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1.
Front Public Health ; 10: 837211, 2022.
Article in English | MEDLINE | ID: covidwho-1785445

ABSTRACT

Since 2012, the World Health Organization has recommended household contact investigation as an evidence-based intervention to find and treat individuals with active tuberculosis (TB), the most common infectious cause of death worldwide after COVID-19. Unfortunately, uptake of this recommendation has been suboptimal in low- and middle-income countries, where the majority of affected individuals reside, and little is known about how to effectively deliver this service. Therefore, we undertook a systematic process to design a novel, theory-informed implementation strategy to promote uptake of contact investigation in Uganda, using the COM-B (Capability-Opportunity-Motivation-Behavior) model and the Behavior Change Wheel (BCW) framework. We systematically engaged national, clinic-, and community-based stakeholders and collectively re-examined the results of our own formative, parallel mixed-methods studies. We identified three core behaviors within contact investigation that we wished to change, and multiple antecedents (i.e., barriers and facilitators) of those behaviors. The BCW framework helped identify multiple intervention functions targeted to these antecedents, as well as several policies that could potentially enhance the effectiveness of those interventions. Finally, we identified multiple behavior change techniques and policies that we incorporated into a multi-component implementation strategy, which we compared to usual care in a household cluster-randomized trial. We introduced some components in both arms, including those designed to facilitate initial uptake of contact investigation, with improvement relative to historical controls. Other components that we introduced to facilitate completion of TB evaluation-home-based TB-HIV evaluation and follow-up text messaging-returned negative results due to implementation failures. In summary, the Behavior Change Wheel framework provided a feasible and transparent approach to designing a theory-informed implementation strategy. Future studies should explore the use of experimental methods such as micro-randomized trials to identify the most active components of implementation strategies, as well as more creative and entrepreneurial methods such as human-centered design to better adapt the forms and fit of implementation strategies to end users.


Subject(s)
COVID-19 , Tuberculosis , Contact Tracing , Family Characteristics , Humans , Tuberculosis/prevention & control , Uganda
2.
Front Public Health ; 9: 736632, 2021.
Article in English | MEDLINE | ID: covidwho-1775881

ABSTRACT

To evaluate China's current rifampin-resistant tuberculosis (RR-TB) screening strategy from stakeholders' perspectives, the perceptions, attitudes, and interests of 245 stakeholders from three eastern, central, and western China provinces on RR-TB screening strategies, were investigated through stakeholder survey and interview. The attitudes toward three RR-TB screening strategies were statistically different: inclination to choose who to screen (Z = 98.477; P < 0.001), funding for rapid diagnostic technology screening either by reimbursed health insurance or directly subsidized financial assistance (Z = 4.142, P < 0.001), and respondents' attitude during RR-TB screening implementation levels (Z = 2.380, P = 0.017). In conclusion, RR-TB screening scope could be expanded by applying rapid diagnostic technologies. Provinces with different economic status could adjust their screening policies accordingly.


Subject(s)
Tuberculosis, Multidrug-Resistant , Tuberculosis , Humans , Mass Screening , Rifampin/therapeutic use , Tuberculosis/diagnosis , Tuberculosis/prevention & control , Tuberculosis, Multidrug-Resistant/diagnosis
5.
6.
Hum Vaccin Immunother ; 17(12): 5284-5295, 2021 12 02.
Article in English | MEDLINE | ID: covidwho-1746993

ABSTRACT

Bacillus Calmette-Guérin (BCG) is the only licensed vaccine against tuberculosis (TB). However, BCG has variable efficacy and cannot completely prevent TB infection and transmission. Therefore, the worldwide prevalence of TB calls for urgent development of a more effective TB vaccine. In the absence of other approved vaccines, it is also necessary to improve the efficacy of BCG itself. Intravenous (IV) BCG administration and BCG revaccination strategies have recently shown promising results for clinical usage. Therefore, it is necessary for us to revisit the BCG vaccination strategies and summarize the current research updates related to BCG vaccination. This literature review provides an updated overview and perspectives of the immunization strategies against TB using BCG, which may inspire the following research on TB vaccine development.


Subject(s)
Mycobacterium bovis , Mycobacterium tuberculosis , Tuberculosis Vaccines , Tuberculosis , BCG Vaccine , Humans , Immunization, Secondary , Tuberculosis/epidemiology , Tuberculosis/prevention & control , Vaccination
7.
Curr HIV/AIDS Rep ; 19(1): 46-53, 2022 02.
Article in English | MEDLINE | ID: covidwho-1748428

ABSTRACT

PURPOSE OF REVIEW: To describe how mitigation measures against COVID-19 have impacted HIV and TB research in South Africa. RECENT FINDINGS: South Africa has the highest number of COVID-19 (34%) cases in Africa, accounting for 43% of all reported COVID-19-related deaths on the continent. The country accounts for 20% of all people living with HIV and ranked third in the world for new TB infections in 2019. While South Africa's investments in its HIV and TB responses enabled it to pivot rapidly to respond to the emerging COVID-19 epidemic, it negatively impacted the HIV and TB response through temporary suspension of research, diversion of key resources for HIV and TB control, and patient access to health care facilities; the full extent of this has yet to emerge. Success in integrating responses to the colliding epidemics could potentially enhance survival outcomes and ensure gains made to date in HIV and TB are not reversed and we stay on track toward achieving the UN 2030 Sustainable Development Goals.


Subject(s)
COVID-19 , HIV Infections , Tuberculosis , COVID-19/epidemiology , HIV Infections/epidemiology , Humans , SARS-CoV-2 , South Africa/epidemiology , Tuberculosis/epidemiology , Tuberculosis/prevention & control
9.
Indian J Tuberc ; 68S: S86-S88, 2021.
Article in English | MEDLINE | ID: covidwho-1720099

ABSTRACT

Smoking, TB and Covid-19 are high prevalence entities with public health consequences. All three of them have a possible complex interaction at cellular level. Smoking behavior makes it difficult to maintain infection control measures. Smoking is known to increase TB infection and also adversely affect treatment outcomes in TB. There is also upcoming evidence which suggests that smoking and TB increase the risk of severe Covid-19 symptoms. Simple infection control measures like, social distancing, cough etiquette, isolation, hand hygiene, quarantine, use of masks etc. play a pivotal role in prevention of these diseases. There is need of strengthening of the public health policies and incorporation of the Covid-19 safety awareness measures into the various national programmes.


Subject(s)
COVID-19/complications , Pneumonia, Viral/complications , Smoking/adverse effects , Tuberculosis/complications , COVID-19/prevention & control , Humans , Pneumonia, Viral/prevention & control , Pneumonia, Viral/virology , Risk Factors , SARS-CoV-2 , Tuberculosis/prevention & control
12.
Lancet Glob Health ; 9(10): e1372-e1379, 2021 10.
Article in English | MEDLINE | ID: covidwho-1701046

ABSTRACT

BACKGROUND: The tuberculosis targets for the UN Sustainable Development Goals (SDGs) call for a 90% reduction in tuberculosis deaths by 2030, compared with 2015, but meeting this target now seems highly improbable. To assess the economic impact of not meeting the target until 2045, we estimated full-income losses in 120 countries, including those due to excess deaths resulting from COVID-19-related disruptions to tuberculosis services, for the period 2020-50. METHODS: Annual mortality risk changes at each age in each year from 2020 to 2050 were estimated for 120 countries. This risk change was then converted to full-income risk by calculating a population-level mortality risk change and multiplying it by the value of a statistical life-year in each country and year. As a comparator, we assumed that current rates of tuberculosis continue to decline through the period of analysis. We calculated the full-income losses, and mean life expectancy losses per person, at birth and at age 35 years, under scenarios in which the SDG targets are met in 2030 and in 2045. We defined the cost of inaction as the difference in full-income losses and tuberculosis mortality between these two scenarios. FINDINGS: From 2020 to 2050, based on the current annual decrease in tuberculosis deaths of 2%, 31·8 million tuberculosis deaths (95% uncertainty interval 25·2 million-39·5 million) are estimated to occur, corresponding to an economic loss of US$17·5 trillion (14·9 trillion-20·4 trillion). If the SDG tuberculosis mortality target is met in 2030, 23·8 million tuberculosis deaths (18·9 million-29·5 million) and $13·1 trillion (11·2 trillion-15·3 trillion) in economic losses can be avoided. If the target is met in 2045, 18·1 million tuberculosis deaths (14·3 million-22·4 million) and $10·2 trillion (8·7 trillion-11·8 trillion) can be avoided. The cost of inaction of not meeting the SDG tuberculosis mortality target until 2045 (vs 2030) is, therefore, 5·7 million tuberculosis deaths (5·1 million-8·1 million) and $3·0 trillion (2·5 trillion-3·5 trillion) in economic losses. COVID-19-related disruptions add $290·3 billion (260·2 billion-570·1 billion) to this cost. INTERPRETATION: Failure to achieve the SDG tuberculosis mortality target by 2030 will lead to profound economic and health losses. The effects of delay will be greatest in sub-Saharan Africa. Affected countries, donor nations, and the private sector should redouble efforts to finance tuberculosis programmes and research because the economic dividend of such strategies is likely to be substantial. FUNDING: None.


Subject(s)
Life Expectancy , Tuberculosis/economics , Tuberculosis/mortality , COVID-19 , Global Burden of Disease/economics , HIV Infections/complications , Humans , Sustainable Development , Tuberculosis/prevention & control
13.
JCI Insight ; 7(3)2022 02 08.
Article in English | MEDLINE | ID: covidwho-1705325

ABSTRACT

BackgroundAdenovirus-vectored (Ad-vectored) vaccines are typically administered via i.m. injection to humans and are incapable of inducing respiratory mucosal immunity. However, aerosol delivery of Ad-vectored vaccines remains poorly characterized, and its ability to induce mucosal immunity in humans is unknown. This phase Ib trial evaluated the safety and immunogenicity of human serotype-5 Ad-vectored tuberculosis (TB) vaccine (AdHu5Ag85A) delivered to humans via inhaled aerosol or i.m. injection.MethodsThirty-one healthy, previously BCG-vaccinated adults were enrolled. AdHu5Ag85A was administered by single-dose aerosol using Aeroneb Solo Nebulizer or by i.m. injection. The study consisted of the low-dose (LD) aerosol, high-dose (HD) aerosol, and i.m. groups. The adverse events were assessed at various times after vaccination. Immunogenicity data were collected from the peripheral blood and bronchoalveolar lavage samples at baseline, as well as at select time points after vaccination.ResultsThe nebulized aerosol droplets were < 5.39 µm in size. Both LD and HD of AdHu5Ag85A administered by aerosol inhalation and i.m. injection were safe and well tolerated. Both aerosol doses, particularly LD, but not i.m., vaccination markedly induced airway tissue-resident memory CD4+ and CD8+ T cells of polyfunctionality. While as expected, i.m. vaccination induced Ag85A-specific T cell responses in the blood, the LD aerosol vaccination also elicited such T cells in the blood. Furthermore, the LD aerosol vaccination induced persisting transcriptional changes in alveolar macrophages.ConclusionInhaled aerosol delivery of Ad-vectored vaccine is a safe and superior way to elicit respiratory mucosal immunity. This study warrants further development of aerosol vaccine strategies against respiratory pathogens, including TB and COVID-19.Trial registrationClinicalTrial.gov, NCT02337270.FundingThe Canadian Institutes for Health Research (CIHR) and the Natural Sciences and Engineering Research Council of Canada funded this work.


Subject(s)
Aerosols/pharmacology , COVID-19/prevention & control , SARS-CoV-2/drug effects , Tuberculosis Vaccines/immunology , Tuberculosis/prevention & control , Administration, Inhalation , Adolescent , Adult , Aerosols/administration & dosage , Antibodies, Neutralizing/blood , BCG Vaccine/immunology , COVID-19/immunology , Female , Humans , Immunity, Mucosal/drug effects , Immunity, Mucosal/immunology , Male , Middle Aged , Mycobacterium tuberculosis/immunology , SARS-CoV-2/immunology , SARS-CoV-2/pathogenicity , Tuberculosis/immunology , Vaccination/methods , Young Adult
14.
Acta Paul. Enferm. (Online) ; 34: eAPE002115, 2021. tab, graf
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-1687918

ABSTRACT

Resumo Objetivo Identificar as evidências científicas sobre o impacto da pandemia de COVID-19 na atenção e no controle da tuberculose. Métodos Revisão de escopo realizada em junho de 2020 nas seguintes bases de dados: Cochrane Library, Embase, LILACS, MEDLINE, PubMed, Web of Science, Cinahl e Scopus; e literatura cinzenta-Opengrey. Os descritores utilizados na busca foram: coronavirus, COVID-19, SARS-CoV-2 e tuberculosis. O processo de seleção foi feito por dois revisores independentes por meio da plataforma Rayyan, com a inclusão de 30 estudos. Resultados A pandemia da COVID-19 teve impacto no controle da tuberculose e os principais desafios decorrentes relacionam-se à influência do distanciamento social no diagnóstico, seguimento e adesão ao tratamento, incluindo a reorganização dos serviços de tuberculose, principalmente como resultado do necessário deslocamento de equipes de saúde que atuavam na área para a atenção à COVID-19, registrando-se também limitação de acesso a insumos e a serviços de saúde, o que de igual modo ocorreu em relação a outros agravos de saúde, evidenciando-se vulnerabilidade programática. Destacam-se, ainda, os efeitos da pandemia na dimensão social, o que contribuiu para o aumento da vulnerabilidade social. Conclusão Muitos são os desafios impostos pela pandemia na COVID-19, particularmente no que diz respeito à manutenção das ações de controle da tuberculose. Espera-se que esta revisão contribua para embasar novos estudos e para a implementação de políticas públicas orientadas ao enfrentamento de ambas as enfermidades.


Resumen Objetivo Identificar las evidencias científicas sobre el impacto de la pandemia de COVID-19 en la atención y el control de la TB. Métodos Revisión de alcance realizada en junio de 2020 en las siguientes bases de datos: Cochrane Library, Embase, LILACS, MEDLINE, PubMed, Web of Science, Cinahl y Scopus, y literatura gris-Opengrey. Los descriptores utilizados en la búsqueda fueron: coronavirus, COVID-19, SARS-CoV-2 y tuberculosis. El proceso de selección fue realizado por dos revisores independientes a través de la plataforma Ryyan, con la inclusión de 30 estudios. Resultados La pandemia de COVID-19 tuvo impacto en el control de la tuberculosis y los principales desafíos derivados están relacionados con la influencia del distanciamiento social en el diagnóstico, seguimiento y adherencia al tratamiento, lo que incluye la reorganización de los servicios de TB, principalmente como resultado del necesario traslado de los equipos de salud que actuaban en el área hacia la atención a la COVID-19. También se registraron limitaciones de acceso a insumos y servicios de salud, lo que ocurrió de igual modo con relación a otros problemas de salud y dejó en evidencia la vulnerabilidad programática. Además, se observan efectos de la pandemia en la dimensión social, lo que contribuye al aumento de la vulnerabilidad social. Conclusión Muchos son los desafíos impuestos por la pandemia de COVID-19, particularmente en lo que se refiere a mantener las acciones de control de la tuberculosis. Se espera que esta revisión contribuya para fundamentar nuevos estudios y para la implementación de políticas públicas orientadas al afrontamiento de ambas enfermedades.


Abstract Objective To identify scientific evidence on the impact of the COVID-19 pandemic on tuberculosis care and control. Methods Scoping review conducted in June 2020 in the following databases: Cochrane Library, Embase, LILACS, MEDLINE, PubMed, Web of Science, Cinahl and Scopus; and Opengrey - grey literature. The descriptors used in the search were: coronavirus, COVID-19, SARS-CoV-2 and tuberculosis. The selection process was performed by two independent reviewers using the Rayyan platform with the inclusion of 30 studies. Results The COVID-19 pandemic had an impact on tuberculosis control and the main challenges arising from it are related to the influence of social distancing on diagnosis, follow-up and adherence to treatment, including the reorganization of tuberculosis services, mainly as a result of the necessary mobilization of health teams working in the area for the care of COVID-19. Limited access to inputs and health services was also registered, which occurred similarly in relation to other health problems, thereby showing programmatic vulnerability. The effects of the pandemic in the social dimension that contributed to increase the social vulnerability also stand out. Conclusion Many challenges have been posed by the COVID-19 pandemic, particularly with regard to maintaining tuberculosis control actions. We expect this review will contribute to support new studies and implement public policies aimed at confronting both diseases.


Subject(s)
Tuberculosis/diagnosis , Tuberculosis/prevention & control , Coronavirus , Social Vulnerability , Pandemics , COVID-19/diagnosis , Delivery of Health Care
15.
BMJ Glob Health ; 7(1)2022 01.
Article in English | MEDLINE | ID: covidwho-1627549

ABSTRACT

The BCG vaccine is a widely given vaccine against tuberculosis (TB), yet studies on effectiveness have shown considerable heterogeneity; as a result, BCG vaccine policies vary greatly across the globe and change across geography, and with time and disease burden. The recently updated third BCG World Atlas (www.bcgatlas.org) is a publicly available online database with information on BCG practices across 194 countries. This helpful resource has been used for over 10 years to support clinicians, TB researchers and TB vaccine development worldwide. Here, we summarise main findings from the third BCG Atlas' most recent update which included additional data collected around BCG strain type, vaccine stockouts and associated changes. Longitudinal analysis enables evaluation of changes in TB incidence over time, a method becoming more common in legislation interventions. A large number of countries in the BCG Atlas (156/194 countries) maintain universal neonatal BCG vaccination, of which 51 are considered low TB burden countries. We demonstrate the majority of countries who changed their national policy moved to targeted vaccination for high-risk groups, were in Europe and also had significant decreases in TB incidence both before and after policy change. Globally, the most common BCG strain continues to be the Danish strain, despite its worldwide manufacturing interruption in 2015. Substantial variation and disproportionality exists in which regions were most affected by stockouts between 2009 and 2019. Tracking and understanding the reasoning behind changes to national BCG practices and their impact on TB burden is critical for decision makers as they contemplate how to include BCG vaccination in future immunisation guidelines in low and high TB burden countries.


Subject(s)
BCG Vaccine , Tuberculosis , Humans , Immunization , Infant, Newborn , Policy , Tuberculosis/epidemiology , Tuberculosis/prevention & control , Vaccination
17.
Int J Infect Dis ; 113 Suppl 1: S68-S72, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1574772

ABSTRACT

Despite slow reductions in the annual burden of active human tuberculosis (TB) cases, zoonotic TB (zTB) remains a poorly monitored and an important unaddressed global problem. There is a higher incidence in some regions and countries, especially where close association exists between growing numbers of cattle (the major source of Mycobacterium bovis) and people, many suffering from poverty, and where dairy products are consumed unpasteurised. More attention needs to be focused on possible increased zTB incidence resulting from growth in dairy production globally and increased demand in low income countries in particular. Evidence of new zoonotic mycobacterial strains in South Asia and Africa (e.g. M. orygis), warrants urgent assessment of prevalence, potential drivers and risk in order to develop appropriate interventions. Control of M. bovis infection in cattle through detect and cull policies remain the mainstay of reducing zTB risk, whilst in certain circumstances animal vaccination is proving beneficial. New point of care diagnostics will help to detect animal infections and human cases. Given the high burden of human tuberculosis (caused by M. tuberculosis) in endemic areas, animals are affected by reverse zoonosis, including multi-drug resistant strains. This, may create drug resistant reservoirs of infection in animals. Like COVID-19, zTB is evolving in an ever-changing global landscape.


Subject(s)
COVID-19 , Tuberculosis , Africa , Animals , Cattle , Humans , Policy , SARS-CoV-2 , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Tuberculosis/prevention & control
18.
Lancet Infect Dis ; 21(11): 1590-1597, 2021 11.
Article in English | MEDLINE | ID: covidwho-1561435

ABSTRACT

BACKGROUND: Trials of BCG vaccination to prevent or reduce severity of COVID-19 are taking place in adults, some of whom have been previously vaccinated, but evidence of the beneficial, non-specific effects of BCG come largely from data on mortality in infants and young children, and from in-vitro and animal studies, after a first BCG vaccination. We assess all-cause mortality following a large BCG revaccination trial in Malawi. METHODS: The Karonga Prevention trial was a population-based, double-blind, randomised controlled in Karonga District, northern Malawi, that enrolled participants between January, 1986, and November, 1989. The trial compared BCG (Glaxo-strain) revaccination versus placebo to prevent tuberculosis and leprosy. 46 889 individuals aged 3 months to 75 years were randomly assigned to receive BCG revaccination (n=23 528) or placebo (n=23 361). Here we report mortality since vaccination as recorded during active follow-up in northern areas of the district in 1991-94, and in a demographic surveillance follow-up in the southern area in 2002-18. 7389 individuals who received BCG (n=3746) or placebo (n=3643) lived in the northern follow-up areas, and 5616 individuals who received BCG (n=2798) or placebo (n=2818) lived in the southern area. Year of death or leaving the area were recorded for those not found. We used survival analysis to estimate all-cause mortality. FINDINGS: Follow-up information was available for 3709 (99·0%) BCG recipients and 3612 (99·1%) placebo recipients in the northern areas, and 2449 (87·5%) BCG recipients and 2413 (85·6%) placebo recipients in the southern area. There was no difference in mortality between the BCG and placebo groups in either area, overall or by age group or sex. In the northern area, there were 129 deaths per 19 694 person-years at risk in the BCG group (6·6 deaths per 1000 person-years at risk [95% CI 5·5-7·8]) versus 133 deaths per 19 111 person-years at risk in the placebo group (7·0 deaths per 1000 person-years at risk [95% CI 5·9-8·2]; HR 0·94 [95% CI 0·74-1·20]; p=0·62). In the southern area, there were 241 deaths per 38 399 person-years at risk in the BCG group (6·3 deaths per 1000 person-years at risk [95% CI 5·5-7·1]) versus 230 deaths per 38 676 person-years at risk in the placebo group (5·9 deaths per 1000 person-years at risk [95% CI 5·2-6·8]; HR 1·06 [95% CI 0·88-1·27]; p=0·54). INTERPRETATION: We found little evidence of any beneficial effect of BCG revaccination on all-cause mortality. The high proportion of deaths attributable to non-infectious causes beyond infancy, and the long time interval since BCG for most deaths, might obscure any benefits. FUNDING: British Leprosy Relief Association (LEPRA); Wellcome Trust.


Subject(s)
BCG Vaccine/administration & dosage , Immunization, Secondary/statistics & numerical data , Mortality , Vaccination/methods , Adolescent , Adult , Aged , BCG Vaccine/immunology , COVID-19/epidemiology , COVID-19/immunology , COVID-19/prevention & control , Child , Child, Preschool , Double-Blind Method , Female , Follow-Up Studies , Humans , Immunogenicity, Vaccine , Leprosy/immunology , Leprosy/mortality , Leprosy/prevention & control , Malawi/epidemiology , Male , Middle Aged , Mycobacterium leprae/immunology , SARS-CoV-2/immunology , Treatment Outcome , Tuberculosis/immunology , Tuberculosis/mortality , Tuberculosis/prevention & control , Vaccination/statistics & numerical data , Young Adult
19.
Vaccine ; 39(50): 7321-7331, 2021 12 08.
Article in English | MEDLINE | ID: covidwho-1550111

ABSTRACT

Bacillus Calmette-Guérin (BCG) vaccine is an attenuated live strain of Mycobacterium bovis. It may be the most widely used vaccine in human history and is the only licensed human tuberculosis (TB) vaccine available. Despite its excellent safety history, a century of use in global vaccination programs, and its significant contribution to reducing TB mortality among children, the efficacy of BCG continues to be disputed due to its incomplete protection against pulmonary TB in adults. Still vaccines offer the best chance to contain the ongoing spread of multi-drug resistance TB and disease dissemination. The development of improved vaccines against TB therefore remains a high global priority. Interestingly, recent studies indicate that genetically modified BCG, or administration of existing BCG through alternate routes, or revaccination, offers improved protection, suggesting that BCG is well poised to make a comeback. Intravesical BCG is also the only approved microbial immunotherapy for any form of cancer, and is the first-line therapy for treatment-naïve non-muscle invasive bladder cancer (NMBIC), which represents a majority of the new bladder cancer cases diagnosed. However, almost a third of patients with NMIBC are either BCG unresponsive or have tumor recurrence, leading to a higher risk of disease progression. With very few advances in intravesical therapy over the past two decades for early-stage disease, and a limited pipeline of therapeutics in Phase 3 or late Phase 2 development, there is a major unmet need for improved intravesical therapies for NMIBC. Indeed, genetically modified candidate BCG vaccines engineered to express molecules that confer stronger protection against pulmonary TB or induce potent anti-tumor immunity in NMIBC have shown promise in both pre-clinical and clinical settings. This review discusses the development of second generation, genetically modified BCG candidates as TB vaccines and as anti-tumor adjuvant therapy for NMIBC.


Subject(s)
Tuberculosis Vaccines , Tuberculosis , Urinary Bladder Neoplasms , BCG Vaccine , Humans , Neoplasm Recurrence, Local , Tuberculosis/prevention & control , Urinary Bladder Neoplasms/therapy
20.
Int J Health Plann Manage ; 37(2): 632-642, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1530151

ABSTRACT

Tuberculosis (TB) is the leading cause of death from a single infectious agent worldwide. The COVID-19 pandemic has overburdened healthcare services around the world especially in resource constrained settings. It has shaken already unstable foundation of TB control programs in India and other high burden states. A 25% decline is expected in TB detection while estimates suggest 13% increase in TB deaths due to the impact of the pandemic. However, the significant intersections between the two diseases perhaps offer potential opportunities for consolidating the efforts to tackle both. The widespread implementation and acceptance of universal masking and social distancing in India has helped limit transmission of both diseases. Integrating the capacity building strategies for the two diseases, optimizing the existing the surveillance and monitoring systems which have been achieved over the years will result in a single vertically integrated national program addressing both, rather than multiple parallel program which utilize the already sparse primary care manpower and infrastructure. In this article, we explore the impact of the COVID-19 pandemic on tuberculosis in India and offer suggestions on how effective health planning can efficiently integrate infrastructure and manpower at primary level to provide care for both COVID-19 and tuberculosis.


Subject(s)
COVID-19 , Tuberculosis , Health Planning , Humans , India/epidemiology , Pandemics/prevention & control , Primary Health Care , SARS-CoV-2 , Tuberculosis/epidemiology , Tuberculosis/prevention & control
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