Recent trends in sexually transmitted infections among adolescents, Catalonia, Spain, 2012-2017.

Monitoring sexually transmitted infections (STIs) in adolescents is essential to inform STI prevention strategies at primary and secondary levels in this key population. We aim to describe recent trends in STIs among adolescents and to analyse their socio-demographic and behavioural characteristics in Catalonia, Spain between 2012 and 2017. Data on Chlamydia trachomatis (CT) infection, gonorrhoea and syphilis cases aged from 13 to 19 years reported to the Catalan Mandatory Notifiable System from 2012 to 2017 were analysed. Diagnosis rates were calculated and a descriptive analysis was performed. Between 2012 and 2017, CT infection, gonorrhoea and syphilis cases reported among adolescents aged 13-19 years accounted for more than one-eleventh of all reported cases in Catalonia. The rate of the three nationally-notifiable STIs increased dramatically among adolescents. CT infection rates rose from 13 to 144.1 per 100,000 adolescents between 2012 and 2017, an increase of 1007%; gonorrhoea cases increased by 246% (from 13.4 to 45.4/100,000) and syphilis cases increased by 247% (from 1.7 to 5.9/100,000). Gonorrhoea and syphilis cases affected mainly males while CT infection cases were mostly in females (84%). Adolescents are being increasingly affected by CT infection, gonorrhoea and syphilis. A broader array of intervention strategies aimed at adolescents should be reinforced through strong prevention campaigns, improved sexual health information, as well as encouragement of regular offers of STI screening by healthcare providers.

Community strategies to tackle tuberculosis according to the WHO region of origin of immigrant communities.

Setting: Tuberculosis (TB) control requires the proper identification and treatment of affected patients and investigation of their contacts. In certain vulnerable immigrant groups, however, these tasks may be hindered due to their ethnic and sociocultural characteristics. Objective: To analyse the results of a community programme designed to locate hard-to-reach immigrants with TB. Design: Descriptive study of all cases diagnosed with confirmed TB referred to the Public and Community Health team of the Drassanes International Health Unit in Barcelona during 2012-2014 due to difficulties in tracing these patients. Both cases and contacts were categorised based on their World Health Organization region of origin. The sociodemographic characteristics of each group and the community interventions carried out during the tracing period are described. Results: A total of 122 cases and 316 contacts were detected. As a result of community-based strategies, 73% of the initial cases completed treatment; 3.8% of the contacts were diagnosed with TB, 91.7% of whom were treated appropriately; 17.1% contacts had latent infection, 79.3% of whom completed chemoprophylaxis. Conclusions: Intervention strategies with a community approach for follow-up and control of TB in certain immigrant communities seem to be effective.

Contexte : La lutte contre la tuberculose (TB) requiert l'identification et le traitement appropriés des patients affectés et l'examen de leurs contacts. Ces tâches peuvent néanmoins être entravées dans certains groupes vulnérables d'immigrants en raison de leurs spécificités ethniques et socioculturelles.Objectif : Analyser les résultats d'un programme communautaire conçu pour localiser les immigrants atteints de TB dont le suivi s'avère difficile.Schéma : Etude descriptive de tous les cas ayant un diagnostic de TB confirmé référés à l'équipe de santé publique et communautaire dans l'unité de santé internationale Drassanes de Barcelone en 2012­2014 en raison des difficultés à les localiser. A la fois les cas et les contacts ont été classés en se basant sur leur région Organisation Mondiale de la Santé d'origine. Les caractéristiques sociodémographiques de chaque groupe et les interventions communautaires réalisées pendant leur recherche sont décrites.Résultats : Ont été détectés 122 cas et 316 contacts. Grâce aux stratégies communautaires, 73% des cas initiaux ont achevé leur traitement, 3,8% des contacts ont eu un diagnostic de TB, dont 91,7% ont été traités correctement ; 17,1% des contacts avaient une infection latente, dont 79,3% ont achevé la chimioprophylaxie.Conclusions: Les stratégies d'intervention par approche communautaire du suivi et de la lutte contre la TB dans certaines communautés d'immigrants semblent efficaces.

Marco de Referencia: El control de la tuberculosis (TB) requiere identificar y tratar adecuadamente a los pacientes afectados y realizar el seguimiento de sus contactos. Sin embargo, la realización de estas tareas puede ser complicada de llevar a cabo en ciertos colectivos de inmigrantes vulnerables debido a sus peculiaridades étnicas y socioculturales.Objetivo: Analizar los resultados de un programa comunitario diseñado para realizar el seguimiento de inmigrantes afectados de TB.Diseño: Estudio descriptivo de todos los casos con diagnóstico confirmado de TB remitidos al equipo de Salud Pública y Salud Comunitaria de la Unidad de Salud Internacional de Drassanes de Barcelona debido a las dificultades para realizar su seguimiento, durante el período 2012­2014. Se describen las características sociodemográficas tanto de los casos como de los contactos categorizados según su región de origen como intervenciones comunitarias llevadas a cabo durante su seguimiento.Resultados: Se detectaron 122 casos y 316 contactos. Como resultado de las estrategias comunitarias el 73% de los casos iniciales completaron el tratamiento. Un 3,8% de los contactos fueron diagnosticados de TB, de los cuales el 91,7% fueron tratados correctamente. El 17,1% de los contactos tenían una infección tuberculosa latente, de los cuales el 79,3% completaron la quimioprofilaxis.Conclusiones: Las estrategias de intervención comunitarias para el seguimiento y control de la TB en ciertos colectivos inmigrantes parecen ser efectivas.

Cost-effectiveness of rifampin for 4 months and isoniazid for 9 months in the treatment of tuberculosis infection.

The purpose of this study was to evaluate the cost-effectiveness of the strategy of controlling the contacts of tuberculosis patients with latent tuberculosis infection by means of treatment with rifampin for 4 months or isoniazid for 9 months. The cost was the sum of the cost of treating latent tuberculosis infection in all contacts plus the cost of treating tuberculosis in whom the disease was not avoided. The effectiveness was expressed as cases avoided. The efficacy adopted was 90 % for rifampin for 4 months and 93 % for isoniazid for 9 months. We carried out a sensitivity analysis for efficacies of rifampin for 4 months of 80 %, 75 %, 69 % and 65 %. Of the 1,002 patients studied, 139 were treated with rifampin for 4 months and 863 were treated with isoniazid for 9 months. The cost-effectiveness was 436,842.83/50 cases avoided with rifampin for 4 months and 692,164.42/40 cases avoided with isoniazid for 9 months. Rifampin for 4 months was dominant. In the sensitivity analysis, rifampin for 4 months was dominant for efficacies of 75 % or greater. The cost-effectiveness analysis favoured the use of rifampin for 4 months when its efficacy was 75 % or greater.

Is isoniazid for 6 months more cost-effective than isoniazid for 9 months?

SETTING: The optimal treatment for latent tuberculosis infection consists of isoniazid (H, INH) for 9-12 months. Although INH for 6 months (6H) is more cost-effective than the 12-month regimen, the cost-effectiveness of the 6H regimen and that of INH for 9 months (9H) have not been compared. OBJECTIVE: To compare the cost-effectiveness of treatment with 6H and 9H. METHODS: Cost-effectiveness was evaluated using the ratio of the cost of preventing one tuberculosis case using 6H vs. 9H. The cost was estimated as the product of the number of patients to be treated to prevent one case using 6H or 9H × the cost of 6H or 9H. RESULTS: A total of 1039 patients were studied. The number of patients that needed to be treated to prevent one case was 33 (95%CI 21-83) using 6H and 26 (95%CI 18-50) using 9H. The cost of 6H and 9H was respectively €444.34 and €578.26, and the cost ratio of preventing one case with 6H/9H was 0.98 (95%CI 0.6-1.5). CONCLUSIONS: The cost-effectiveness of treatment with 6H and 9H is similar.