The strategy of tuberculosis (TB) contact investigation is essential for enhancing disease detection. We conducted a cross-sectional study to evaluate the yield of contact investigation for new TB cases, estimate the prevalence of TB, and identify characteristics of index cases associated with infection among contacts of new cases notified between 2010 and 2020 in São Paulo, Brazil. Out of 186466 index TB cases, 131055 (70.3%) underwent contact investigation. A total of 652286 contacts were screened, of which 451704 (69.2%) were examined. Of these, 12243 were diagnosed with active TB (yield of 1.9%), resulting in a number needed to screen of 53 and a number needed to test of 37 to identify one new TB case. The weighted prevalence for the total contacts screened was 2.8% (95% confidence interval [CI]: 2.7%–2.9%), suggesting underreporting of 6021 (95% CI: 5269–6673) cases. The likelihood of TB diagnosis was higher among contacts of cases identified through active case-finding, abnormal chest X-ray, pulmonary TB, or drug resistance, as well as among children, adults, women, individuals in socially vulnerable situations, and those with underlying clinical conditions. The study highlights significant TB underreporting among contacts, recommending strengthened contact investigation to promptly identify and treat new cases.

Hong Kong is an intermediate tuberculosis (TB) endemicity city dominated by reactivation diseases. A cross-sectional study on the clinical and epidemiologic data of newly diagnosed TB cases was conducted in such a setting, to examine the association between ambient PM2.5 and TB reactivation. After the exclusion of cases most likely resulting from recent infection, four distinct TB population phenotypes were delineated by latent class analysis based on their reactivation risk and clinical profiles (N = 2,153): ‘Elderly male’ (26%), ‘Otherwise healthy younger adult’ (34%), ‘Older female’ (19%) and ‘Male smoker’ (21%). Overall, exposure to high concentrations of ambient PM2.5 6 and 12 months before the notification was significantly associated with ‘Otherwise healthy younger adults’ membership (OR = 1.07 and 1.11, respectively) compared with ‘Elderly male’. Such association was less evident for other phenotypes. The differential pattern of association between ambient PM2.5 exposure and TB population phenotypes suggested the role of ambient PM2.5 in TB reactivation.

Despite global efforts to end tuberculosis (TB), the goal of preventing catastrophic health expenditure (CHE) due to TB remains unmet. This cross-sectional study was conducted in Guizhou Province, Southwest China. Data were collected from the Hospital Information System and a survey of TB patients who had completed standardized antituberculosis treatment between January and March 2021. Among the 2 283 participants, the average total expenditure and out-of-pocket expenditure were $1 506.6 (median = $760.5) and $683.6 (median = $437.8), respectively. Health insurance reimbursement reduced CHE by 16.8%, with a contribution rate of 24.9%, and the concentration index changed from -0.070 prereimbursement to -0.099 postreimbursement. However, the contribution of health insurance varied significantly across different economic strata, with contribution rates of 6.4% for the lowest economic group and 53.1% for the highest group. For patients from lower socioeconomic strata, health insurance contributed 10.7% to CHE in the prediagnostic phase and 23.5% during treatment. While social health insurance alleviated the financial burden for TB patients, it did not provide sufficient protection for those in lower economic strata or during the prediagnostic stage. This study underscores the need for more effective and equitable subsidy policies for TB patients .

This study aimed to assess nutritional status and associated factors among adult tuberculosis patients in public health centres in Horro Guduru Wollega Zone, Western Ethiopia, 2021. An institutional-based cross-sectional study was conducted among 334 randomly selected adult TB patients at public health centres from May 7, 2021, to June 21, 2021. Data were collected using structured questionnaires and anthropometric measurements. The nutritional status was measured by using body mass index (BMI). Data was entered into EpiData version 4.6 and exported to SPSS version 25 for analysis. A bivariate and multivariable multinomial logistic regression analysis was done to identify factors associated with nutritional status. The prevalence of under and overnutrition was found to be 48.2% and 8.7%, respectively. Female TB patients (AOR = 3.48, 95% CI: (1.918–6.314)), patients who didn’t receive dietary counselling (AOR = 2.51, 95% CI: (1.335–4.720)), TB patients on the initiation phase of treatment (AOR = 3.76, 95% CI: (2.072–6.852)), and meal frequency less than three times per day (AOR = 3.6, 95% CI: (1.942–6.676)) were significantly associated with under nutrition. The prevalence of undernutrition was high in the study area. Being a female, being in the initiation phase of treatment, lack of dietary counselling, and having meal less than three per day were independently associated with undernutrition. Hence, regular nutritional assessments, dietary counselling, and nutritional support should be encouraged at the facility and community level.

Pulmonary tuberculosis (PTB) elimination efforts must consider the global growth of the ageing population. Here we used TB surveillance data from Texas, United States (2008–2020; total n = 10656) to identify unique characteristics and outcomes in older adults (OA, ≥65 years) with PTB, compared to young adults (YA, 18–39 years) or middle-aged adults (40–64 years). We found that the proportion of OA with PTB increased from 15% in 2008 to 24% in 2020 (trend p < 0.05). Diabetes was highly prevalent in OA (32%) but not associated with adverse outcomes. Death was 13-fold higher in OA compared to YA and was 7% at the time of diagnosis which suggests diagnostic delays. However, once TB was suspected, we found no differences in culture, smear, or nucleic acid detection of mycobacteria (although less lung cavitations) in OA. During treatment, OA had less drug-resistant TB, few adverse reactions and adhered with TB treatment. We recommend training healthcare workers to ‘think TB’ in OA, for prompt treatment initiation to diminish deaths. Furthermore, OA should be added as a priority group to the latent TB treatment guidelines by the World Health Organization, to prevent TB disease in this highly vulnerable group.

Tuberculosis (TB) remains a global leading cause of death, necessitating an investigation into its unequal distribution. Sun exposure, linked to vitamin D (VD) synthesis, has been proposed as a protective factor. This study aimed to analyse TB rates in Spain over time and space and explore their relationship with sunlight exposure. An ecological study examined the associations between rainfall, sunshine hours, and TB incidence in Spain. Data from the National Epidemiological Surveillance Network (RENAVE in Spanish) and the Spanish Meteorological Agency (AEMET in Spanish) from 2012 to 2020 were utilized. Correlation and spatial regression analyses were conducted. Between 2012 and 2020, 43,419 non-imported TB cases were reported. A geographic pattern (north–south) and distinct seasonality (spring peaks and autumn troughs) were observed. Sunshine hours and rainfall displayed a strong negative correlation. Spatial regression and seasonal models identified a negative correlation between TB incidence and sunshine hours, with a four-month lag. A clear spatiotemporal association between TB incidence and sunshine hours emerged in Spain from 2012 to 2020. VD levels likely mediate this relationship, being influenced by sunlight exposure and TB development. Further research is warranted to elucidate the causal pathway and inform public health strategies for improved TB control.

Tuberculosis (TB) contact tracing and TB preventive treatment are key tools in preventing the transmission of TB with the aim of eliminating the disease. Our study seeks to demonstrate how the infection spread from an individual patient to the entire community and how proactive contact tracing facilitated prompt diagnosis and treatment. Our work was conducted as a retrospective analysis of the spread of TB infection within the Roma community in the Czech Republic, following the case of an index patient who succumbed to pulmonary TB. Several levels of care and preventive and treatment measures are outlined. Confirming the identity of the Mycobacterium tuberculosis strain was achieved using molecular methods. Among the 39 individuals examined, TB disease was detected in eight patients and TB infection was detected in six patients. The investigation of contacts within this group yielded positive results in 36% of cases, necessitating treatment. The study’s findings provide evidence that actively tracing individuals at risk can lead to early detection of cases, prompt treatment, and prevention of further disease transmission. The study also indicates that the highest risk of infection occurs within the sick person’s household and that young children under the age of 5 are most susceptible to falling ill.

The yield of contact investigation on relapsed tuberculosis (TB) cases can guide strategies and resource allocation in the TB control programme. We conducted a retrospective cohort study to review the yield of contact investigation in relapsed TB cases and identify factors associated with TB infection (TBI) among close contacts of relapsed TB cases notified between 2018 and 2022 in Singapore. TB infection positivity was higher among contacts of relapsed cases which were culture-positive for Mycobacterium tuberculosis complex compared to those who were only polymerase chain reaction (PCR)-positive (14.8% vs. 12.3%). On multivariate analysis, after adjusting for age and gender of the index, gender, and existing comorbidities of contacts, factors independently associated with TBI were culture and smear positivity of the index (AOR 1.41, 95%CI 1.02–1.94), higher odds with every 10 years of increase in age compared to contacts below aged 30, contacts who were not Singapore residents (AOR 2.09, 95%CI 1.46–2.97), and household contacts (AOR 2.19, 95%CI 1.44–3.34). Although the yield of screening was higher for those who were culture-positive compared to only PCR-positive relapsed cases, contact tracing for only PCR-positive cases may still be important in a country with moderate TB incidence, should resources allow.

El estudio de la Misión Salesiana (siglos diecinueve y veinte) contribuye al conocimiento del impacto que las misiones religiosas tuvieron en América. Los registros históricos sugieren un cambio en la dieta, hacinamiento y alta frecuencia de enfermedades pulmonares infecciosas, como la tuberculosis. Muchos problemas de salud surgen de desequilibrios dietarios. La insuficiencia nutricional crónica hace que los individuos sean más susceptibles a las enfermedades infecciosas, y esto a su vez reduce la disponibilidad de nutrientes para la persona, creando una retroalimentación positiva. El objetivo de este trabajo es explorar el impacto que tuvo el contacto continuo en Patagonia Austral —específicamente en el caso de la Misión Salesiana— sobre la población originaria, a partir del análisis de marcadores metabólico-nutricionales e infecciosos y teniendo en cuenta el estado nutricional y estilo de vida de los individuos que allí habitaron. Para evaluar el cambio se compararon los resultados de los individuos de la misión con información previamente publicada y nuevas revelaciones de individuos del norte de la Isla Grande de Tierra del Fuego. Por un lado, se observó una elevada prevalencia de signos patológicos tales como hiperostosis porótica, cribra orbitalia, hipoplasia del esmalte y caries; por otro, fuentes documentales y estudios de isótopos estables indican un cambio en la dieta que conlleva una reducción en la variedad de alimentos. Los cambios producidos en el estilo de vida y la alta frecuencia de enfermedades infecciosas pudieron actuar sinérgicamente, influyendo en la drástica reducción del número de personas que habitaba dentro de la misión.

Mental disorders are common among persons with tuberculosis (TB), and the COVID-19 pandemic has only amplified the mental and physical health consequences of this deadly synergy. Here, we call to attention the immense vulnerability of people with TB to mental disorders during the pandemic and highlight the unique challenges and opportunities that the pandemic brings to the future integration of global TB and mental healthcare. We argue that the pandemic era is an ideal period to accelerate this integration and we provide research and policy recommendations to actualise this urgent need.

In New Zealand there is a long history of research studies working with wild free-living brushtail possums (Trichosurus vulpecula) where euthanasia of large numbers of animals is frequently required. The most commonly used method for euthanising trapped possums is by blunt-force trauma. If possums being euthanised are potentially infected with bovine tuberculosis (TB), however, the blunt-force trauma method is associated with risks of researcher exposure to TB infection (eg risk of being scratched, bitten or blood-splattered). Here, we trial the use of a close-range shot to the head with a high-velocity air rifle as an alternative method for the euthanasia of cage-trapped possums. Our trial revealed that the air rifle method reduced the potential disease exposure risks to researchers by minimising blood-spatter area, and by completely avoiding the likelihood of both accidents due to animal handling and animal escapes. While both methods induced immediate unconsciousness leading to death, the air rifle method was quicker (ie shorter conscious handling and total time) and arguably had better animal welfare performance by significantly reducing the time to unconsciousness. Thus, we conclude that the air rifle method is suitably humane for possum euthanasia and should be considered when dealing with potentially TB-infected cage-trapped possums.