National position statement for the management of latent tuberculosis infection
DOI:
https://doi.org/10.33321/cdi.2017.41.29Keywords:
tuberculosis, management, latent tuberculosis infectionAbstract
The primary role of any tuberculosis (TB) control program is to ensure the prompt identification and effective treatment of active disease. The host immune system often succeeds in containing the initial (or primary) infection with Mycobacterium tuberculosis (Mtb), but may fail to eliminate the pathogen. The persistence of viable organisms explains the potential for the development of active disease years or even decades after infection. This is known as latent tuberculosis infection (LTBI) although, rather than a distinct entity, this probably represents part of a dynamic spectrum. Individuals with LTBI are asymptomatic and it is therefore clinically undetectable. The World Health Organization (WHO) estimates that one-third of the global population has been infected with Mtb, with highest prevalence of LTBI in countries/regions with the highest prevalence of active disease. In 2013, 88% of 1322 notifications in Australia were in the overseas-born population (incidence 19.5 per 100,000 v. 1.0 per 100,000), with this proportion rising over the course of the last decade. Combined with epidemiological evidence of low local transmission, this strongly implies that the vast majority resulted from reactivation of latent infection acquired prior to immigration. Contrasting trends in TB incidence in other developed countries probably reflect differences in policy regarding LTBI. Conclusion: The diagnosis and treatment of LTBI represents an important opportunity for intervention by jurisdictional TB control programs.
Downloads
References
Barry CE, 3rd, Boshoff HI, Dartois V, Dick T, Ehrt S, Flynn J, et al. The spectrum of latent tuberculosis: rethinking the biology and intervention strategies. Nat Rev Microbiol 2009;7(12):845-855.
Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC. Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project. JAMA 1999;282(7):677-686.
Houben RM, Dodd PJ. The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling. PLoS Med 2016;13(10):e1002152.
Toms C, Stapledon R, Waring J, Douglas P. Tuberculosis notifications in Australia, 2012 and 2013. Commun Dis Intell Q Rep 2015;39(2):E217-235.
Globan M, Lavender C, Leslie D, Brown L, Denholm J, Raios K, et al. Molecular epidemiology of tuberculosis in Victoria, Australia, reveals low level of transmission. Int J Tuberc Lung Dis 2016;20(5):652-658.
Gurjav U, Outhred AC, Jelfs P, McCallum N, Wang Q, Hill-Cawthorne GA, et al. Whole Genome Sequencing Demonstrates Limited Transmission within Identified Mycobacterium tuberculosis Clusters in New South Wales, Australia. PLoS One 2016;11(10):e0163612.
Ormerod LP. Further evidence supporting programmatic screening for, and treatment of latent TB Infection (LTBI) in new entrants to the UK from high TB prevalence countries. Thorax 2013;68(3):201.
Waring J, National Tuberculosis Advisory Committee. National Tuberculosis Advisory Committee Guideline: Management of Tuberculosis Risk in Healthcare Workers in Australia. Communicable Diseases Intelligence 2017;in press.
Pareek M, Watson JP, Ormerod LP, Kon OM, Woltmann G, White PJ, et al. Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis. Lancet Infect Dis 2011;11(6):435-444.
In: Tuberculosis: Clinical diagnosis and management of tuberculosis, and measures for its prevention and control. London; 2011.
Pareek M, Bond M, Shorey J, Seneviratne S, Guy M, White P, et al. Community-based evaluation of immigrant tuberculosis screening using interferon gamma release assays and tuberculin skin testing: observational study and economic analysis. Thorax 2013;68(3):230-239.
Denholm JT, McBryde ES. Can Australia eliminate TB? Modelling immigration strategies for reaching MDG targets in a low-transmission setting. Aust N Z J Public Health 2014;38(1):78-82.
In: Guidelines on the Management of Latent Tuberculosis Infection. Geneva; 2015.
Connell TG, Tebruegge M, Ritz N, Bryant PA, Leslie D, Curtis N. Indeterminate interferon-gamma release assay results in children. Pediatr Infect Dis J 2010;29(3):285-286.
Assistance TCfT. International Standards for Tuberculosis Care (ISTC). In. The Hague; 2009.
Efficacy of various durations of isoniazid preventive therapy for tuberculosis: five years of follow-up in the IUAT trial. International Union Against Tuberculosis Committee on Prophylaxis. Bull World Health Organ 1982;60(4):555-564.
Comstock GW. How much isoniazid is needed for prevention of tuberculosis among immunocompetent adults? Int J Tuberc Lung Dis 1999;3(10):847-850.
Smieja MJ, Marchetti CA, Cook DJ, Smaill FM. Isoniazid for preventing tuberculosis in non-HIV infected persons. Cochrane Database Syst Rev 2000(2):CD001363.
Akolo C, Adetifa I, Shepperd S, Volmink J. Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database Syst Rev 2010(1):CD000171.
Comstock GW, Baum C, Snider DE, Jr. Isoniazid prophylaxis among Alaskan Eskimos: a final report of the bethel isoniazid studies. Am Rev Respir Dis 1979;119(5):827-830.
Kopanoff DE, Snider DE, Jr., Caras GJ. Isoniazid-related hepatitis: a U.S. Public Health Service cooperative surveillance study. Am Rev Respir Dis 1978;117(6):991-1001.
Nolan CM, Goldberg SV, Buskin SE. Hepatotoxicity associated with isoniazid preventive therapy: a 7-year survey from a public health tuberculosis clinic. JAMA 1999;281(11):1014-1018.
A double-blind placebo-controlled clinical trial of three antituberculosis chemoprophylaxis regimens in patients with silicosis in Hong Kong. Hong Kong Chest Service/Tuberculosis Research Centre, Madras/British Medical Research Council. Am Rev Respir Dis 1992;145(1):36-41.
Polesky A, Farber HW, Gottlieb DJ, Park H, Levinson S, O’Connell JJ, et al. Rifampin preventive therapy for tuberculosis in Boston’s homeless. Am J Respir Crit Care Med 1996;154(5):1473-1477.
Villarino ME, Ridzon R, Weismuller PC, Elcock M, Maxwell RM, Meador J, et al. Rifampin preventive therapy for tuberculosis infection: experience with 157 adolescents. Am J Respir Crit Care Med 1997;155(5):1735-1738.
Update: adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection--United States, 2003. MMWR Morb Mortal Wkly Rep 2003;52(31):735-739.
Ziakas PD, Mylonakis E. 4 months of rifampin compared with 9 months of isoniazid for the management of latent tuberculosis infection: a meta-analysis and cost-effectiveness study that focuses on compliance and liver toxicity. Clin Infect Dis 2009;49(12):1883-1889.
Menzies D. Randomized Clinical Trial Comparing 4RIF vs. 9INH for LTBI Treatment-effectiveness. ClinicalTrials.gov 2009. Report No.: NCT00931736. Available from: https://clinicaltrials.gov/ct2/show/NCT00931736
Ena J, Valls V. Short-course therapy with rifampin plus isoniazid, compared with standard therapy with isoniazid, for latent tuberculosis infection: a meta-analysis. Clin Infect Dis 2005;40(5):670-676.
Panickar JR, Hoskyns W. Treatment failure in tuberculosis. Eur Respir J 2007;29(3):561-564.
Spyridis NP, Spyridis PG, Gelesme A, Sypsa V, Valianatou M, Metsou F, et al. The effectiveness of a 9-month regimen of isoniazid alone versus 3- and 4-month regimens of isoniazid plus rifampin for treatment of latent tuberculosis infection in children: results of an 11-year randomized study. Clin Infect Dis 2007;45(6):715-722.
Bright-Thomas R, Nandwani S, Smith J, Morris JA, Ormerod LP. Effectiveness of 3 months of rifampicin and isoniazid chemoprophylaxis for the treatment of latent tuberculosis infection in children. Arch Dis Child 2010;95(8):600-602.
Downloads
Published
How to Cite
License
Copyright (c) 2017 Communicable Diseases Intelligence
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
