[Epidemiological profile of extensively drug-resistant tuberculosis in Peru, 2013-2015Perfil epidemiológico da tuberculose extremamente resistente no Peru, 2013-2015]. / Perfil epidemiológico de la tuberculosis extensivamente resistente en el Perú, 2013-2015.

OBJECTIVE: Describe the clinical and epidemiological characteristics and resistance profile of cases of extensively drug-resistant tuberculosis (XDR-TB) diagnosed in Peru from 2013 to 2015. METHODS: This descriptive study included patients who met the definition of XDR-TB and were reported to the national epidemiological surveillance system of Peru's Ministry of Health. It used a descriptive analysis and, to identify spatial distribution, a heat map based on kernel density estimation. RESULTS: It was estimated that XDR-TB cases diagnosed as new represented 7.3% of all multidrug-resistant tuberculosis (MDR-TB) cases reported during the study period; 74% of patients were aged 15 to 44 years old; and the male-female ratio was 1.7. Half of the country's departments reported at least one case of XDR-TB, and 42% of new cases had no history of resistance or previous treatment. In the other half of the departments, the majority had previous MDR and pre-XDR resistance. Among the cases, 57.7% presented resistance to 5 and 7 first- and second-line drugs and 41.6% presented resistance to 8 and 10 drugs. CONCLUSIONS: This study offers important details of the epidemiological profile of XDR-TB in Peru, where there has been an increase in cases of primary XDR-TB; that is, cases with no prior history of disease. Furthermore, this form of tuberculosis has spread to a greater number of departments in the country.

OBJETIVO: Descrever as características clínico-epidemiológicas e o perfil de resistência dos casos de tuberculose extremamente resistente (TB-XDR) diagnosticados no Peru entre 2013 e 2015. MÉTODOS: Estudo descritivo que incluiu pacientes que cumpriam a definição de TB-XDR e foram notificados ao sistema nacional de vigilância epidemiológica do Ministério da Saúde do Peru. Foi realizada uma análise descritiva e elaborado um mapa de calor (heat map) com base na estimativa de densidade de Kernel para identificar a distribuição espacial. RESULTADOS: Estimou-se que os casos de TB-XDR diagnosticados como novos representaram 7,3% do número total de casos de tuberculose multidrogarresistente (TB-MDR) notificados no período do estudo, 74% dos casos tiveram entre 15 e 44 anos de idade, e a relação homem/mulher foi de 1,7. A metade dos departamentos notificou pelo menos um caso de TB-XDR, e 42% dos casos novos não tinham histórico de resistência ou tratamento prévio. Na outra metade dos departamentos, a maioria tinha resistência prévia do tipo MDR e pré-XDR. Ao todo, 57,7% dos casos apresentaram resistência a 5 e 7 medicamentos e 41,6% apresentaram resistência a 8 e 10 medicamentos de primeira e segunda linha. CONCLUSÕES: Este estudo apresenta detalhes importantes do perfil epidemiológico da TB-XDR no Peru, onde se observa um aumento no número de casos de TB-XDR primária, isto é, casos sem histórico de doença anterior. Além disso, esta forma de TB estendeu-se a um maior número de departamentos do país.

Perfil epidemiológico de la tuberculosis extensivamente resistente en el Perú, 2013-2015

[RESUMEN]. Objetivo. Describir las características clínico-epidemiológicas y el perfil de resistencia de los casos de tuberculosis extensivamente resistente (TB-XDR) diagnosticados en Perú entre los años 2013 y 2015. Métodos. Estudio descriptivo que incluyó a los pacientes que cumplían con la definición de TB-XDR y que fueron notificados al sistema nacional de vigilancia epidemiológica del Ministerio de Salud del Perú. Se realizó un análisis descriptivo y se elaboró un mapa de calor basado en la estimación de densidad Kernel para identificar la distribución espacial. Resultados. Se estimó que los casos de TB-XDR diagnosticados como nuevos representaron 7,3% del total de casos de tuberculosis multidrogorresistente (TB-MDR) reportados para el período de estudio, 74% de los casos tenían entre 15 y 44 años y la relación hombre/mujer fue de 1,7. La mitad de los departamentos reportó al menos un caso de TB-XDR, con 42% de casos nuevos sin ningún antecedente de resistencia ni tratamiento previo. En la otra mitad de los departamentos, la mayoría tenían resistencia previa tipo MDR y de tipo pre-XDR. El 57,7% de los casos presentaron resistencia a 5 y 7 drogas y 41,6% presentaba resistencia a 8 y 10 drogas de primera y segunda línea. Conclusiones. Este estudio ofrece detalles importantes del perfil epidemiológico de la TB-XDR en el Perú, donde se muestra un incremento de los casos de TB-XDR primario; es decir, casos sin antecedentes de enfermedad previa. Además, esta forma de tuberculosis se ha extendido a un mayor número de departamentos del país.

[ABSTRACT]. Objective. Describe the clinical and epidemiological characteristics and resistance profile of cases of extensively drug-resistant tuberculosis (XDR-TB) diagnosed in Peru from 2013 to 2015. Methods. This descriptive study included patients who met the definition of XDR-TB and were reported to the national epidemiological surveillance system of Peru’s Ministry of Health. It used a descriptive analysis and, to identify spatial distribution, a heat map based on kernel density estimation. Results. It was estimated that XDR-TB cases diagnosed as new represented 7.3% of all multidrug-resistant tuberculosis (MDR-TB) cases reported during the study period; 74% of patients were aged 15 to 44 years old; and the male-female ratio was 1.7. Half of the country’s departments reported at least one case of XDR-TB, and 42% of new cases had no history of resistance or previous treatment. In the other half of the departments, the majority had previous MDR and pre-XDR resistance. Among the cases, 57.7% presented resistance to 5 and 7 first- and second-line drugs and 41.6% presented resistance to 8 and 10 drugs. Conclusions. This study offers important details of the epidemiological profile of XDR-TB in Peru, where there has been an increase in cases of primary XDR-TB; that is, cases with no prior history of disease. Furthermore, this form of tuberculosis has spread to a greater number of departments in the country.

[RESUMO]. Objetivo. Descrever as características clínico-epidemiológicas e o perfil de resistência dos casos de tuberculose extremamente resistente (TB-XDR) diagnosticados no Peru entre 2013 e 2015. Métodos. Estudo descritivo que incluiu pacientes que cumpriam a definição de TB-XDR e foram notificados ao sistema nacional de vigilância epidemiológica do Ministério da Saúde do Peru. Foi realizada uma análise descritiva e elaborado um mapa de calor (heat map) com base na estimativa de densidade de Kernel para identificar a distribuição espacial. Resultados. Estimou-se que os casos de TB-XDR diagnosticados como novos representaram 7,3% do número total de casos de tuberculose multidrogarresistente (TB-MDR) notificados no período do estudo, 74% dos casos tiveram entre 15 e 44 anos de idade, e a relação homem/mulher foi de 1,7. A metade dos departamentos notificou pelo menos um caso de TB-XDR, e 42% dos casos novos não tinham histórico de resistência ou tratamento prévio. Na outra metade dos departamentos, a maioria tinha resistência prévia do tipo MDR e pré-XDR. Ao todo, 57,7% dos casos apresentaram resistência a 5 e 7 medicamentos e 41,6% apresentaram resistência a 8 e 10 medicamentos de primeira e segunda linha. Conclusões. Este estudo apresenta detalhes importantes do perfil epidemiológico da TB-XDR no Peru, onde se observa um aumento no número de casos de TB-XDR primária, isto é, casos sem histórico de doença anterior. Além disso, esta forma de TB estendeu-se a um maior número de departamentos do país.

Prevalencia de infección tuberculosa latente en trabajadores de salud de establecimientos del primer nivel de atención. Lima, Perú / Prevalence of latent tuberculosis infection in health workers from primary health care centers in Lima, Peru

RESUMEN Con el propósito de disponer de información sobre los riesgos para infección por tuberculosis, la Dirección General de Epidemiología del Ministerio de Salud, desarrolló una vigilancia centinela en establecimientos de salud de la Provincia constitucional del Callao, dicha vigilancia incluyó el diagnóstico de infección tuberculosa latente (ITL) mediante la aplicación del método IGRA. El objetivo del presente estudio fue estimar la prevalencia de ITL en trabajadores de salud de un área con alta carga de enfermedad de tuberculosis. La prevalencia de ITL en trabajadores de salud fue 56%. En trabajadores con más de 10 años de servicio la prevalencia se incrementó a 63% y en trabajadores con más de 35 años de servicio se encontraron prevalencias entre 58 y 60%. Existe una alta prevalencia de ITL en trabajadores de salud de establecimientos del primer nivel de atención, identificándose al mayor tiempo de servicio, como uno de los principales factores de riesgo.

ABSTRACT To evaluate the risk of tuberculosis (TB) infection, the General Directorate of Epidemiology of the Ministry of Health developed a sentinel surveillance system in health centers located in the Constitutional Province of Callao. This surveillance system included the diagnosis of latent tuberculosis infection (LTI) using interferon gamma release assays. The objective of the present study was to estimate the prevalence of LTI in health workers in a region with a high burden of TB. The prevalence of LTI in health workers was 56%. The prevalence of LTI was 63% in workers with more than 10 years of service and 58-60% in workers with more than 35 years of service. The prevalence of LTI in health workers from primary health care centers was high, and longer service time was one of the main risk factors.

[Prevalence of latent tuberculosis infection in health workers from primary health care centers in Lima, Peru]. / Prevalencia de infección tuberculosa latente en trabajadores de salud de establecimientos del primer nivel de atención. Lima, Perú.

To evaluate the risk of tuberculosis (TB) infection, the General Directorate of Epidemiology of the Ministry of Health developed a sentinel surveillance system in health centers located in the Constitutional Province of Callao. This surveillance system included the diagnosis of latent tuberculosis infection (LTI) using interferon gamma release assays. The objective of the present study was to estimate the prevalence of LTI in health workers in a region with a high burden of TB. The prevalence of LTI in health workers was 56%. The prevalence of LTI was 63% in workers with more than 10 years of service and 58-60% in workers with more than 35 years of service. The prevalence of LTI in health workers from primary health care centers was high, and longer service time was one of the main risk factors.

Con el propósito de disponer de información sobre los riesgos para infección por tuberculosis, la Dirección General de Epidemiología del Ministerio de Salud, desarrolló una vigilancia centinela en establecimientos de salud de la Provincia constitucional del Callao, dicha vigilancia incluyó el diagnóstico de infección tuberculosa latente (ITL) mediante la aplicación del método IGRA. El objetivo del presente estudio fue estimar la prevalencia de ITL en trabajadores de salud de un área con alta carga de enfermedad de tuberculosis. La prevalencia de ITL en trabajadores de salud fue 56%. En trabajadores con más de 10 años de servicio la prevalencia se incrementó a 63% y en trabajadores con más de 35 años de servicio se encontraron prevalencias entre 58 y 60%. Existe una alta prevalencia de ITL en trabajadores de salud de establecimientos del primer nivel de atención, identificándose al mayor tiempo de servicio, como uno de los principales factores de riesgo.

Tuberculosis en trabajadores de salud en el Perú, 2013-2015 / Tuberculosis in health workers in Peru, 2013-2015

RESUMEN Objetivos. Describir las características epidemiológicas de la tuberculosis en trabajadores de salud del Perú. Materiales y métodos . Se realizó un estudio descriptivo que incluyó a todos los trabajadores de salud con tuberculosis notificados al sistema nacional de vigilancia epidemiológica del Ministerio de Salud (MINSA) del Perú, durante los años 2013, 2014 y 2015. Resultados . Se notificaron 755 casos de tuberculosis en trabajadores de salud, el 60% laboraban en hospitales, 28% en establecimientos del primer nivel de atención y 12% en establecimientos privados. 57% de los casos laboraban en establecimientos de salud de Lima Metropolitana y el Callao. La edad promedio de los trabajadores fue de 38 años (rango 19 a 89 años) y 63,6% fueron mujeres; 6,1% de los casos fueron resistentes, principalmente tuberculosis multidrogorresistente; 67% de los casos fueron tuberculosis pulmonar con confirmación bacteriológica. Profesionales y técnicos de la salud representaron el 82,5% de los casos, consultorios, hospitalización y emergencia, fueron las áreas donde laboraban el 55,2% de los casos. Conclusiones . La tuberculosis constituye un riesgo laboral importante para los trabajadores de salud de los establecimientos de salud públicos y privados, afecta principalmente al grupo de profesionales y técnicos de la salud que realizan labores en áreas de cuidado y atención directa con pacientes en grandes hospitales de Perú.

ABSTRACT Objectives. To describe the characteristics of tuberculosis epidemiology in Peruvian health workers. Materials and methods. A descriptive study was performed. It included all health workers with tuberculosis listed in the national epidemiological surveillance system of the Peruvian Ministry of Health, during 2013, 2014, and 2015. Results. A total of 755 cases of tuberculosis in health workers were reported: 60% worked in hospitals, 28% worked in primary-care facilities, and 12% worked in private facilities. In 57% of the cases, they worked in health facilities in Lima Metropolitan area and Callao. The average age of workers was 38 years (ranging from 19 to 89 years), and 63.6% were women. Of the cases, 6.1% were resistant, mainly multidrug-resistant tuberculosis, 67% of the cases had bacteriological confirmation of pulmonary tuberculosis. Health professionals and technicians represented 82.5% of the cases, and 55.2% corresponded to doctor’s offices, hospital admissions, and emergency rooms, the areas where they worked. Conclusions. Tuberculosis poses a significant work risk for health workers of both public and private facilities. It mainly affects health professionals and technicians providing direct care and assistance to patients in large Peruvian hospitals.

[Tuberculosis in health workers in Peru, 2013-2015]. / Tuberculosis en trabajadores de salud en el Perú, 2013-2015.

OBJECTIVES.: To describe the characteristics of tuberculosis epidemiology in Peruvian health workers. MATERIALS AND METHODS.: A descriptive study was performed. It included all health workers with tuberculosis listed in the national epidemiological surveillance system of the Peruvian Ministry of Health, during 2013, 2014, and 2015. RESULTS.: A total of 755 cases of tuberculosis in health workers were reported: 60% worked in hospitals, 28% worked in primary-care facilities, and 12% worked in private facilities. In 57% of the cases, they worked in health facilities in Lima Metropolitan area and Callao. The average age of workers was 38 years (ranging from 19 to 89 years), and 63.6% were women. Of the cases, 6.1% were resistant, mainly multidrug-resistant tuberculosis, 67% of the cases had bacteriological confirmation of pulmonary tuberculosis. Health professionals and technicians represented 82.5% of the cases, and 55.2% corresponded to doctor's offices, hospital admissions, and emergency rooms, the areas where they worked. CONCLUSIONS.: Tuberculosis poses a significant work risk for health workers of both public and private facilities. It mainly affects health professionals and technicians providing direct care and assistance to patients in large Peruvian hospitals.