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Attitudes about tuberculosis prevention in the elimination phase: a survey among physicians in Germany.

Gutsfeld C, Olaru ID, Vollrath O, Lange C - PLoS ONE (2014)

Bottom Line: Among 16 risk factors immunosuppressive therapy, HIV-infection and treatment with TNF-antagonist were thought to be the most important risk factors for the development of tuberculosis in Germany.Exposure to a patient with tuberculosis ranked on the 10th position.In the event of a positive tuberculin-skin-test or interferon-γ release assay only 50%, 40%, 36% and 25% of physicians found that preventive chemotherapy was indicated for individuals undergoing tumor necrosis factor-antagonist therapy, close contacts of tuberculosis patients, HIV-infected individuals and migrants, respectively.

View Article: PubMed Central - PubMed

Affiliation: Division of Clinical Infectious Diseases, German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Borstel, Germany; Department of Psychosomatic Medicine, Sachsenklinik, Bad Lausick, Germany.

ABSTRACT

Background: Targeted and stringent measures of tuberculosis prevention are necessary to achieve the goal of tuberculosis elimination in countries of low tuberculosis incidence.

Methods: We ascertained the knowledge about tuberculosis risk factors and stringency of tuberculosis prevention measures by a standardized questionnaire among physicians in Germany involved in the care of individuals from classical risk groups for tuberculosis.

Results: 510 physicians responded to the online survey. Among 16 risk factors immunosuppressive therapy, HIV-infection and treatment with TNF-antagonist were thought to be the most important risk factors for the development of tuberculosis in Germany. Exposure to a patient with tuberculosis ranked on the 10th position. In the event of a positive tuberculin-skin-test or interferon-γ release assay only 50%, 40%, 36% and 25% of physicians found that preventive chemotherapy was indicated for individuals undergoing tumor necrosis factor-antagonist therapy, close contacts of tuberculosis patients, HIV-infected individuals and migrants, respectively.

Conclusions: A remarkably low proportion of individuals with latent infection with Mycobacterium tuberculosis belonging to classical risk groups for tuberculosis are considered candidates for preventive chemotherapy in Germany. Better knowledge about the risk for tuberculosis in different groups and more stringent and targeted preventive interventions will probably be necessary to achieve tuberculosis elimination in Germany.

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Subjective ranking (1 = highest risk; 16 = lowest risk) of risk groups for the future development of tuberculosis according to German physicians involved in LTBI testing (left) in comparison with the range of reported relative risks (RR) for the development of tuberculosis in the same risk groups according to published studies ranked according to the highest risk reported (right).References are shown in square brackets (max. to min.) [39]–[70]. *Risk is expressed as relative risk for cohort studies or controlled trials, odds ratio for case-control studies and incidence rate ratio when incidence in cases was compared to that in the general population. In the case of migrants the highest value for risk is not plotted on the graph (relative risk of 315.5). TNFα – tumor necrosis factor α, SOT – solid organ transplant, JJI bypass – jejunoileal bypass, IVDU – intravenous drug users, BMT – bone marrow transplant, IS therapy – immunosuppressive therapy, Rx – radiological.
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pone-0112681-g001: Subjective ranking (1 = highest risk; 16 = lowest risk) of risk groups for the future development of tuberculosis according to German physicians involved in LTBI testing (left) in comparison with the range of reported relative risks (RR) for the development of tuberculosis in the same risk groups according to published studies ranked according to the highest risk reported (right).References are shown in square brackets (max. to min.) [39]–[70]. *Risk is expressed as relative risk for cohort studies or controlled trials, odds ratio for case-control studies and incidence rate ratio when incidence in cases was compared to that in the general population. In the case of migrants the highest value for risk is not plotted on the graph (relative risk of 315.5). TNFα – tumor necrosis factor α, SOT – solid organ transplant, JJI bypass – jejunoileal bypass, IVDU – intravenous drug users, BMT – bone marrow transplant, IS therapy – immunosuppressive therapy, Rx – radiological.

Mentions: When physicians were asked to prioritize groups with the highest risk for the future development of TB, patients with an immunosuppressive therapy, HIV-seropositive patients and patients with a TNF-antagonist-therapy, were ranked on positions 1–3 among 16 risks groups (figure 1-right). Interestingly, contact persons of patients diagnosed with TB were ranked on position 10/16. Physicians’ attitude of groups at risk for the future development of TB and data from the published literature (figure 1-left) did not match.


Attitudes about tuberculosis prevention in the elimination phase: a survey among physicians in Germany.

Gutsfeld C, Olaru ID, Vollrath O, Lange C - PLoS ONE (2014)

Subjective ranking (1 = highest risk; 16 = lowest risk) of risk groups for the future development of tuberculosis according to German physicians involved in LTBI testing (left) in comparison with the range of reported relative risks (RR) for the development of tuberculosis in the same risk groups according to published studies ranked according to the highest risk reported (right).References are shown in square brackets (max. to min.) [39]–[70]. *Risk is expressed as relative risk for cohort studies or controlled trials, odds ratio for case-control studies and incidence rate ratio when incidence in cases was compared to that in the general population. In the case of migrants the highest value for risk is not plotted on the graph (relative risk of 315.5). TNFα – tumor necrosis factor α, SOT – solid organ transplant, JJI bypass – jejunoileal bypass, IVDU – intravenous drug users, BMT – bone marrow transplant, IS therapy – immunosuppressive therapy, Rx – radiological.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231044&req=5

pone-0112681-g001: Subjective ranking (1 = highest risk; 16 = lowest risk) of risk groups for the future development of tuberculosis according to German physicians involved in LTBI testing (left) in comparison with the range of reported relative risks (RR) for the development of tuberculosis in the same risk groups according to published studies ranked according to the highest risk reported (right).References are shown in square brackets (max. to min.) [39]–[70]. *Risk is expressed as relative risk for cohort studies or controlled trials, odds ratio for case-control studies and incidence rate ratio when incidence in cases was compared to that in the general population. In the case of migrants the highest value for risk is not plotted on the graph (relative risk of 315.5). TNFα – tumor necrosis factor α, SOT – solid organ transplant, JJI bypass – jejunoileal bypass, IVDU – intravenous drug users, BMT – bone marrow transplant, IS therapy – immunosuppressive therapy, Rx – radiological.
Mentions: When physicians were asked to prioritize groups with the highest risk for the future development of TB, patients with an immunosuppressive therapy, HIV-seropositive patients and patients with a TNF-antagonist-therapy, were ranked on positions 1–3 among 16 risks groups (figure 1-right). Interestingly, contact persons of patients diagnosed with TB were ranked on position 10/16. Physicians’ attitude of groups at risk for the future development of TB and data from the published literature (figure 1-left) did not match.

Bottom Line: Among 16 risk factors immunosuppressive therapy, HIV-infection and treatment with TNF-antagonist were thought to be the most important risk factors for the development of tuberculosis in Germany.Exposure to a patient with tuberculosis ranked on the 10th position.In the event of a positive tuberculin-skin-test or interferon-γ release assay only 50%, 40%, 36% and 25% of physicians found that preventive chemotherapy was indicated for individuals undergoing tumor necrosis factor-antagonist therapy, close contacts of tuberculosis patients, HIV-infected individuals and migrants, respectively.

View Article: PubMed Central - PubMed

Affiliation: Division of Clinical Infectious Diseases, German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Borstel, Germany; Department of Psychosomatic Medicine, Sachsenklinik, Bad Lausick, Germany.

ABSTRACT

Background: Targeted and stringent measures of tuberculosis prevention are necessary to achieve the goal of tuberculosis elimination in countries of low tuberculosis incidence.

Methods: We ascertained the knowledge about tuberculosis risk factors and stringency of tuberculosis prevention measures by a standardized questionnaire among physicians in Germany involved in the care of individuals from classical risk groups for tuberculosis.

Results: 510 physicians responded to the online survey. Among 16 risk factors immunosuppressive therapy, HIV-infection and treatment with TNF-antagonist were thought to be the most important risk factors for the development of tuberculosis in Germany. Exposure to a patient with tuberculosis ranked on the 10th position. In the event of a positive tuberculin-skin-test or interferon-γ release assay only 50%, 40%, 36% and 25% of physicians found that preventive chemotherapy was indicated for individuals undergoing tumor necrosis factor-antagonist therapy, close contacts of tuberculosis patients, HIV-infected individuals and migrants, respectively.

Conclusions: A remarkably low proportion of individuals with latent infection with Mycobacterium tuberculosis belonging to classical risk groups for tuberculosis are considered candidates for preventive chemotherapy in Germany. Better knowledge about the risk for tuberculosis in different groups and more stringent and targeted preventive interventions will probably be necessary to achieve tuberculosis elimination in Germany.

Show MeSH
Related in: MedlinePlus