European shortage of purified protein derivative and its impact on tuberculosis screening practices.

SETTING: In June 2014, we became aware that shortages of purified protein derivative (PPD), the test substance used for the tuberculin skin test (TST), had occurred in several European health care institutions providing care for children with tuberculosis (TB). OBJECTIVE: To establish the extent of the shortage, a survey was performed. DESIGN: Survey conducted over a 1-month period (June-July 2014) among members of the Paediatric Tuberculosis Network European Trials Group (ptbnet). RESULTS: Thirty-five physicians from 23 European countries contributed data. The most commonly used PPD product was RT23 (Statens Serum Institut; n = 22, 63%). Twenty-one (60%) participants reported that their institution was experiencing a PPD shortage. The majority (n = 17, 81%) of those reporting a shortage were using RT23. Thirteen (37%) participants reported changes in screening practices resulting from the shortage, including sourcing PPD from alternative manufacturers, restricting remaining supplies to patients at greatest risk or replacing TST by an interferon-gamma release assay. CONCLUSIONS: The data show that a PPD shortage occurred in 2014, affecting multiple European countries. The shortage resulted in changes in TB screening capabilities and practices, potentially compromising both patient care as well as public health efforts. Appropriate actions to prevent future PPD shortages should be explored urgently by public health agencies and key stakeholders.

High risk of tuberculosis in health care workers in Romania.

SETTING: The main university hospital in Iasi, Romania. OBJECTIVE: To assess whether health care workers (HCWs) have a higher risk of acquiring tuberculosis (TB) than the general population, and if TB incidence varies between departments, to develop adequate infection control measures. DESIGN: All records of TB cases among HCWs were reviewed by cross-checking laboratory and medical records (retrospectively, 1971--1996; prospectively 1997--2003, following the implementation of the first World Health Organization pilot project in Romania). Annual TB incidence rates among HCWs were calculated and compared with those of the general population; relative and attributable risk with 95% confidence intervals (CI) were calculated. RESULTS: Fifty TB cases were diagnosed in HCWs; 42% were nurses, 24% ancillary staff, 12% physicians, 10% laboratory staff, 10% administrative staff and 2% radiology technicians. The mean incidence of TB in Romania during the study period was 96.8 per 100,000 persons/year (95%CI 83.5-110.1); the mean incidence among HCWs was 942.8/100,000 persons/year (95%CI 726.3-1159.3, P < 0.001); comparing the two previous absolute risks, the mean relative risk was 11 (95%CI 8-14) and the attributable risk 846. CONCLUSION: TB is a major occupational hazard in Iasi, Romania, where a great potential exists for further development of an effective infection control plan.

[The efficacy of the intensive, short-duration chemotherapy of patients with cavitary pulmonary tuberculosis]. / Eficienta chimioterapiei intensive, de scurta durata, la bolnavii cu tuberculoza pulmonara cavitara.

This study was carried out on 100 cases of cavitary pulmonary tuberculosis in patients eliminating tuberculosis bacilli, as noted at microscopic study. The treatment included four drugs (RHSZ) in 95 case, and 3 drugs in the remaining patients. All the treatments were tailored to individual needs. The duration of chemotherapy was of 6 months in 62 cases. It was prolonged to 9 months in 33 cases and to 12 months in 5 cases. In 81 patients the drugs were applied regularly. The results have demonstrated that at 6 months negative cultures were obtained in 98 patients although the excavations were closed in only 55 cases. At 9 months all the patients were negative but excavations were closed in only 71. Suppression of elimination of bacilli was achieved in 99 of the cases at 12 months, but the excavations were closed in only 92 of the patients. Ninety-nine patients were investigated after 2.5-3.0 years. Five of them were again positive, 94.5% were negative and the excavations were closed in 91.9%. The importance of the cavitary score is discussed with regard to the risk of renewed positivity, and an association is recommended of surgical collapsing and exeresis at the right time.

[Evolution of chronic pulmonary tuberculosis and the possibility of preventing chronicization (in the Iasi judicial district)]. / Evolutia tuberculozei pulmonare cronice si posibilitatile de prevenire a cronicizarii (în teritoriul jud. Iasi).

The instantaneous prevalence of patients with pulmonary tuberculosis has been evaluated; the patients were included in the dispensarization group I between 1974 and 1980. Initially there was a decrease of the prevalence of the patients in Group I B but over the last years this was stable at 11.7-13.5 0/0000 inhabitants. The decrease which had been obtained at first was due to the immediate effect of repeated treatments with new tuberculostatic drugs resulting in sterilization and inclusion in the Group II of dispensarization of many of the preexisting patients while the ceiling which occurred later was determined by the quantitative balance of therapeutic failures and relapses entering the Group I B and cases which left the Group as a result of medical solutions, death or change of address. It was also noted that most of the patients in whom presence of the bacilli had been determined by microscopic techniques and by cultures constituted a relatively stable group over the entire period of the study, and oscillated between 11 and 17.5%, and 56.5 and 65.9% respectively. The quantitative balance established over the last years between the "entrances" and the "exits" from Group I B may be altered firstly by lowering the number of failures and relapses after the first treatment. The nature of unfavourable factors which influence the prognosis may be classified as follows: bio-psycho-social implications (males--81.5%, age--between 30 and 50 years, 51.4%, lack of occupation, 31.5%, low educational level, 80.1% chronic ethyl intoxication 51.4%, psychoses, 12.7%, other associated diseases, 34.3%, and primary drug resistance, 7.1%); consequences of a late detection; deficiencies in the rhythm and the duration of the first treatment with tuberculostatic drugs (non-cooperation--64.2%, irregularities--38.5%, interruptions--42.8%, secondary drug resistance--14.2%).

[The value of bacteriological controls in the epidemiological studies of tuberculosis]. / Valoarea controlului bacteriologic în urmarirea din punct de vedere epidemiologic a tuberculozei.

The authors make an analysis of bacteriological data concerning patients with tuberculosis from a certain area (the Jassy County) which have been recorded between 1971 and 1980. An analysis is presented of the instantaneous and of the maximal prevalence of tuberculous bacilli carriers in the urban and the rural environments, and the incidence of tuberculosis in children and adults, also in the urban and the rural media. Some other aspects are studied of primary drug resistance, as well as of secondary resistance. The data presented in the paper stress the major role of the bacteriological investigation in the epidemiological follow-up of tuberculosis, as well as the fact that bacteriological indicators are capable to evidence essential aspects of the evolution of tuberculosis endemia in a certain area.

[Evolution of endemic tuberculosis in the Iasi District: between 1972 and 1980]. / Evolutia endemiei de tuberculoza în judetul Iasi între anii 1972 si 1980.

Continuing our longitudinal study on the evolution of the tuberculosis endemic in the Iasi district, the epidemiometric indicators recorded between 1972 and 1980 were estimated. It was noticed that the epidemiological state of tuberculosis has improved considerably. The instantaneous prevalence of the bacillary patients decreased with 72% and the maximum one with 66.4%. The limitation of the contagion sources was reflected on the prevalence of tuberculosis in children, which decreased in the same period with 87.2%. The epidemiological process regressed slowly in the adult population, while in children it regressed rapidly and substantially.

[Informational system in prevention and integrated fight against tuberculosis]. / Sistem informational în prevenirea si combaterea integrata a tuberculozei.

The authors have sent out a special form to a total of 50 specialists and general practitioners, and their answers it appeared that these physicians consider necessary to review and to render more technical the system used for the information in view of the prevention and the integrated fight against tuberculosis. The authors recall the fundamental technical notions in this connection and present the generators and the recipients of information related to the fight against tuberculosis, the informational flow in the anti-tuberculous activity, the standardized informational instruments of the Ministry of Health and the informational channels which are accessible in the practice. In conclusion the authors present the stocking and the transfer of anti-tuberculous information, synthesized on a functional representation of the informational system in the prevention and the integrated fight against tuberculosis.

[Evaluation of initial supervised and integrated treatment of tuberculosis]. / Evaluarea tratamentului initial al tuberculozei, aplicat, supravegheat si integrat.

The operational and technical efficiencies were evaluated, of the initial, intermittently administered chemotherapy, supervised and integrated by the general medical network. The treatment was applied in 160 patients detected in 53 rural medical districts. It was noted that under the operational aspect the treatment was applied in 100% of the eligible patients, and administration of all the necessary doses was achieved in 91,6% of the patients. Bacteriological negativation by the direct examination was obtained after three months and negative cultures were obtained in 93,3% of the patients at three months and in 97,4% of all patients after 9 and 12 months. Closure (filling) of the cavities was obtained in 75,4% of the cases after three months of treatment, and in 87,7% of all cases after 9 and 12 months. Finally the technical efficiency was completed by an assessment of the socio-professional recovery, that was achieved in 91,8% of the cases.