Latent tuberculosis infection: the final frontier of tuberculosis elimination in the USA

LoBue, Philip; Mermin, Jonathan

doi:10.1016/s1473-3099(17)30248-7

Cited by 90 publications

(73 citation statements)

References 29 publications

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“…Better point‐of‐care diagnostic tests able to distinguish active from latent TB combined with a risk assessment, radiological screening for fibrotic lesions and shorter treatment for LTBI would certainly benefit global TB prevention efforts. Targeting resources towards those at highest risk for both TB infection and reactivation will have the greatest immediate impact, but appear insufficient to achieve elimination based on the US experience . Achieving TB elimination will require treating people who have a significant lifetime risk for active TB but who do not currently have a specific risk for reactivation.…”

Section: Discussionmentioning

confidence: 99%

“…Targeting resources towards those at highest risk for both TB infection and reactivation will have the greatest immediate impact, but appear insufficient to achieve elimination based on the US experience. 67 Achieving TB elimination will require treating people who have a significant lifetime risk for active TB but who do not currently have a specific risk for reactivation. The IGRAs provide an opportunity for more targeted LTBI treatment than with the TST, but implementation of costly, laboratory-intensive IGRA testing remains limited or not available in many settings.…”

Section: Discussionmentioning

confidence: 99%

“…The use of IGRA for diagnosis and rifamycin‐based regimens for treatment of LTBI appears to be a cost‐effective community intervention for immigrants in the US, both with and without medical risks for progression . In Japan, mandatory reporting of LTBI may facilitate the evaluation of country‐level strategies that could help inform strategies in the US and elsewhere …”

Section: The Challenge Of Implementing National Tb Elimination Plansmentioning

confidence: 99%

“…Countries developing a national plan in support of the global TB elimination goal should consider the successes and challenges the US has experienced in nearly three decades since the US TB elimination plan was first proposed in 1989. 67 TB has reached historic lows in the US through great efforts towards detecting and treating active disease, preventing transmission in healthcare facilities and congregate settings and treating LTBI in close contacts and PLWH, resulting in estimated societal savings of $6.7-$14.5 billion. 68 Treatment of LTBI among recent immigrants and refugees was largely limited to those with radiological evidence of inactive TB, and the impact of those efforts appear to have plateaued with TB rates stagnated in recent years at 30 per million.…”

Section: The Challenge Of Implementing National Tb Elimination Plansmentioning

confidence: 99%

“…70 In Japan, mandatory reporting of LTBI may facilitate the evaluation of country-level strategies 71 that could help inform strategies in the US and elsewhere. 67,71 For countries with an intermediate or higher TB incidence, implementing effective LTBI treatment programmes represents both a challenge and opportunity. 72 A recent national prevalence survey in the Philippines found 14% of adults had radiological findings suspicious for TB, of whom 3.5% had bacteriologically confirmed active disease.…”

Section: The Challenge Of Implementing National Tb Elimination Plansmentioning

confidence: 99%

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Latent tuberculosis infection: Opportunities and challenges

et al. 2018

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Diagnosing and treating latent tuberculosis (TB) infection (LTBI) is recognized by the World Health Organization as an important strategy to accelerate the decline in global TB and achieve TB elimination. Even among low-TB burden countries that have achieved high rates of detection and successful treatment for active TB, a number of barriers have prevented implementing or expanding LTBI treatment programmes. Of those infected with TB, relatively few will develop active disease and the current diagnostic tests have a low predictive value. LTBI treatment using isoniazid (INH) has low completion rates due to the long duration of therapy and poor tolerability. Both patients and physicians often perceive the risk of toxicity to be greater than the risk of reactivation TB. As a result, LTBI treatment has had a limited or negligible role outside of countries with high resources and low burden of disease. New tools have emerged including the interferon-gamma release assays that more accurately diagnose LTBI, particularly in people vaccinated with Bacillus Calmette-Guerin (BCG). Shorter, better tolerated treatment using rifamycins are proving safe and effective alternatives to INH. While still imperfect, TB prevention using these new diagnostic and treatment tools appear cost effective in modelling studies in the United States and have the potential to improve TB prevention efforts globally. Continued research to understand the host-organism interactions within the spectrum of LTBI is needed to develop better tools. Until then, overcoming the barriers and optimizing our current tools is essential for progressing toward TB elimination.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: The Challenge Of Implementing National Tb Elimination Plansmentioning

confidence: 99%

Section: The Challenge Of Implementing National Tb Elimination Plansmentioning

confidence: 99%

Section: The Challenge Of Implementing National Tb Elimination Plansmentioning

confidence: 99%

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Latent tuberculosis infection: Opportunities and challenges

et al. 2018

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LncRNA CCAT1 is overexpressed in tuberculosis patients and predicts their survival

Zhang

Zeng

et al. 2021

Immunity Inflam & Disease

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Introduction: LncRNA CCAT1 promotes inflammatory responses, which contribute to tuberculosis. Therefore, CCAT1 may participate in tuberculosis.Therefore, we analyzed the involvement of CCAT1 in tuberculosis.Methods: Plasma samples were donated by a total of 200 patients with newly developed tuberculosis (N-TB), 102 patients with recurrent tuberculosis (R-TB), and 102 healthy controls on the day of admission. Plasma samples were also collected from N-TB and R-TB patients every month after the initiation of treatment for a total of 6 months. CCAT1 expression in these samples was detected by quantitative reverse transcription polymerase chain reaction. Levels of IFN-γ, IL-1β, iNOS, TNF-α, and IL-10 in plasma were determined by enzyme-linked immunosorbent assay. N-TB and R-TB patients were monitored for 2 months to analyze their survival.Results: On the day of admission, the highest levels of CCAT1, IFN-γ, IL-1β, iNOS, and TNF-α were detected in N-TB patients, followed by R-TB patients and controls, while the lowest levels of plasma IL-10 were detected in N-TB patients, followed by R-TB patients and controls. Across R-TB and N-TB patients, CCAT1 was inversely correlated with IL-10 but not closely correlated with other inflammatory factors. During the treatment, plasma CCAT1 levels decreased in both N-TB and R-TB patients. High CCAT1 levels were closely correlated with high mortality rates of both N-TB and R-TB patients. Conclusion: CCAT1 is overexpressed in tuberculosis patients and predicts their survival. Its function in tuberculosis may be related to IL-10.

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Structural identifiability analysis of age-structured PDE epidemic models

2022

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Computational and mathematical models rely heavily on estimated parameter values for model development. Identifiability analysis determines how well the parameters of a model can be estimated from experimental data. Identifiability analysis is crucial for interpreting and determining confidence in model parameter values and to provide biologically relevant predictions. Structural identifiability analysis, in which one assumes data to be noiseless and arbitrarily fine-grained, has been extensively studied in the context of ordinary differential equation (ODE) models, but has not yet been widely explored for age-structured partial differential equation (PDE) models. These models present additional difficulties due to increased number of variables and partial derivatives as well as the presence of boundary conditions. In this work, we establish a pipeline for structural identifiability analysis of age-structured PDE models using a differential algebra framework and derive identifiability results for specific age-structured models. We use epidemic models to demonstrate this framework because of their wide-spread use in many different diseases and for the corresponding parallel work previously done for ODEs. In our application of the identifiability analysis pipeline, we focus on a Susceptible-Exposed-Infected model for which we compare identifiability results for a PDE and corresponding ODE system and explore effects of age-dependent parameters on identifiability. We also show how practical identifiability analysis can be applied in this example.

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Latent tuberculosis infection: the final frontier of tuberculosis elimination in the USA

Cited by 90 publications

References 29 publications

Latent tuberculosis infection: Opportunities and challenges

Latent tuberculosis infection: Opportunities and challenges

LncRNA CCAT1 is overexpressed in tuberculosis patients and predicts their survival

Structural identifiability analysis of age-structured PDE epidemic models

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