Tolerance of young infants to a single, large dose of vitamin A: a randomized community trial in Nepal.

A randomized, double-masked trial was carried out in rural Nepal to investigate the incidence and severity of acute side-effects among neonates ( < 1 month of age) and infants aged 1-6 months who received a large, oral dose of vitamin A (15,000 retinol equivalents (RE) (50,000 IU) and 30,000 RE (100,000 IU), respectively) or placebo (75 RE (250 IU) and 150 RE (500 IU), respectively) in oil. Infants (vitamin A group, n = 1461; controls, n = 1379) were assessed for vomiting, loose stools, fever, and irritability during the 24 hours before and after dosing. Fontanelles were palpated 24 hours after dosing. Neonates exhibited no excess risk of adverse side-effects after receiving 15,000 RE. Compared with controls the older infants who ingested 30,000 RE had a 1.6% excess rate of vomiting (95% confidence interval (CI): 0.2-3.0%) and a 0.5% excess rate (95% CI: -0.1 to 1.1%) in the occurrence of bulging fontanelles. There were no other significant differences in the older infants. The controlled, periodic distribution of a single 15,000 RE dose of vitamin A therefore confers no apparent acute risk to young infants; a 30,000 RE dose is associated with a minimum risk of transient, acute side-effects.     

Geographical patterns of end-stage renal disease incidence and risk factors in rural and urban areas of South Carolina

To assess the geographical patterns of end-stage renal disease (ESRD) incidence and to identify the risk factors on the regional differences, the authors conducted an ecological study on incidence of ESRD and related risk factors in the 46 counties of South Carolina (SC). Age and gender adjusted, race specific incidence rates for each county in SC were calculated for the 11,346 ESRD patients of all ages who registered in the United States Renal Data Systems Network 6 from 1990 to 1999. County level exposure measures on population physician density, hospitalization rates of diabetes and hypertension, per capita income, percent college degree, and percent below poverty were evaluated. There was a significant increase in mean incidence rates of ESRD from 1990 to 1999 in SC (p<0.0001). The incidence rates were consistently higher in rural than in urban counties. Population physician density (relative risk (RR) 0.49, 95% confidence interval (95%Cl, 0.41-0.58) and rural residence (adjusted RR 1.66, 95%Cl 1.59-1.74) were significantly associated with ESRD incidence. The strong relationship between ESRD and physician density suggests that access to adequate treatment of diabetes and hypertension is of paramount importance for ESRD prevention, and has important public policy implications.     

The association of housing density,isolation and tuberculosis in Canadian First Nations communities

BACKGROUND: First Nations communities in Canada experience disproportionately high levels of overcrowded housing, degree of isolation, and rates of tuberculosis (TB). A study was done to assess the association between housing density, isolation, and the occurrence of TB in First Nations communities. METHODS: Average persons per room (ppr), isolation type, average household income, population, and TB cases (1997-1999) at the community level were entered into a database. Tuberculosis notification rates and 95% CI were calculated for different strata of ppr and isolation. Two multiple logistic regression models were developed to examine the association of ppr, isolation, income, and population with the occurrence of >/=1, or >/=2, TB cases in a community. RESULTS: The rate was 18.9 per 100,000 (95% CI: 13.3-24.6) in communities with an average of 0.4-0.6 ppr, while communities with 1.0-1.2 ppr had a rate of 113.0 per 100,000 (95% CI: 95.4-130.5). An increase of 0.1 ppr in a community was associated with a 40% increase in risk of >/=2 TB cases occurring, while an increase of $10,000 in community household income was associated with 0.25 the risk, and being an isolated community increased risk by 2.5 times. CONCLUSIONS: This study shows a significant association between housing density, isolation, income levels, and TB. Overcrowded housing has the potential to increase exposure of susceptible individuals to infectious TB cases, and isolation from health services may increase the likelihood of TB.     

Differences in tuberculosis incidence rates in township and in rural populations in Ntcheu District, Malawi

There has been a large upsurge of tuberculosis (TB) in many countries in sub-Saharan Africa, mainly as a result of the co-existing human immunodeficiency virus (HIV) epidemic. Malawi has had a well-run National TB Control Programme (NTP) with good registration and recording of cases. For some years the NTP has had the impression that TB in the country is concentrated around townships and is less prevalent in the rural areas. This impression was investigated in a rural district (Ntcheu District) in Malawi. Data on new TB cases were collected from the district TB register for the years 1992-96 and average annual TB incidence rates per 100,000 for semi-urban and rural populations were calculated for this period. There was a significantly higher incidence of TB, particularly amongst cases with smear-negative pulmonary TB and extrapulmonary TB, in the semi-urban population compared with the rural population. Possible explanations could be higher HIV seroprevalence rates in semi-urban areas compared with rural areas, under-diagnosis at health centres or poor access to medical facilities for rural people.     

乡村卫生组织一体化对肺结核患者发现的作用评价

目的评价目前实行的乡村卫生组织一体化对肺结核患者发现的作用。方法从县区结防机构常规报表、初诊病人登记本等资料中获得数据,通过比较一体化县和对照县之间的差别,评价乡村卫生一体化对肺结核患者发现工作的作用。结果一体化县初诊患者中主动就诊和乡镇医院转诊患者比例(83.2%、4.5%)高于对照县(76.4%、3.8%)(χ2=96.433,P﹤0.001;χ2=78.505,P﹤0.001);一体化县确诊患者的就诊延误和确诊延误均比对照县的延误时间短(Z=-2.53,P=0.01;Z=-4.40,P﹤0.01)。结论乡村一体化在一定程度上提高了主动就诊患者的比例,缩短了患者的延迟,但仍存在转诊比例较低等问题,应采取进一步措施保证肺结核患者的发现工作质量。     

2003-2007年石家庄市登记新涂阳肺结核病人情况分析

目的了解石家庄市新涂阳肺结核病人特征,以采取更有效的防控措施。方法对2003—2007年石家庄市结核病控制工作季报表资料进行分析。结果2003—2007年石家庄市各级结防机构共登记新涂阳肺结核病人16865例,新涂阳肺结核病人平均登记率为36．61／10万。男性登记数和登记率均高于女性,登记率随年龄增长呈增高的趋势。15—25岁年龄组病人的登记数和占新涂阳总病人数的百分比均最高,15—54岁年龄组的新涂阳病人数占总病人数的66％。23个县、市区平均登记率波动在12．47／10万～44．82／10万。农村县（市）的新涂阳登记率高于石家庄市区,分别为33／10万、12／10万。新涂阳肺结核病人登记率与初诊病人占全人口比例呈正相关（r=0．705）。结论农村最具劳动能力的青壮年为重点发病人群。结核病仍是制约农村地区特别是贫困地区经济和社会发展的重大疾病之一,石家庄市的结核病防控工作的重点仍应放在农村。青年学生也是结核病的高发群体,学校的结核病控制工作应进一步加强。     

Tuberculosis notifications in Australia, 2002.

In 2002, there were 1,028 cases of tuberculosis (TB) reported to the National Notifiable Disease Surveillance System, of which 997 were new cases, 30 were relapses and 1 unknown. The incidence rate of TB in Australia in 2002 was 5.2 cases per 100,000 population. The highest incidence of TB was reported in people born overseas (20.2 cases per 100,000 population), followed by Indigenous Australians (8.5 cases per 100,000 population). By contrast, the incidence rate of TB in the nonIndigenous Australian-born population was 1.1 cases per 100,000 population. This pattern of TB incidence rates amongst the sub-populations of Australia has been observed for over 10 years. The rates were evaluated against the performance indicators set by the National Tuberculosis Advisory Committee to ensure that Australia's record of TB control is maintained and improved.     

Tuberculosis outbreak in a low-incidence state--Indiana, 2001-2004

States with fewer than 3.5 cases of tuberculosis (TB) per 100,000 population are designated as states with low incidence for TB, corresponding to CDC's interim target rate for 2000, with a goal to eliminate TB in the United States by 2010. Indiana is a low-incidence state, with a TB case rate of 2.3 per 100,000 population in 2003. However, during 2000-2002, Allen County, Indiana, exceeded the state TB case rate with a mean case rate of 2.9 (range: 2.7-3.0) per 100,000 population. The TB case rate in Allen County increased to 4.7 per 100,000 population (with 16 patients reported with TB disease) in 2003 and to 7.0 per 100,000 population (with 12 patients reported with TB disease) during the first half of 2004. The Allen County Department of Health (ACDH), the Indiana State Department of Health, and CDC are investigating this ongoing TB outbreak. This report describes the preliminary results of the investigation, the efforts of ACDH to restructure its TB program, and the importance of maintaining TB-control efforts in low-incidence states.     

Epidemiology of Tuberculosis in the Southeastern Iran

In order to study the epidemiology of tuberculosis (TB) in Zabol, situated in the Southeast of Iran, this study was performed. Two thousand seven hundred and twenty-nine cases of tuberculosis disease were identified during 1998–2002. The notification rate was 135/100,000 population in 2002, which was higher than this rate in previous years. The notification rate of TB in Afghan population was significantly higher than Iranian population (202 cases/100,000 in Afghan and 122 cases/100,000 in Iranian population. The case notifications in 1998–2001 were 134, 131, 130, and 130 in 100,000 populations, respectively. The prevalence of smear-positive cases was 76/100,000 population in 2002 and the ratio of smear-positive cases to smear-negative and extrapulmonary cases was 1.46. This region remains high TB rates. It is necessary to pay attention to the detection of TB, by making their register in order to enhance the effectiveness and to reduce the cost of existing methods.     

Tuberculosis notifications in Australia, 2001.

In 2001, there were 997 cases of tuberculosis (TB) reported to the National Notifiable Diseases Surveillance System, of which, 967 were new cases of TB and 30 cases were relapses. The incidence rate of TB in Australia in 2001 was 5.1 cases per 100,000 population. The highest incidence of TB was reported in people born overseas (19.3 cases per 100,000 population), followed by Indigenous Australians (9.8 cases per 100,000 population). In contrast, the incidence rate of TB in the non-Indigenous Australian-born population was 1.0 cases per 100,000 population. This pattern of TB incidence rates amongst the sub-populations of Australia has been observed for over 10 years. Eighty-six per cent of TB cases completed treatment in 2001. Treatment was unsuccessful in 7 cases and only 22 cases defaulted. The National Tuberculosis Advisory Committee has published a National Strategic Plan with performance indicators to ensure that this enviable record of TB control is maintained and improved.     

The number of beds needed for patients with infectious diseases that require hospitalization by law

PURPOSE: Using a statistical model, a study was conducted on the number of beds that are needed for patients with infectious diseases who are required by law to be hospitalized. METHODS: Based on 1995 data, the incidence of such infectious diseases and the average duration of isolation of these patients in Japan were obtained. Using a Poisson distribution, the probability that the number of patients that exceeds a specific number over an average duration of hospitalization was computed in a finite population. The observation period was then extended to one year and the probability that the number of patients did not exceed a specific number during one year was calculated. RESULTS: In 1995, the annual incidence of infectious diseases requiring isolation by hospitalization was 1.38 per 100,000 population and the average duration of hospital confinement was 13.8 days. The estimated patient numbers calculated based on the probability of less than 0.001 that the number of patients would not exceed a specific number were: 2 for 30,000 population, 3 for 50,000 through 100,000, 5 for 200,000 and 300,000, 5 for 400,000 and 500,000, 6 for 750,000 and 1,000,000, 8 for 2,000,000, and 10 for 3,000,000. CONCLUSION: By using a Poisson distribution, a method was developed for estimating the number of beds that are needed for patients with infectious diseases when hospitalization was mandatory.     

Transmission of Mycobacterium tuberculosis associated with failed completion of treatment for latent tuberculosis infection--Chickasaw County,Mississippi, June 1999-March 2002

During June 1999-March 2002, a total of 16 tuberculosis (TB) cases were reported from Chickasaw County, Mississippi (2000 population: 19,440), corresponding to annual TB incidences of 20.5-27.6 cases per 100,000 population. In comparison, annual TB incidences for Mississippi during the same period decreased from 7.8 to 5.4 cases per 100,000 population. This report summarizes the results of an investigation of the patients and their contacts and demonstrates the need for strategies to increase the proportion of infected contacts that successfully complete treatment for latent TB infection (LTBI).     

Spatial and temporal distribution of tuberculosis in indigenous and non-indigenous of Rondônia State, Western Amazon, Brazil

This study analyzed the spatial and temporal distribution of crude and adjusted rates of incidence of tuberculosis (TB) between 1997 and 2006, identifying areas of greatest risk to the indigenous and non-indigenous population of Rond?nia State, Brazil. An ecological study was conducted analyzing municipalities and Indian reserves, using the local empirical Bayesian method. The crude average rate of incidence of TB among the non-indigenous population was 35.6/100,000 inhabitants, while for the indigenous population it was 415.0/100,000. Rates greater than 600/100,000 were reported in the Karipuna, Sete de Setembro, Igarapé, Ribeir?o and Karitiana reserves. We observed a greater number of cases in under 15 year-olds with little schooling in contrast to the situation in the non-indigenous population. After making adjustments, the rates in some Indian reserves exceeded 240/100,000 inhabitants, while in coinciding municipalities incidence was between the range of 61-120/100,000. The Bayesian method led to decreased overall heterogeneity in rates. Evidence suggests that the indigenous population is more vulnerable to contracting TB and highlighted areas that require further attention to ensure the adequate control of TB in Rond?nia.     

Tuberculosis among health care workers

To assess the annual risk for latent tuberculosis infection (LTBI) among health care workers (HCWs), the incidence rate ratio for tuberculosis (TB) among HCWs worldwide, and the population-attributable fraction of TB to exposure of HCWs in their work settings, we reviewed the literature. Stratified pooled estimates for the LTBI rate for countries with low (<50 cases/100,000 population), intermediate (50-100/100,000 population), and high (>100/100,000 population) TB incidence were 3.8% (95% confidence interval [CI] 3.0%-4.6%), 6.9% (95% CI 3.4%-10.3%), and 8.4% (95% CI 2.7%-14.0%), respectively. For TB, estimated incident rate ratios were 2.4 (95% CI 1.2-3.6), 2.4 (95% CI 1.0-3.8), and 3.7 (95% CI 2.9-4.5), respectively. Median estimated population-attributable fraction for TB was as high as 0.4%. HCWs are at higher than average risk for TB. Sound TB infection control measures should be implemented in all health care facilities with patients suspected of having infectious TB.     

Trends in Tuberculosis Reported From the Appalachian Region: United States, 1993-2005

ABSTRACT:  Context: Appalachia has been characterized by its poverty, a factor associated with tuberculosis, yet little is known about the disease in this region. Purpose: To determine whether Appalachian tuberculosis risk factors, trends, and rates differ from the rest of the United States. Methods: Analysis of tuberculosis cases reported to the Centers for Disease Control and Prevention's National Tuberculosis Surveillance System (NTSS) within the 50 states and the District of Columbia from 1993 through 2005. Results: The 2005 rate of tuberculosis in rural Appalachia was 2.1/100,000, compared to 2.7/100,000 in urban Appalachia. Urban non-Appalachia had a 2005 tuberculosis rate of 5.4/100,000. Over the 13-year period, tuberculosis rates fell in Appalachia at an annual rate of 7.8%. In one age group (15- to 24-year-olds) the rates increased at an annual rate of 2.8%. Foreign-born Hispanics were the largest racial/ethnic group in this age group. When private providers gave exclusive care for tuberculosis disease, Appalachians were less likely to complete therapy in a timely manner when compared to non-Appalachians (OR 0.6, 95% CI 0.5-0.7). Conclusions: Tuberculosis rates and trends are similar in urban and rural Appalachia. It is crucial for public health officials in Appalachia to address the escalating TB rate among 15- to 24-year-olds by focusing prevention efforts on the growing numbers of foreign-born cases. Due to the increased risk of treatment failure among Appalachians who do not seek care from the health department, public health authorities must ensure completion of treatment for patients who seek private providers.     

2006-2015年北京市昌平区肺结核报告发病情况分析

目的 分析2006-2015年北京市昌平区肺结核报告发病情况及其流行病学特征,为针对性的制定结核病防治策略提供依据。 方法 利用《传染病报告信息管理系统》的统计报表模块收集肺结核数据信息,运用描述性统计学方法对监测数据进行分析。 结果 2006-2015年昌平区报告肺结核病例7 082例,发病率由2006年的76.87/10万上升到2008年的127.55/10万,又下降到2015年的40.69/10万,各年发病率差异有统计学意义(P<0.0001),10年间共报告1 672例涂阳患者(占23.61%),发病率由2006年19.36/10万上升到2008年的28.50/10万,又下降到2015年的10.53/10万,差异有统计学意义(P<0.0001)。报告病例中男性(4 633例)是女性(2 449例)的1.89倍,各年度男性与女性患者发病率差异均有统计学意义(P<0.0001)。报告病例主要集中在15~25岁年龄组(47.99%)和65岁以上(9.90%)人群,职业分布以农民、家务及待业、学生、干部职员、工人为主,占报告病例的71.19%。本地户籍患者报告病例(5 441例)是非户籍患者(1 641例)的3.32倍,各年度本地户籍与非本地户籍患者报告发病率差异均有统计学意义(P<0.0001),非户籍患者报告发病率整体上呈先升后降的趋势,在2008年达到近十年的高峰,发病率为53.26/10万。 结论 2006-2015年北京市昌平区肺结核发病率呈下降趋势,但是结核病的流行仍然严重,应继续加强对重点人群的结核病防治工作。     

Screening for tuberculosis among orphans in a developing country

BACKGROUND: There has been a recent resurgence of tuberculosis (TB) as a worldwide public health concern. It is a well-documented health problem in Haiti, where the reported prevalence is 123.9 per 100,000 population. While the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) policy papers for the eradication of TB recommend screening in shelters, prisons, and other congregate-living facilities, screening in institutional orphanages is not specifically mentioned. METHODS: A total of 445 orphans with no documentation of Bacillus Calmette-Guerin (BCG) vaccine at six orphanages representing urban, suburban, and rural Haiti were screened for TB using standardized purified protein derivative (PPD). An inoculum of 0.1 cc was introduced intradermally, with site checks for induration at 48-72 hours after inoculation. Induration >5 mm was recorded as positive. Active cases of TB were defined by symptoms such as fever, night sweats, cough greater than 1 month, or signs of extrapulmonary TB (like scrofula or Pott's disease). RESULTS: The number of positive PPD tests was 170 of the 445 children tested, or 38,202 per 100,000; there were 10 active cases. The overall prevalence of tuberculin positivity in the three orphanages with one or more active cases was 44%, compared to 13% in the three with no identified active cases. CONCLUSIONS: The data indicate that TB prevalence among the orphans screened was 1123 per 100,000. This is substantially greater than that reported for the general Haitian population. These data thus suggest children living in orphanages as a previously unidentified high-risk group for TB infection. Further investigation of TB is recommended for orphans in developing countries.     

Nutritional risk factors for tuberculosis among adults in the United States, 1971-1992

The risk of developing tuberculosis (TB) may be related to nutritional status. To determine the impact of nutritional status on TB incidence, the authors analyzed data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study (NHEFS). NHANES I collected information on a probability sample of the US population in 1971-1975. Adults were followed up in 1982-1992. Incident TB cases were ascertained through interviews, medical records, and death certificates. TB incidences were compared across different levels of nutritional status after controlling for potential confounding using proportional hazards regression appropriate to the complex sample design. TB incidence among adults with normal body mass index was 24.7 per 100,000 person-years (95% confidence interval (CI): 13.0, 36.3). In contrast, among persons who were underweight, overweight, and obese, estimated TB incidence rates were 260.2 (95% CI: 98.6, 421.8), 8.9 (95% CI: 2.2, 15.6), and 5.1 (95% CI: 0.0, 10.5) per 100,000 person-years, respectively. Adjusted hazard ratios were 12.43 (95% CI: 5.75, 26.95), 0.28 (95% CI: 0.13, 0.63), and 0.20 (95% CI: 0.07, 0.62), respectively, after controlling for demographic, socioeconomic, and medical characteristics. A low serum albumin level also increased the risk of TB, but low vitamin A, thiamine, riboflavin, and iron status did not. A population's nutritional profile is an important determinant of its TB incidence.     

Tuberculosis in hemodialysis patients in New Jersey: a statewide study.

OBJECTIVE: To study the incidence of tuberculosis (TB), tuberculin skin testing (TST) practices, and infection control practices at outpatient hemodialysis centers. DESIGN: Mail surveys performed in December 1994 and 1995. MAIN OUTCOME MEASURES: The numbers of patients with incident active TB during 1994 and 1995, TST policies during 1994, and TB infection control policies in 1994. SETTING: All outpatient dialysis centers in New Jersey. PATIENTS OR PARTICIPANTS: Healthcare workers and patients in dialysis centers in New Jersey. RESULTS: Of 47 centers, 41 provided information on TST and TB infection control policies and practices. TSTs were performed on newly hired healthcare workers at all 41 centers and on established workers at 39 centers. In contrast, only 1 center reported performing TSTs on hemodialysis patients; 5 other centers reported screening of patients for TB using chest radiographs. Active TB was reported in 3 of 4,550 chronic hemodialysis patients in 1994 (rate, 66/100,000 patient-years) and in 4 of 4,831 patients in 1995 (rate, 83/100,000 patient-years). Both rates were several times higher than the rate in the New Jersey general population during this period (10.7-10.8/100,000). CONCLUSION: Although based on small numbers of patients with TB, we found a relatively high incidence of TB among hemodialysis patients in New Jersey. Most centers reported performing TSTs on workers but not on patients. These results suggest the need for improved TB screening and infection control precautions at outpatient dialysis centers.