Old ideas to innovate tuberculosis control: preventive treatment to achieve elimination

Diel, Roland; Loddenkemper, R.; Zellweger, Jean Pierre; Sotgiu, Giovanni; D’Ambrosio, Lia; Werf, Marieke J. van der; Dara, Masoud; Detjen, Anne; Gondrie, P; Reichman, Lee B.; Blasi, Francesco; Migliori, Giovanni Battista

doi:10.1183/09031936.00205512

Cited by 160 publications

(154 citation statements)

References 121 publications

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“…As it must be recognised, following current trends, Europe is unlikely to achieve elimination of the disease by the target date of 2050 [23,24], we urgently need new vaccines, as well as improved diagnostics [25,26] and new drugs [27][28][29]. With respect to economic considerations, the aim of the present study was to evaluate the costs associated with TB disease in order to determine whether they outweigh the investment needed to generate a new vaccine.…”

Section: Introductionmentioning

confidence: 99%

Costs of tuberculosis disease in the European Union: a systematic analysis and cost calculation

Vandeputte²,

et al. 2013

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Without better vaccines it is unlikely that tuberculosis (TB) will ever be eliminated. An investment of ,J560 million is considered necessary to develop a new, effective vaccine in the European Union (EU). However, less is known about the costs of TB disease in the EU. We performed a systematic review of literature and institutional websites addressing the 27 EU members to summarise cost data. We searched MEDLINE, EMBASE and Cochrane bibliographies for relevant articles.Combining direct and indirect costs, we arrived at an average per-TB case costs in the original EU-15 states plus Cyprus, Malta and Slovenia of J10 282 for drug-susceptible TB, J57 213 for multidrug resistant (MDR)-TB and J170 744 for extensively drug resistant (XDR)-TB. In the remaining new EU states, costs amounted to J3427 for drug-susceptible TB and J24 166 for MDR-TB/XDR-TB. For the 70 340 susceptible TB cases, 1488 MDR-TB and 136 XDR-TB cases notified in 2011 costs of J536 890 315 accumulated in 2012. In the same year, the 103 104 disability-adjusted life years caused by these cases, when stated in monetary terms, amounted to a total of J5 361 408 000.Thus, the resulting economic burden of TB in the EU clearly outweighs the cost of investing in more efficient vaccines against TB. @ERSpublications The economic burden of tuberculosis in the EU outweights the cost of investing in more efficient vaccines against tuberculosis

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Section: Introductionmentioning

confidence: 99%

Costs of tuberculosis disease in the European Union: a systematic analysis and cost calculation

Vandeputte²,

et al. 2013

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“…This heterogeneity may lead to different outcomes, ranging from clearing the infection to pre-reactivation of the disease, probably reflecting various states of bacterial behaviour between dormancy and steady state replication [8][9][10][11]. The identification of these different LTBI subgroups is important, as it may help to target preventive therapy only to those subjects that have the highest risk to reactivate their infection [4,5]. We have previously reported that, in contrast to TST and the commercialized IGRA (QuantiFERON-TB Gold In-Tube assay or QFT -GIT and T-SPOT.TB), the IFN-γ response to the mycobacterial latency antigen heparin-binding haemagglutinin (HBHA) provides good discrimination between subjects with LTBI and patients with active TB [12,13].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, these LTBI subjects have a lifetime risk of about 10% to reactivate their infection, leading to progression to TB disease, this risk being higher in different clinical conditions associated with immune deficiency [2,3]. Despite being asymptomatic, these subjects constitute an enormous reservoir of M. tuberculosis and TB elimination requires focus on sterilizing the pool of LTBI individuals [4,5]. The WHO recommends systematic screening of contacts of TB patients and high-risk groups in order to achieve the post 2015 tuberculosis strategy aiming to reduce the tuberculosis incidence by 90% by 2035 compared with the 2015 incidence [6].…”

Section: Introductionmentioning

confidence: 99%

Immunological Signatures Identifying Different Stages of Latent Mycobacterium tuberculosis Infection and Discriminating Latent from Active Tuberculosis in Humans

Veronique¹

2015

J Clin Cell Immunol

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Objectives: One third of the world population is considered latently infected with Mycobacterium tuberculosis (LTBI) and sterilizing this reservoir of bacteria that may reactivate is required for tuberculosis (TB) elimination. The group of individuals with LTBI is heterogeneous with some of them being more at risk to develop TB disease than others. Improved diagnosis of subjects with LTBI is needed, allowing to differentiate subjects with LTBI from those with active TB, and to select among LTBI subjects those who are more at risk to develop active TB. We have characterized at the cellular level both the quantitative and qualitative T cell responses to different mycobacterial antigens in selected populations of infected subjects in order to identify new biomarkers that could help to identify M. tuberculosis-infected subjects and to stratify them in risk groups for reactivation of the infection.Methods: lymphoblast frequencies and cytokine production (IFN-γ, TNF-α, IL-2) among CD4 + and CD8 + T cells were analyzed by flow cytometry after in vitro stimulation with the latency antigen heparin-binding haemagglutinin (HBHA) or early-secreted antigen Target-6 (ESAT-6) of peripheral blood mononuclear cells from clinically well characterized M. tuberculosis-infected humans (28 LTBI, 22 TB disease,12 controls). The LTBI group defined according to the Center for Disease Control guidelines was subdivided into QuantiFERON-TB Gold in-Tube (QFT) positive and negative subgroups.Results: similar to TB patients, QFT + LTBI subjects had higher proportions of HBHA-induced TNF-α single+ CD4 + lymphocytes than QFT -LTBI subjects (p<0.05). Compared to LTBI subjects, TB patients had higher frequencies of ESAT-6-induced CD8 + lymphoblasts (p<0.001), higher proportions of ESAT-6-induced IFN-γ + TNF-α + CD4 + T lymphocytes (p<0.05), and lower proportions of HBHA-induced IFN-γ + TNF-α + IL-2 + (p<0.05) CD4 + T lymphocytes.Conclusions: these data provide new biomarkers to discriminate active TB from LTBI, and more interestingly, help to identify LTBI subjects with increased likelihood to develop TB disease.

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“…With respect to the post-2015 World Health Organization goal of TB elimination, defined as fewer than one case per million population, by 2050, identifying and prioritising treatment of individuals with latent TB at high risk of progression is essential to prevention [10]. Given the demonstrated risk conveyed by prior household TB exposure, our study affirms the importance of household contact tracing for TB and latent TB case finding and treatment.…”

mentioning

confidence: 53%

The association between public transport and active tuberculosis in Lima, Peru

Furukawa

Mendoza-Ticona²,

Alarcón-Villaverde

et al. 2013

Eur Respir J

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Old ideas to innovate tuberculosis control: preventive treatment to achieve elimination

Cited by 160 publications

References 121 publications

Costs of tuberculosis disease in the European Union: a systematic analysis and cost calculation

Costs of tuberculosis disease in the European Union: a systematic analysis and cost calculation

Immunological Signatures Identifying Different Stages of Latent Mycobacterium tuberculosis Infection and Discriminating Latent from Active Tuberculosis in Humans

The association between public transport and active tuberculosis in Lima, Peru

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