Investigating tuberculosis trends in England

Crofts, Jonathan; Gelb, David; Andrews, Nicholas; Delpech, Valérie; Watson, John M.; Abubakar, Ibrahim

doi:10.1016/j.puhe.2008.04.011

Cited by 27 publications

(17 citation statements)

References 25 publications

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“…The Merseyside cohorts illustrate the nationwide shift in demographics of HIV infection,13 and the corresponding change in patterns of presentation, with more HIV related reactivation of TB in the later time period 5 14. Our study did not take into account the contribution of patients with poor English skills, reported to be a contributory factor in delayed HIV diagnosis in TB patients 15.…”

Section: Discussionmentioning

confidence: 89%

Acute presentations of HIV are still missed in low prevalence areas

Ratcliffe

Thomas

Beeching

et al. 2011

Postgraduate Medical Journal

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Objectives To evaluate missed opportunities and delays in the diagnosis of HIV in a low prevalence setting over a 24 year period. Methods Patients with acute presentations of HIV were included in a retrospective note based review. Data were compared from acute presentations in 1985e2001 (88/ 241 new patients) with 2005e2007 (99/136 new patients). The number of recorded clinical and laboratory clues to infection and subsequent time delays to diagnosis of HIV were evaluated. Results The findings reflect the shifting demographics of HIV in the UK over the past two decades, exemplified by an eightfold increase in tuberculosis at presentation.

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Section: Discussionmentioning

confidence: 89%

Acute presentations of HIV are still missed in low prevalence areas

Ratcliffe

Thomas

Beeching

et al. 2011

Postgraduate Medical Journal

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“…2 In the UK, after many decades during which both the risk of infection with M. tuberculosis and the incidence of TB decreased, the last decade of the 20th century and the first decade of the 21st century saw a steady rise in TB cases. 3 From 2005 to 2011, there were around 8000 cases of TB per year in England. This declined to 6520 cases in 2014, but England still has the highest rate of TB in Western Europe.…”

Section: Tuberculosis Epidemiologymentioning

confidence: 99%

Observational study to estimate the changes in the effectiveness of bacillus Calmette–Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK

Mangtani

Nguipdop-Djomo

Keogh

et al. 2017

Health Technol Assess

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Background Until recently, evidence that protection from the bacillus Calmette–Guérin (BCG) vaccination lasted beyond 10 years was limited. In the past few years, studies in Brazil and the USA (in Native Americans) have suggested that protection from BCG vaccination against tuberculosis (TB) in childhood can last for several decades. The UK’s universal school-age BCG vaccination programme was stopped in 2005 and the programme of selective vaccination of high-risk (usually ethnic minority) infants was enhanced. Objectives To assess the duration of protection of infant and school-age BCG vaccination against TB in the UK. Methods Two case–control studies of the duration of protection of BCG vaccination were conducted, the first on minority ethnic groups who were eligible for infant BCG vaccination 0–19 years earlier and the second on white subjects eligible for school-age BCG vaccination 10–29 years earlier. TB cases were selected from notifications to the UK national Enhanced Tuberculosis Surveillance system from 2003 to 2012. Population-based control subjects, frequency matched for age, were recruited. BCG vaccination status was established from BCG records, scar reading and BCG history. Information on potential confounders was collected using computer-assisted interviews. Vaccine effectiveness was estimated as a function of time since vaccination, using a case–cohort analysis based on Cox regression. Results In the infant BCG study, vaccination status was determined using vaccination records as recall was poor and concordance between records and scar reading was limited. A protective effect was seen up to 10 years following infant vaccination [< 5 years since vaccination: vaccine effectiveness (VE) 66%, 95% confidence interval (CI) 17% to 86%; 5–10 years since vaccination: VE 75%, 95% CI 43% to 89%], but there was weak evidence of an effect 10–15 years after vaccination (VE 36%, 95% CI negative to 77%; p = 0.396). The analyses of the protective effect of infant BCG vaccination were adjusted for confounders, including birth cohort and ethnicity. For school-aged BCG vaccination, VE was 51% (95% CI 21% to 69%) 10–15 years after vaccination and 57% (95% CI 33% to 72%) 15–20 years after vaccination, beyond which time protection appeared to wane. Ascertainment of vaccination status was based on self-reported history and scar reading. Limitations The difficulty in examining vaccination sites in older women in the high-risk minority ethnic study population and the sparsity of vaccine record data in the later time periods precluded robust assessment of protection from infant BCG vaccination > 10 years after vaccination. Conclusions Infant BCG vaccination in a population at high risk for TB was shown to provide protection for at least 10 years, whereas in the white population school-age vaccination was shown to provide protection for at least 20 years. This evidence may inform TB vaccination programmes (e.g. the timing of administration of improved TB vaccines, if they become available) and cost-effectiveness studies. Methods to deal with missing record data in the infant study could be explored, including the use of scar reading. Funding The National Institute for Health Research Health Technology Assessment programme. During the conduct of the study, Jonathan Sterne, Ibrahim Abubakar and Laura C Rodrigues received other funding from NIHR; Ibrahim Abubakar and Laura C Rodrigues have also received funding from the Medical Research Council. Punam Mangtani received funding from the Biotechnology and Biological Sciences Research Council.

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“…In the UK, this may be contributing to the general rise in tuberculosis [12]. Using a sample of digital chest radiographs from a hard to reach population at high risk of tuberculosis in London, we assessed some of the factors associated with greater diagnostic accuracy and determined levels of agreement between readers.…”

Section: To the Editorsmentioning

confidence: 99%

Diagnostic accuracy of digital chest radiography for pulmonary tuberculosis in a UK urban population

Abubakar¹,

Story²,

Lipman³

et al. 2010

Eur Respir J

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To the Editors: Population screening for tuberculosis was discontinued in most Western countries, largely due to the decreasing prevalence of the disease. The use of chest radiograph examination for population screening has, therefore, appropriately declined and is now limited to the screening of high-risk groups, such as immigrants 1, prisoners or homeless persons in certain countries 2 and for disease prevalence surveys 3. Chest radiography, however, remains a key tool for the clinical diagnosis of pulmonary tuberculosis. Previous studies suggest that chest radiograph abnormalities in tuberculosis are not specific and levels of intra- and inter-reader agreement are very variable 4–6. Modern digital tuberculosis screening has been noted to have high levels of sensitivity where chest radiograph examination is standardised, quality assured and a simple coding system is used 7–9. Levels of reader agreement are also reported to be higher among experienced readers 10. In many low incidence countries, tuberculosis is concentrating in specific urban populations, such as homeless persons and drug users, with high prevalence rates reported 2, 11. In the UK, this may be contributing to the general rise in tuberculosis 12. Using a sample of digital chest radiographs from a hard to reach population at high risk of tuberculosis in London, we assessed some of the factors associated with greater diagnostic accuracy and determined levels of agreement between readers. The study was carried out in London (UK), Amsterdam and Rotterdam (the Netherlands) between July and October 2008. Of 20 physicians invited, 13 participated: three radiologists, six respiratory physicians and one infectious disease physician from London and three public health tuberculosis physicians from Amsterdam and Rotterdam. 56 randomly selected chest radiographs were chosen: 18 confirmed cases of tuberculosis, 19 other abnormalities and 19 normal film

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Investigating tuberculosis trends in England

Cited by 27 publications

References 25 publications

Acute presentations of HIV are still missed in low prevalence areas

Acute presentations of HIV are still missed in low prevalence areas

Observational study to estimate the changes in the effectiveness of bacillus Calmette–Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK

Diagnostic accuracy of digital chest radiography for pulmonary tuberculosis in a UK urban population

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