Epidemiology of Culture-Negative Pulmonary Tuberculosis-Alameda County, 2010-2019.

CONTEXT: Patients with culture-negative pulmonary TB (PTB) can face delays in diagnosis that worsen outcomes and lead to ongoing transmission. An understanding of current trends and characteristics of culture-negative PTB can support earlier detection and access to care. OBJECTIVE: Describe epidemiology of culture-negative PTB. DESIGN, SETTING, PARTICIPANTS: We utilized Alameda County TB surveillance data from 2010 to 2019. Culture-negative PTB cases met clinical but not laboratory criteria for PTB per US National Tuberculosis Surveillance System definitions. We calculated trends in annual incidence and proportion of culture-negative PTB using Poisson and weighted linear regression, respectively. We further compared demographic and clinical characteristics among culture-negative versus culture-positive PTB cases. RESULTS: During 2010-2019, there were 870 cases of PTB, of which 152 (17%) were culture-negative. The incidence of culture-negative PTB declined by 76%, from 1.9/100 000 to 0.46/100 000 ( P for trend <.01), while the incidence of culture-positive PTB reduced by 37% (6.5/100 000 to 4.1/100 000, P for trend =.1). Culture-negative PTB case-patients were more likely than culture-positive PTB case-patients to be younger (7.9% were children <15 years old vs 1.1%; P < .01), recent immigrants within 5 years of arrival (38.2% vs 25.5%; P < .01), and have a TB contact (11.2% vs 2.9%; P < .01). Culture-negative PTB case-patients were less likely than culture-positive PTB case-patients to be evaluated because of TB symptoms (57.2% vs 74.7%; P < .01) or have cavitation on chest imaging (13.1% vs 38.8%; P < .01). At the same time culture-negative PTB case-patients were less likely to die during TB treatment (2.0% vs 9.6%; P < .01). CONCLUSIONS: The incidence of culture-negative PTB disproportionately declined compared with culture-positive TB and raises concern for gaps in detection. Expansion of screening programs for recent immigrants and TB contacts and greater recognition of risk factors may increase detection of culture-negative PTB.

Tuberculosis Disease Among Adults Aged 65 Years and Older: Alameda County, California, 2016-2019.

Background: Older adults aged ≥65 years old represent an increasing proportion of tuberculosis (TB) cases in the United States, but limited evidence exists on the characteristics and treatment outcomes that differentiate them from younger adults. Methods: We evaluated Alameda County TB surveillance data from 2016 to 2019 and abstracted public health charts for older adult TB cases. Clinical presentation and treatment outcomes were compared in older and younger adults (15-64 years), and multivariable logistic regression was conducted to assess risk factors for TB treatment noncompletion among older adults. Results: Of 517 TB cases, 172 (33.2%) were older adults and 101 were ≥75 years old. Compared to younger adults, older TB cases were more likely to be non-US-born, and have diabetes. For diagnosis, older adults were more likely to have negative interferon-gamma release assays (24.6% vs 16.0%; P = .01) and were less likely to have cavitary disease (18.6% vs 26.7%; P < .001). One third of older adults experienced an adverse event; older adults were less likely to complete TB treatment (77.7% vs 88.4%; P = .002) and were more likely to die during TB treatment (16.3% vs 2.9%; P < .01), especially among those ≥75 years old, who had a mortality rate of 22.9%. In multivariable analysis, dementia was significantly associated with treatment noncompletion (adjusted odds ratio, 5.05; 95% confidence interval, 1.33-20.32; P = .02). Conclusions: Diabetes, negative diagnostic tests, and poor treatment outcomes were more prevalent in older adult TB cases. A greater understanding of their TB presentation and comorbidities will inform interventions to improve outcomes among older adults.

Prevalence of Latent Tuberculosis Infection Among Persons with Chronic Hepatitis B Virus Infection: A Systematic Review and Meta-Analysis.

BACKGROUND: Tuberculosis (TB) and chronic hepatitis B virus infection (HBV) can be prevented through latent tuberculosis infection (LTBI) treatment and HBV vaccination, respectively. Prevalence of LTBI and HBV are six- and ninefold higher among non-US-born compared to US-born persons, respectively. Few studies have described the prevalence of LTBI-HBV co-infection. AIMS: In this study, we estimated LTBI prevalence among persons with chronic HBV. METHODS: We conducted a systematic review and meta-analysis using PubMed from inception through September 1, 2019, and identified and reviewed studies that provided data regarding LTBI prevalence among adults with chronic HBV. Pooled LTBI prevalence among adults with HBV was calculated using a random-effects meta-analysis model. RESULTS: A total of 1,205 articles were identified by systematic review of the published literature. Six studies were included in the meta-analysis; five studies were conducted in North America, and one was in China. LTBI prevalence among adults with chronic HBV was estimated to be 34.25% (95% confidence interval: 17.88-50.62%). CONCLUSION: LTBI prevalence among adults with chronic HBV was two times higher than the LTBI prevalence among all non-US-born persons. The high LTBI prevalence and increased risk of hepatotoxicity with TB medications among persons with chronic HBV may warrant consideration of routine screening for HBV among persons who are tested for LTBI. Reducing morbidity and mortality associated with TB and chronic HBV may require healthcare systems and public health to ensure that persons at risk of both infections are screened and treated for LTBI and chronic HBV.

Surveying the RHIO landscape. A description of current RHIO models, with a focus on patient identification.

Across the country, new RHIOs are being formed every day. The 21 RHIOs studied by the work group illustrate the variety of purposes, funding, and record linking methods RHIOs may adopt. As this trend continues to evolve and improve, RHIOs may prove to be a valuable stepping stone on the road to a national system in which a patient's medical data will be available anywhere, anytime. Accurate patient identification and linking are the foundation of health technology that is implemented in a RHIO or any similar network that shares patient information. Without accurate patient identification, patient safety and quality of care are compromised. When high percentages of duplication or overlaying of records occurs in electronic health record databases, physician trust in the system is lost. As HIM professionals, we must be involved in addressing the security and confidentiality of RHIO databases and in defining the record linking method appropriate to the RHIO. As professionals skilled in patient identification methods and possessing significant organizational skills and personnel management experience, HIM professionals should become involved in this process at the earliest opportunity in the RHIO formation. HIM professionals can participate in long-term planning, business plan development, and organizational structure definition. Future articles will address how HIM professionals can become involved, what particular attributes and skills they can bring to the table, and job descriptions appropriate to HIM professionals in the healthcare information sharing industry. The work group urges all HIM professionals to become involved personally in this exciting new field.