvieron en cuenta los problemas sociales y el escaso acceso a la atencion ambulatoria ademas de los criterios antes mencionados, se estimo que hasta un 85% de los ingresos y las camas eran realmente necesarios. Conclusion Gran parte de la amplia infraestructura hospitalaria dedicada a la tuberculosis en la Federacion de Rusia es innecesaria si nos atenemos a unos criterios clinicos y de salud publica, pero la infraestructura de hospitales en el contexto del sistema de control de la tuberculosis cumple una importante funcion de apoyo social. Para mejorar la eficiencia del sistema habra que reformar las normas y disposiciones relativas a la asignacion de recursos y la atencion clinica, y aplicar enfoques de bajo costo a la gestion de los casos de pacientes con problemas sociales. Ademas, debera potenciarse la gestion de los trabajadores empleados en el sistema de atencion de la tuberculosis. Palabras clave Tuberculosis pulmonar/terapia/utilizacion; Costos de hospital; Hospitales especializados; Capacidad de camas en hospitales; Ocupacion de camas; Hospitalizacion; Pacientes internos; Eficiencia organizacional; Encuestas de atencion de la salud; Estudios transversales; Federacion de Rusia (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII.], Voir page 49 le resume en francais. En la pagina 50 figura un resumen en espanol. Introduction The Russian Federation's health-care system is characterized by centralized planning and administration, government [...]

Almost a third of the world's population is infected with Mycobacterium tuberculosis, the organism that causes tuberculosis disease. Most of those infected never fall ill, but individuals who do can recover if they have access to effective therapies. This paper discusses certain ethical and ethnographic issues raised by cases in which patients are infected with M. tuberculosis strains resistant to at least the two most powerful drugs on which therapy is usually based. In most poor countries, people with such multidrug-resistant tuberculosis (MDR-TB) were, until very recently, considered 'untreatable.' In addition to being consigned to a permanent state of ill health, they were also at risk of transmitting their resistant strain to others. In this paper we discuss the logic of 'cost-effectiveness,' which international health policy-makers utilized to make the case that treatment of MDR-TB is not feasible in resource poor settings. These analyses, which have held sway in public health policy for many years, are flawed, we argue, because they ignore and conceal the social determinants of access to health services and often rely on assumptions rather than evidence. We propose that policies based solely on analyses of cost-effectiveness of specific interventions for individual settings can be short-sighted and, because they do not pay sufficient attention to the social, political, economic, epidemiological and pathophysiological factors influencing the production of health, will ultimately hinder progress toward effective global TB control. Keywords: Tuberculosis; Health policy; Cost-effectiveness; Poverty

During the late 1980s and early 1990s, the number of children reported with tuberculosis (TB) increased in New York City (NYC) as well as nationally. (1-6) Pediatric TB cases are […]

OBJECTIVE: To compare the HIV/AIDS epidemics in Australia and sub-Saharan Africa, to outline reasons for differences, and to consider implications for the Asia and Pacific region. METHODS: Comparison of key indicators of the epidemic in Australia, and Africa viewed largely through the experience of the Hlabisa health district, South Africa. RESULTS: To the end of 1997, for all Australia, the estimated cumulative number of HIV infections was approximately 19,000, whereas in Hlabisa 31,000 infections are estimated to have occurred. Compared with the low and declining incidence of HIV in Australia (80% of HIV infected people receive antiretroviral therapy whereas in Hlabisa these drugs are not available. IMPLICATIONS: It seems possible that Asia and the Pacific will experience a similar HIV/AIDS epidemic to that in Africa. Levels of HIV are already high in parts of Asia, and social conditions in pads of the region might be considered ripe for the spread of HIV. As Australia strengthens economic and political ties within the region, so should more be done to help Pacific and Asian neighbours to prevent and respond to the HIV epidemic.

The authors collected data on admissions of HIV-infected patients over 14 years old who were admitted to an infectious disease hospital. Of the 3,112 HIV-positive patients, they discovered a large proportion of cryptococcosis, tuberculosis, and wasting syndrome.

Individuals infected with HIV in sub-Saharan Africa have a higher risk of developing tuberculosis than other individuals. A survey of the medical literature found that 20% to 67% of the tuberculosis patients in East, West, Central and Southern Africa are infected with HIV. An increase in the number of patients with tuberculosis coincided with the HIV epidemic in several African countries. Tuberculosis patients infected with HIV are more likely to experience extreme weight loss, diarrhea and lymph node involvement than those who are not infected with HIV. Patients infected with HIV are also more likely to have tuberculosis outside the lungs or tuberculous meningitis than those who are not. The same types of drugs can be used to treat tuberculosis patients infected with HIV and those who are not, but HIV-positive patients are more likely to have drug-resistant tuberculosis., Objectives.--To review the epidemiologic, clinical, and pathological characteristics and the public health implications of human immunodeficiency virus (HIV)associated tuberculosis in sub-Saharan Africa. Data Sources.--Published medical literature (English and French) and proceedings of intemational and African conferences on the acquired immunodeficiencysyndrome (AIDS). Study Selection.--Selection by the authors of articles most pertinent to HIV infection and tuberculosis in Africa and internationally. Data Extraction.--Direct reporting of quantitative data (eg, HIV seroprevalence levels) and of qualitative descriptions and conclusions from selected literature. Data Synthesis.--High rates (20% to 67%) of HIV infection in patients with tuberculosis have been reported from East, West, Central, and Southern Africa. An increase in tuberculosis cases has been reported at the same time as the emergence of AIDS in several countries. Autopsies in Abidjan, Ivory Coast (Cote d&apos;Ivoire), have shown tuberculosis as the most frequent opportunistic infection in patients dying of AIDS. Clinical differences in patients with tuberculosis who were HIV-positive and HIV-negative are reviewed, the most important being a greatly increased mortality rate in HIV-associated disease. Access to HIV testing is required for firm diagnosis, for clinical care and counseling, and for public health surveillance. Conclusions.--The epidemiology of tuberculosis has been profoundly influenced by the epidemic of HlV infection in sub-Saharan Africa. Greatly increased human and material resources are required for this neglected problem in international health.

Introduction Tuberculosis, long known to be a major cause of morbidity and mortality throughout the world, has for the past several decades been a neglected disease in both industrialized and [...], The overall tuberculosis situation in the world in 1990 and its recent trends are viewed by an analysis of the case notifications to WHO and tuberculosis mortality reports. Estimates of the prevalence of tuberculosis infection and the incidence of tuberculosis disease and deaths predicted in 1990 were carried out with simple epidemiological models. Approximately one third of the world's population is infected with Mycobacterium tuberculosis. In the past decade, an average of 2.5 to 3.2 million cases were notified every year globally, the small decrease in notification rates in recent years being offset by population growth. In 1990, an estimated 8 million people developed tuberculosis worldwide and 2.6 to 2.9 million died. The majority of these cases and deaths occurred in Asia, with an increasing number among HIV-infected individuals, especially in Africa where an upward trend is clearly detectable. Data on tuberculosis cases notified by WHO Member States demonstrate the magnitude of the problem but must be interpreted with caution. Being less than the expected incidence, they reflect the inadequacies of tuberculosis control programmes. This review confirms the very high global magnitude of the tuberculosis problem and calls for an urgent revitalization of tuberculosis control programmes throughout the world.

The article discusses provisional 2008 data from a report by the National Tuberculosis (TB) Surveillance System Data has revealed that the incidence of TB in the United States is declining every year and the need is to increase TB prevention and control capacity mainly among foreign-born and minority populations.

Since the beginning of the century mortality from tuberculosis has declined from 202 per 100,000 population to 9 per 100,000 population in the United States. However, it is still a major cause of death in developing countries, and has begun to increase in the United States because acquired immunodeficiency syndrome (AIDS) has made many more people susceptible to infection. One of the most serious complications of tuberculosis is pericarditis (inflammation of the membranous sac surrounding the heart). The development and progression of tuberculous pericarditis are described, and the findings from a physical examination and from laboratory tests for diagnosis are discussed. The infection underlying tuberculous pericarditis is treated with the drug rifampin, given in combination with other drugs. Corticosteroids may also be helpful. If the growth of fibrous tissue begins to constrict the heart, or if removal of fluid in the pericardium does not lower blood pressure in the veins, pericardiectomy (surgical removal of the pericardial sac) may be necessary. Although some physicians recommend pericardiectomy for all patients with tuberculous pericarditis, others do not. In one study, only 17 of 240 patients required the surgery, and in another, drug therapy alone was effective in 30 of 41 patients. Surgery is not recommended for routine treatment. Mortality among patients with tuberculous pericarditis is now below 50 percent. However, whether drug therapy prevents constrictive pericarditis is still not clear. (Consumer Summary produced by Reliance Medical Information, Inc.)

People who are already ill are particularly susceptible to tuberculosis (TB). Not surprisingly, patients with AIDS are at increased risk for TB; Haitians and intravenous drug users appear to be at higher risk. The co-occurrence of AIDS and TB in subjects in Illinois was evaluated to project future prevalence and to develop a strategy for its control. Of approximately 2,000 patients, 46 had TB. Black patients and those who used intravenous drugs were at higher risk of TB. Half of the TB cases had non-lung lesions, compared with only 16 percent of nationwide TB cases. Calculations reveal that 4.1 percent of AIDS patients develop active TB. A rate of 11 cases of TB per 100,000 people by 1993 is projected. The report suggests that early identification and treatment of patients with AIDS who have TB is important in dealing with TB. Specifically, intravenous drug users should be screened for both AIDS and TB. Isoniazid, a drug commonly used for TB treatment, should be given to all TB-infected persons regardless of age. Education of health care workers, of the public, and of the government so as to confront this almost vanquished disease should be given in order to obtain the resources needed to deal with tuberculosis. (Consumer Summary produced by Reliance Medical Information, Inc.)