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Individuals Of All Ages With Positive Skin Or Blood Test Should Receive Preventive Treatment For TB, New Study Says

Preventive treatment for tuberculosis (TB) can stop latent TB infections from developing into deadly TB disease. Despite TB infection being fully treatable, there is no global consensus as to which subgroups of individuals exposed to TB should be prioritized for preventive treatment, nor whether the benefits of this treatment vary based on factors such as age or confirmed infection.

A new study led by a Boston University School of Public Health (BUSPH) researcher provides clarity to this issue, finding that exposed individuals with confirmed TB infection—i.E. A positive skin or blood test—should receive priority treatment in settings with a low prevalence of the disease, regardless of their age.

However, in high-burden settings, all exposed individuals should be considered for preventative treatment, even without a confirmed infection, according to the findings published in The Lancet Respiratory Medicine.

This strategy can help end the tuberculosis epidemic and support global public health efforts to reduce TB mortality by 95% by 2035 (from 2015 estimates). In 2022, there were more than 10 million cases of active TB worldwide, resulting in 1.5 million deaths.

"Tuberculosis affects tens of millions of people every year and has long-term lasting effects, even after people recover," says study lead and corresponding author Dr. Leonardo Martinez, assistant professor of epidemiology at BUSPH. "Finding ways to optimize prevention is really important to tackle the epidemic."

For the study, Dr. Martinez and colleagues conducted a comprehensive review and analysis to identify new cases of TB among people who were in close contact with individuals diagnosed with the disease, and compared the effectiveness of preventive treatment in these exposed individuals based on age, infection status, and burden of TB in their settings.

Among 439,644 participants, the team found that preventive TB treatment was 49% effective among the 2,496 individuals who developed TB, but particularly among individuals with a positive skin or blood test (for which the effectiveness was 80%).

Notably, the researchers found that preventive TB treatment was not effective in most individuals who did not show evidence of infection, except for children under 5.

For those who did have a positive skin or blood test, the effectiveness of the treatment was comparable among individuals of all age groups—adults, children ages 5-17, and children under 5—and the treatment was more effective among individuals in high-burden settings than low-burden settings.

The team also estimated the number of individuals needed to receive treatment (NNT) in order to prevent one person from developing TB disease. Regardless of infection status, the NNT was lower in high-burden settings (29 to 43 people) versus low-burden settings (213 to 455 people). Despite the fact that individuals with negative blood or skin tests do not seem to benefit from preventive treatments, the researchers say the overall low NNT may justify prioritizing this treatment to all exposed contacts in areas where testing for TB infection is inaccessible.

"While it is critical to find and treat people who are spreading TB in the community, the threat of global TB will never end until people with latent TB receive treatment," says study co-author Dr. C. Robert Horsburgh, professor of global health. "The results of this study show just how effective such treatment can be."

More information: Effectiveness of preventive treatment among different age groups and Mycobacterium tuberculosis infection status: a systematic review and individual-participant data meta- analysis of contact tracing studies, The Lancet Respiratory Medicine (2024). DOI: 10.1016/S2213-2600(24)00083-3

Citation: Individuals of all ages with positive skin or blood test should receive preventive treatment for TB, new study says (2024, May 8) retrieved 8 May 2024 from https://medicalxpress.Com/news/2024-05-individuals-ages-positive-skin-blood.Html

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Purdue University Student Health Service

State Immunization Requirements for Enrolled Students  Immunization Records Reminder

Students are reminded to submit proof of immunizations against rubeola (10-day measles), rubella (German measles), mumps, meningitis, diphtheria and tetanus to the PUSH immunization portal prior to completing your Purdue 101 online orientation program. If you do not submit proof of immunization, a hold will be placed on your account and you will be unable to register for classes.

To comply with immunization requirements, you must complete the medical clearances section in your Patient Portal. Log into the portal, look for the "Medical Clearances" tab on the left and update any items marked "Non Compliant" by submitting documentation. Further instructions can be found here.

If you need a tuberculosis test or vaccines that cannot be completed at home, they may be completed at PUSH as soon as you arrive to campus. If you need to receive a particular vaccine, please make an appointment with PUSH or another local pharmacy.

Indiana state law requires all new, regularly enrolled students attending residential campuses of Indiana public universities be immunized against Rubeola (10 day measles), Rubella (German measles), Mumps, Meningitis, Diphtheria, and Tetanus. This law requires the university to block the enrollment of any student who does not comply with immunization requirements. If your record is held for immunization noncompliance, registration for future courses cannot be completed until all requirements have been met.

Immunization proof must be legible, in English, and include the student's name. Students may upload their official immunization record OR a completed immunization information form signed by an MD, DO, NP, or RN. The official immunization record does not need to be signed by a provider. 

Immunizations required by the state of Indiana: Vaccine Requirement Rubeola (Measles, MMR) 2 doses of live vaccine administered after first birthday and at least 28 days apart. Rubella (MMR) 2 doses of live vaccine administered after first birthday and at least 28 days apart. Mumps (MMR) 2 doses of live vaccine administered after first birthday and at least 28 days apart. Tetanus Diphtheria (Td or Tdap) No more than 10 years before starting classes. Meningitis (Men Quad/Conjugate, MCV4) One dose on or after 16th birthday, if 23 years or younger. Meningococcal B (Separate from Meningitis) 2 doses of the same brand (Bexsero or Trumenba), if 23 or younger. International students only Tuberculosis Clearance International students must have a QFT (Quantiferon blood test) or T-Spot (not PPD) with a negative result. This test must be completed in the United States and no more than 3 months before classes start. Test must be completed on the same date, or at least 28 days after any live vaccine. Those with an abnormal TB test result, will have additional steps to complete. Students not in compliance will not be able to register for future courses until the requirement has been met. Learn more about Tuberculosis.

State-required immunizations are available at the Student Health Center and through other healthcare providers.

FAQS MENINGOCOCCAL VACCINES Why Men B?

Purdue requires 2 doses of the Meningitis B vaccine for all incoming students under the age of 24. College students are at an increased risk of being infected with the rare, but serious disease.

Does MCV4 (Menveo or Menactra) meet the Men B requirement?

No. Meningococcal B is a separate vaccine. MCV4 protects against variants A,C,W, and Y. Meningococcal B protects from the B variant. The brand names for Meningococcal B are Bexsero and Trumenba.

If I am 24 or older when I start classes, am I required to complete meningococcal vaccines?

No, this is only required for students under 24 when classes start.

Will I be able to register for classes if I have completed the 1st dose of Men B, but cannot complete the 2nd dose before classes start due to the vaccine's dosing schedule?

Yes. If you have started the vaccine but are unable to complete the 2nd dose because of the dosing schedule (28 days or 6 months between vaccines), PUSH staff will give you more time to complete the series when we review your submission.

TB TEST If I am registered as a domestic student, am I required to complete a TB test?

No, the TB test is only required for international students.

Can I complete the TB test in my home country?

No, Indiana law requires that the TB test be completed in the United States.

Why do I see TB test as a requirement in Medical Clearances even though I'm a domestic student?

Before classes start, all incoming students see the same items in medical clearances. Once classes start, students will be placed in their final populations and the requirements will correctly reflect the student's status. The TB test requirement is listed so that those that are required to complete this have a location to submit.

What TB tests are accepted?

Purdue will only accept a TB blood test meaning that your blood must be drawn by a lab. The TB skin test (PPD/Mantoux) are not acceptable.

IMMUNIZATION PROOF Does my provider need to sign my immunization records before submitting?

No. If you are submitting your immunization record, no hand-written signature is required. This is only required on the immunization history form.

How do I upload additional proof once I have completed the initial submission?

Additional records will be added using the green update box next to the immunization proof line in Medical Clearances. This is the same location records were originally submitted. Even though it states compliant now, the student can continue to submit additional records as needed.

If I upload proof of immunizations, do I still need to enter the dates each vaccine was completed?

Yes. Your submission cannot be reviewed until proof is submitted and immunization dates have been entered.

I submitted immunization proof several days ago. Why does it still say Awaiting Review?

The review process can take up to 10 days to review. If there are any problems with the student's submission, PUSH staff will send the student a secure message.

Why am I unable to access the patient portal?

Grad students do not have access to the patient portal until classes start. Please hold on to your record until then and submit once portal access is available. If you are an undergrad and cannot login to the portal, please contact us at shc@purdue.Edu.

I have logged into my patient portal and there is no way to submit immunization proof in Medical Clearances.

Students who took previous classes through Purdue, either on campus or as an online student, will be considered "former students" until classes start. Once classes start, the student's population will correct itself and they will be able to enter immunization dates. If you'd like to submit immunization dates before classes start, please email shc@purdue.Edu.

Does PUSH accept MMR titers as proof of measles, mumps, and rubella?

Yes. The titer must include the numeric value as well as the numeric reference range or state "immune" to meet titer requirements.

EXEMPTIONS

In the event of an outbreak of any of the vaccine preventable diseases covered by this law on or near campus, students holding exemptions will be excluded from all campus activities, for their protection, until the outbreak is declared to be over.

How do I apply for a religious exemption from immunizations?

Students, or their parent/guardian if the student is a minor, will write a statement indicating the reason that they cannot obtain immunizations. The statement must be hand-signed and dated. Once reviewed, the student will find the response in the letters section of their patient portal.

How do I apply for a medical exemption from immunizations?

A medical exemption will be granted upon receipt of a written statement from a healthcare provider indicating the nature and duration of the medical condition which contraindicates an immunization, as well as the specific vaccine identified as detrimental to the student's health or certifying pregnancy or suspected pregnancy. Medical exemptions expire when the medical condition(s) contraindicating immunization change in a manner which permits immunization.

Contact Info:PURDUE STUDENT HEALTH CENTER601 Stadium Mall DriveImmunization Office - Room 138W. Lafayette, Indiana 47907-2052Email: shc@purdue.EduFax: (765) 496-1907Telephone: (765) 494-1837

New Study Finds Interferon-γ Release Assays More Effective Than Skin Tests In Predicting Tuberculosis

In a recent study published in JAMA Network Open, researchers compared the performance of tuberculin skin test (TST) and interferon-γ release assays (IGRAs) in predicting tuberculosis (TB).

Study: Comparison of Tuberculin Skin Testing and Interferon-γ Release Assays in Predicting Tuberculosis Disease. Image Credit: BLACKDAY/Shutterstock.Com

Background

In the United States (US), most TB cases are among asymptomatic subjects with TB infection (TBI), i.E., latent TBI, that could later progress to an active TB.

While studies have shown the effectiveness of TBI treatments in preventing progression to TB, optimal TBI tests are required to identify those at risk. Two types of TB tests have been approved in the US: IGRAs (T-SPOT.TB [TSPOT] and QuantiFERON-TB Gold In-Tube [QFT-GIT]) and TST.

About the study

In the present study, researchers evaluated the ability of the TST and two IGRAs to predict the progression to TB.

Individuals were eligible if they had close contact with a person with TB, were born in, visitors to, or immigrants from a country with high/medium TB incidence, lived with human immunodeficiency virus (HIV), or were members of a local population with TBI prevalence ≥ 25%.

Participants were recruited from 18 TB clinics between July 12, 2012, and May 5, 2017. Excluded subjects were foster children, TBI or TB treatment recipients, and those with anaphylaxis to tuberculin.

Subjects were tested with three tests at the start; they also self-reported their medical history, vaccination status, race/ethnicity, and epidemiologic and demographic risk factors.

All subjects were followed up till November 15, 2020, to examine the development of TB. Possible TB cases were identified based on clinical signs, symptoms, or test results and were verified by a medical review.

Some individuals detected with TB ≤ 30 days post-enrolment were categorized as cases with prevalent TB and were included in sensitivity analyses only.

Fisher exact and chi-squared tests were used to compare demographic and epidemiologic data and medical history between individuals with and without TB. For incident TB cases, the time to TB was calculated.

Sensitivity, specificity, and positive (PPVs) and negative (NPVs) predictive values were estimated. Pairwise comparisons of each test were performed, and PPV ratios were computed.

Several sensitivity analyses were performed by varying the positive test result cutoffs or restricting cases to those with pulmonary TB/culture-confirmed results.

Additionally, the incremental gain of a second test result in predicting TB was calculated. Further, among subjects with ≥ one positive test, the effect of TBI treatment on progression to TB was evaluated.

Findings

Overall, the researchers enrolled 22,020 individuals. Most individuals (82%) were born outside the US. Over 51% were male, 9.6% were close contacts, 11.9% were Hispanic, 9.5% were White, 29.8% were Asian, and 20.8% were Black.

TB was detected in 129 individuals; 87 were prevalent TB cases. Among incident TB cases, 32 had culture-confirmed results, 19 had a smear-positive result, and five had pulmonary TB.

Incident TB was more prevalent among individuals aged < 2 or > 65, close contacts, and those with diabetes or chronic kidney failure.

Participants were followed up for a median of 6.4 years. The median time to TB detection was 2.7 years. QFT-GIT and TSPOT significantly outperformed TST in pairwise comparisons. There were no differences in performance between IGRAs. Sensitivity analyses produced consistent results.

The incremental gain in PPV for positive TSPOT and QFT-GIT results was significant, given a positive TST.

The team found that subjects with ≥ one positive test result were eight times more likely to progress to TB than those without a positive test. Further, treatment completion among those with a positive test was significantly protective in preventing incident TB compared to untreated subjects.

Conclusions

In sum, IGRAs performed superior to the TST in predicting incident TB. These findings were consistent in sensitivity analyses. The study results support using IGRAs for TB prediction even when TST results exist.

Notably, QFT-Plus has replaced QFT-GIT and is currently in use; however, it was unavailable throughout the study. Nonetheless, QFT-GIT is comparable to QFT-Plus.

Furthermore, the findings may not be generalizable as the study was conducted in at-risk individuals.

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