Experience of a technical assistance project on strengthening a local national tuberculosis programme, Lusaka, Zambia: 2012-2015 / 国際保健医療

Objectives  The authors conducted a technical assistance project on tuberculosis (TB) control in Bauleni, Chelston, and Chilenje, Lusaka, Zambia in 2012-2015. Herein we describe the project activities and achievements. Methods  We trained community health volunteers (CHVs) and organized their activities. We evaluated the project considering the trends of TB cases, particularly the percent of bacteriologically confirmed TB cases among the presumptive (suspected) TB cases, and treatment outcomes.Results  We organized training for the CHVs of three areas. The CHVs conducted a total of 160 community sensitizations attended by over 50 000 community members. They visited their assigned patients 23 716 times. At Bauleni, the number of bacteriologically positive (bac+) cases exhibited a decreasing trend (r = −0.55, p=0.03), whereas that of the presumptive TB cases exhibited an increasing trend (r = 0.70, p = 0.004). At Chelston, both the numbers of bac+ cases and the presumptive TB cases exhibited increasing trends (r = 0.52, p = 0.046 and r = 0.68, p = 0.005, respectively). At Chilenje, the number of bac+ TB cases exhibited a decreasing trend (r = −0.84, p < 0.001), whereas that of the presumptive TB cases did not change (r = 0.09, p = 0.76). In all three areas, the proportions of the bac+ cases among the presumptive TB cases exhibited decreasing trends (p < 0.0001 at all three clinics). The treatment success rates improved in Chelston and Chilenje from 50.7% and 61.9%, respectively, in early 2011 to 78.3% and 97.0%, respectively, in late 2014 (both p < 0.001). The treatment success rates of Bauleni maintained at over 85% in most quarters. Conclusion  The activities of the project contributed to the strengthened local national TB programme, resulting in the decreased burden of TB in the areas.

Which community volunteers participate most frequently in support programs for TB patients? Case report from Lusaka, Zambia, 2015 / 国際保健医療

Objectives  The Japan International Cooperation Agency, Japan Anti-Tuberculosis Association and the Lusaka district health office conducted Community Mobilization for TB/HIV Care Project at three health centres in Lusaka, Zambia from 2012 to 2015. This study describes the assessment of the factors associated with high participation rates of tuberculosis (TB) treatment supporters (TSs) in patient support activities. Methods  A cross-sectional study was conducted for the evaluation. Information about individual participation to the weekly patient support activities at the health centres between September 2014 and February 2015 was drawn from the health centres’ administrative records. Data were collected between February and March 2015 via a structured questionnaire administered to TSs working at the health centres. Descriptive, univariate and multiple logistic regression analyses were done to identify factors associated with high participation of TSs. Results  For the 74 respondents, the average monthly participation rate between September 2014 and February 2015 was 83.2%. The rate was tended to be over 80% for the TSs who had temporary work or no work, or were housewives, and those who had experience as a group leader. The TSs who did not complete primary education were positively associated with participating over 80% of the time compared to those who had a secondary or higher education. Conclusion  The study provided information on the higher participation of TSs’ activities including their job, education status and leadership experiences. In recruiting TSs, priority should be given to those who have a temporary job or no work, or are housewives. Those who have lower education levels should not be excluded from the selection because they participated more often. Selecting an individual as a leader may facilitate the commitment of the person to the activities. These can be used in selection criteria of TSs in the similar setting.

An enterohaemorrhagic Escherichia coli outbreak spread through the environment at an institute for people with intellectual disabilities in Japan in 2005

Objective@#An enterohaemorrhagic Escherichia coli (EHEC) outbreak at an institute with multiple facilities for children and adults with intellectual disabilities was investigated to characterize the cases and identify risk factors for infection.@*Methods@#A case was defined as a resident, a staff member or a visitor at the institute from 16 May through 30 June 2005 testing positive for type 2 Vero toxin-producing EHEC O157:H7 (confirmed case) or exhibiting bloody diarrhoea for two or more days (probable case). We collected and analysed demographic, clinical, laboratory and individual behaviour data to identify possible risk factors for infection and infection routes.@*Results@#We recorded 58 confirmed cases, of which 13 were symptomatic. One probable case was also found. The median age of the patients was 37 years (range: 6–59 years). Thirty-six patients (61%) were male. Thirteen patients (93%) had diarrhoea and six (43%) had abdominal pain. Two developed haemolytic-uraemic syndrome but recovered. All the patients were treated with antibiotics and tested negative after treatment. Some residents had problems with personal hygiene. The residents of one of the facilities who cleaned a particular restroom had 18.0 times higher odds of being infected with EHEC (95% confidence interval: 4.0–102.4) than those who did not.@*Discussion@#The source of the outbreak could not be identified; however, the infection may have spread through environmental sources contaminated with EHEC. We recommend that institutional settings, particularly those that accommodate people with intellectual disabilities, clean restrooms as often as possible to reduce possible infection from contact with infected surfaces.

A tuberculosis contact investigation involving a large number of contacts tested with interferon-gamma release assay at a nursing school: Kanagawa, Japan, 2012

@#In May 2012, a teacher of a nursing school with about 300 staff members and students in Japan was diagnosed with sputum smear-positive pulmonary tuberculosis (TB), leading to an investigation involving nearly 300 contacts. We describe the contacts’ closeness to the index TB patient and the likelihood of TB infection and disease. A case of TB was defined as an individual with positive bacteriological tests or by a physician diagnosis of TB. A latent TB infection (LTBI) case was defined as an individual who had a positive interferon-gamma release assay (IGRA). A total of 283 persons screened with IGRA were analysed. Eight persons (2.8%, 95% confidence interval [CI]: 1.2–5.4) tested positive by IGRA; one student who had intermediate (less than 10 hours) contact with the index patient was found to have pulmonary TB by chest X-ray. The positivity in IGRA among staff members with very close contact with the index patient (4 of 21, 19%, 95% CI: 5.4–42%) with a statistically significant relative risk of 17 (95% CI: 2.0–140) was high compared with that of the intermediate contacts (1 of 88, 1.1% [95% CI: 0.028–6.2]). There was a statistically significant trend in the risk of TB infection and closeness with the index patient among the staff members and students (P < 0.00022). In congregate settings such as schools, the scope of contact investigation may have to be expanded to detect a TB case among those who had brief contact with the index patient.

Strengthening the communicable disease surveillance and response system, Amhara Region, Ethiopia, 2012-2014: Review of a technical cooperation project / 国際保健医療

<p><b>Objectives</b></p><p>  The International Health Regulations (2005) bound the member states of the World Health Organization (WHO) to initiate epidemiological investigations of disease outbreaks and to notify WHO within 24 hours of their detection if the event is deemed to constitute public health emergency of international concern. The Japan International Cooperation Agency started the Amhara Regional Infectious Disease Surveillance Project to strengthen the surveillance and response system in the Amhara Region of Ethiopia in 2008. The objectives of the study were to review the project activities and to share the experiences and lessons learned in 22 districts of the North and South Gondar and West Gojjam Zones from mid-2012 through 2014.</p><p><b>Methods</b></p><p>  We conducted training for district surveillance officers and focal point personnel at health centres (HCs), monitoring visits to district health offices and HCs, held review meetings on surveillance, and provided technical assistance in outbreak investigations. We evaluated the project activities in terms of the timeliness of the surveillance reports submitted by the health facilities, provision of technical assistance in outbreak investigations, and the number of training sessions held for the surveillance personnel.</p><p><b>Results</b></p><p>  The timeliness of submission of surveillance reports had improved to almost 100% at end of 2014 compared with before the review period (about 68%). From the third quarter of 2013, we conducted monitoring visits to 59 HCs every semester. We were involved in 11 outbreak investigations of measles, anthrax, pertussis, neonatal tetanus, and typhoid fever. We held a total of 25 training sessions for district surveillance officers and HC focal points.</p><p><b>Conclusion</b></p><p>  The project successfully strengthened the surveillance and response system. We recommend that the Amhara Regional Health Bureau maintain its commitment to the system in terms of human resources and funding. Training for surveillance officers and focal points should be conducted periodically.</p>

Tuberculosis in foreign students in Japan, 2010–2014: a comparison with the notification rates in their countries of origin

This study characterizes the foreign students with tuberculosis (TB) registered in Japan from 2010 to 2014 and compares their TB notification rates with those in their countries of origin. The TB notification rates in foreign students were retrieved from the National Epidemiological Surveillance of Infectious Disease system in Japan. National TB notification data from 16 countries and areas were extracted from the World Health Organization’s and the official health websites of the countries and areas. There were 1128 foreign students in Japan who developed TB between 2010 and 2014; nearly half of the cases were from China ( = 530, 46.9%), and 688 (61.0%) were male with a median age of 23 years. The TB notification data for foreign students were highest in students from the Philippines (675/100 000 person years, 95% confidence interval: 372–977). The notification rates in foreign students from seven countries were significantly higher than the average notification rate in their countries of origin (China, Indonesia, Mongolia, Myanmar, Nepal, the Philippines and Viet Nam). The Republic of Korea and Taiwan, China had significantly lower rates in foreign students than in their countries of origin. The notification rates for foreign students in Japan may reflect a more accurate risk of developing TB among the immigrants to Japan than the TB notification rates in their countries of origin. These results may be helpful to identify the immigrants’ countries/areas of origin with the necessity of pre-entry TB screening.