Recommendations for the screening of paediatric latent tuberculosis infection in indigenous communities: a systematic review of screening strategies among high-risk groups in low-incidence countries

Faust, Lena; McCarthy, Anne; Schreiber, Yoko

doi:10.1186/s12889-018-5886-7

Cited by 11 publications

(9 citation statements)

References 51 publications

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“…Previous studies, particularly related to risk for HIV infection in the context of HIV exposure suggest that food insecurity may be an independent risk factor for infectious disease (Rollins, 2007). Other studies suggest that household food insecurity puts children in a more susceptible position for tuberculosis infection (Faust et al, 2018). In multivariable analyses adjusting for crowding, unemployment and Spanish language use in the TAB cohort, food insecurity score trended towards association with household COVID infection (OR 1.25, 95%CI 0.97-1.61).…”

Section: Risk For Covid-19 Infection With Household Food Insecuritymentioning

confidence: 99%

High Food Insecurity in Latinx Families and Associated COVID-19 Infection in the Greater Bay Area, California

Escobar¹,

Mendez²,

Encinas³

et al. 2020

Preprint

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Background: Food insecurity impacts nearly one-in-four Latinx households in the United States and has been exacerbated by the novel coronavirus or COVID-19 pandemic. Methods: We examined the impact of COVID-19 on household and child food security in three preexisting, longitudinal, Latinx urban cohorts in the San Francisco Bay Area (N=375 households, 1,875 individuals). Households were initially recruited during pregnancy and postpartum at Zuckerberg San Francisco General Hospital (ZSFG) and UCSF Benioff prior to the COVID-19 pandemic. For this COVID sub-study, participants responded to a 15-minute telephonic interview. Participants answered 18 questions from the US Food Security Food Module (US HFSSM), described food consumption, housing and employment status, and history of COVID-19 infection as per community or hospital-based testing. Food security and insecurity levels were compared with prior year metrics. Results: We found low levels of household food security in Latinx families (by cohort: 29.2%; 34.2%; 60.0%) and child food security (56.9%; 54.1%; 78.0%) with differences between cohorts explained by self-reported levels of education and employment status. Food security levels were much lower than those reported previously in two cohorts where data had been recorded from prior years. Reported history of COVID-19 infection in households was 4.8% (95% Confidence Interval (CI); 1.5-14.3%); 7.2% (95%CI; 3.6-13.9%) and 3.5% (95%CI; 1.7-7.2%) by cohort and was associated with food insecurity in the two larger cohorts (p=0.03; p=0.01 respectively). Conclusions: Latinx families in the Bay Area with children are experiencing a sharp rise in food insecurity levels during the COVID-19 epidemic. Food insecurity, similar to other indices of poverty, is associated with increased risk for COVID-19 infection. Comprehensive interventions are needed to address food insecurity in Latinx populations and further studies are needed to better assess independent associations between household food insecurity, poor nutritional health and risk of COVID-19 infection.

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Section: Risk For Covid-19 Infection With Household Food Insecuritymentioning

confidence: 99%

High Food Insecurity in Latinx Families and Associated COVID-19 Infection in the Greater Bay Area, California

Escobar¹,

Mendez²,

Encinas³

et al. 2020

Preprint

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“…All these children should be examined twice, that is, when performing the tuberculin test and when evaluating the results. Thus, our data provide evidence favouring risk assessment over universal screening with a TST in low‐burden countries . Replacing the universal testing with the targeted testing approach prevents false‐positive tests, exposure to chest X‐rays and lengthy preventive treatment regimens.…”

Section: Discussionmentioning

confidence: 79%

Evaluating a 24‐year tuberculosis screening in first‐grade elementary schoolers in a low‐burden area

2019

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Aim: Early diagnosis of tuberculosis infection can significantly contribute to the control of the disease. The aim of the present study was to describe the tuberculin skin test (TST) trends over a 24-year period (1990-2013) and explore the value of universal tuberculosis screening in a low-burden area.Methods: All first graders that underwent TST during the 24-year study period on the island of Crete, Greece, were retrospectively included in the study.Results: A total of 82 402 children (92.3% of Greek nationality; 51.0% male) underwent TST, of whom 335 (0.41%, 95% CI 0.37-0.46) were found to have positive TST while 0.27% of the study population had a TST between 5 and 9 mm. The tuberculin index declined significantly between 1990-1994 and 2010-2013 (0.67 vs 0.26; RR 2.73, 95% CI 1.82-4.09; p < 0.0001). Positive TST result was significantly higher in the immigrant than the native group (0.66% vs 0.24%; RR 3.76 95%, CI 2.89-4.84; p < 0.0001). In the last study years, 386 children (488 native; 153 immigrant) should be tested for one to be found TST positive.Conclusion: Our findings question the massive tuberculin testing in low-burden areas and point to selective screening of high-risk groups.

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“…Findings that supported targeted vaccination among selected risk groups rather than universal vaccination included a high number of vaccinations needed to prevent one TB case in low-burden areas [34], along with a potentially high number of adverse events per prevented case [52], and the persisting low risk of infection in low-incidence settings making mass vaccination unnecessary [10, 11, 13]. It was also emphasized that a further benefit of the discontinuation of mass vaccination in low-incidence settings was the restoration of the diagnostic utility of the TST for the identification of LTBI [10]; an important consideration given that detection and prophylaxis of LTBI continues to be a component of TB control in the Canadian Indigenous context [57], and because interferon-γ-release assays are not widely available [58].…”

Section: Resultsmentioning

confidence: 99%

A systematic review of BCG vaccination policies among high-risk groups in low TB-burden countries: implications for vaccination strategy in Canadian indigenous communities

Faust

Schreiber

Bocking³

2019

BMC Public Health

Self Cite

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BackgroundBacille Calmette-Guérin (BCG) vaccination against tuberculosis (TB) is widespread in high-TB-burden countries, however, BCG vaccination policies in low-burden countries vary. Considering the uncertainties surrounding BCG efficacy and the lower likelihood of TB exposure in low-incidence countries, most have discontinued mass vaccination, choosing instead a targeted vaccination strategy among high-risk groups. Given the increased risk of TB infection in Canadian Indigenous communities compared to the general Canadian population, these communities are a pertinent example of high-incidence groups in an otherwise low-burden country, warranting particular consideration regarding BCG vaccination strategy. This systematic review aims to synthesise and critically appraise the literature on BCG vaccination strategies in high-risk groups in low-incidence settings to provide policy considerations relevant to the Canadian Indigenous context.Methods: A literature search of the Medline and Embase databases was conducted, returning studies pertaining to BCG vaccine efficacy, TB incidence under specific vaccination policies, BCG-associated adverse events, and vaccination policy guidelines in low-burden countries. Study screening was tracked using the Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia), and data pertaining to the above points of interest were extracted.ResultsThe final review included 49 studies, spanning 15 countries. Although almost all of these countries had implemented a form of mass or routine vaccination previously, 11 have since moved to targeted vaccination of selected risk groups, in most cases due to the low risk of infection among the general population and thus the high number of vaccinations needed to prevent one case in the context of low-incidence settings. Regarding identifying risk groups for targeted screening, community-based (rather than individual risk-factor-based) vaccination has been found to be beneficial in high-incidence communities within low-incidence countries, suggesting this approach may be beneficial in the Canadian Indigenous setting.ConclusionsCommunity-based vaccination of high-incidence communities may be beneficial in the Canadian Indigenous context, however, where BCG vaccination is implemented, delivery strategies and potential barriers to achieving adequate coverage in this setting should be considered. Where an existing vaccination program is discontinued, it is crucial that an effective TB surveillance system is in place, and that case-finding, screening, and diagnostic efforts are strengthened in order to ensure adequate TB control. This is particularly relevant in Canadian Indigenous and other remote or under-served communities, where barriers to surveillance, screening, and diagnosis persist.

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Recommendations for the screening of paediatric latent tuberculosis infection in indigenous communities: a systematic review of screening strategies among high-risk groups in low-incidence countries

Cited by 11 publications

References 51 publications

High Food Insecurity in Latinx Families and Associated COVID-19 Infection in the Greater Bay Area, California

High Food Insecurity in Latinx Families and Associated COVID-19 Infection in the Greater Bay Area, California

Evaluating a 24‐year tuberculosis screening in first‐grade elementary schoolers in a low‐burden area

A systematic review of BCG vaccination policies among high-risk groups in low TB-burden countries: implications for vaccination strategy in Canadian indigenous communities

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