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Response to: Socio-political prescriptions for latent tuberculosis infection are required to prevent reactivation of tuberculosis
Accepted Manuscript Title: Response to: Socio-political prescriptions for LTBI are required to prevent re-activation of TB Author: G.J. Fox PII: DOI: Reference:
S1201-9712(17)30087-5 http://dx.doi.org/doi:10.1016/j.ijid.2017.03.004 IJID 2893
To appear in:
International Journal of Infectious Diseases
Author: C.C. Dobler PII: DOI: Reference:
S1201-9712(17)30087-5 http://dx.doi.org/doi:10.1016/j.ijid.2017.03.004 IJID 2893
To appear in:
International Journal of Infectious Diseases
Author: B.J. Marais PII: DOI: Reference:
S1201-9712(17)30087-5 http://dx.doi.org/doi:10.1016/j.ijid.2017.03.004 IJID 2893
To appear in:
International Journal of Infectious Diseases
Author: J.T. Denholm PII: DOI: Reference:
S1201-9712(17)30087-5 http://dx.doi.org/doi:10.1016/j.ijid.2017.03.004 IJID 2893
To appear in:
International Journal of Infectious Diseases
Received date: Accepted date:
3-3-2017 6-3-2017
Please cite this article as: Denholm J.T.Response to: Socio-political prescriptions for LTBI are required to prevent re-activation of TB.International Journal of Infectious Diseases http://dx.doi.org/10.1016/j.ijid.2017.03.004
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Response to: Socio-political prescriptions for LTBI are required to prevent re-activation of TB
Fox GJ1, Dobler CC1,2, Marais BJ3, Denholm JT4, 5
1
Sydney Medical School, University of Sydney, Sydney, Australia;
2
South Western Sydney Clinical
School, University of New South Wales, Sydney, Australia; 3The Children’s Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia;
4
Victorian Tuberculosis Program, Melbourne Health, Victoria Australia;
5
Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria, Australia
Correspondence to: Dr Greg J Fox Room 574 Blackburn Building University of Sydney Sydney, Australia, 2006 Tel: +61-412912538 E-mail: [email protected]
References: 3
Abstract: The importance of addressing the conditions that predispose individuals and populations to develop tuberculosis is increasingly being recognised. Accurate quantification of preventive therapy’s protective effect and the provision of pragmatic guidance for clinical care and public
health intervention is important. However, this approach must be nested within a socio-political context which addresses associated disadvantage and inequality.
Keywords: Latent tuberculosis infection; tuberculosis; prevention; therapy;
We thank Coussens and colleagues for highlighting the importance of addressing the broader social and political context within which tuberculosis (TB) occurs. While our review focused upon the contribution of antibiotic therapy to the prevention of TB, we strongly agree that a biomedical approach must be nested within a broader understanding of the socio-political drivers of the epidemic. It is well recognized that TB serves as an “indicator disease” of global poverty and inequality [1]. The importance of social interventions to preventing incident TB has long been recognised. In the pre-antibiotic era, the “Papworth Experiment” (1918 to 1943) found that a combination of initiatives to improve employment, housing and nutrition reduced the incidence of TB in children [2]. Conversely, rapid increases in TB occurred in the aftermath of the first and second World Wars, when European populations faced widespread deprivation [3].
The importance of addressing the conditions that predispose individuals and populations to develop TB is increasingly being recognised. The post-2015 WHO “End TB” Strategy laudably acknowledges the need for both effective biomedical and public health responses and a broader focus upon poverty alleviation, human rights, ethics and equity [1,4].
Our manuscript specifically focussed on the available biomedical evidence for, and
optimal approaches to, the use of preventive therapy. Biomedical approaches do play an important role in certain high-risk individuals. Preventive therapy has been shown to reduce morbidity among appropriately selected individuals. We believe that accurate quantification of preventive therapy’s protective effect, and the provision of pragmatic guidance for clinical and public health interventions, are important.
However, we respectfully disagree with Coussens et.al. that the use of preventive therapy itself in any way “buttress[es] the impoverished social conditions” of tuberculosis patients, or implicitly condones widening social inequality.
We also
question the assertion that individuals who migrate from high to low-burden settings may be more likely to develop TB on account of their migration. Data from Australia suggest that the converse is true [5]. This is likely on account of reduced exposure in their new environment, although the ‘healthy migrant phenomenon’ may also contribute.
As we described, preventive therapy may not have sustained benefits in an environment where disease transmission remains unchecked [6].
Hence, mass
administration of preventive therapy in a population cannot currently be recommended. Nevertheless, we agree with Coussens that population-wide interventions should be couched in a broader understanding of the context that sustains the disease. This is a salient reminder, at a time where growing the global TB epidemic has strong socio-political dimensions. Nevertheless, this does not reduce the relevance of pragmatic patient and population-centred care.
Conflicts of interest: None to declare
References [1] Lonnroth K, Castro KG, Chakaya JM, et al. Tuberculosis control and elimination 2010-50: cure, care, and social development. Lancet 2010;375:1814-29. [2] Bhargava A, Pai M, Bhargava M, Marais BJ, Menzies D. Can social interventions prevent tuberculosis?: the Papworth experiment (1918-1943) revisited. Am J Respir Crit Care Med 2012;186:442-9. [3] Daniel TM. The history of tuberculosis. Respir Med 2006;100:1862-70. [4] Lonnroth K, Raviglione M. The WHO's new End TB Strategy in the post-2015 era of the Sustainable Development Goals. Trans R Soc Trop Med Hyg 2016;110:148-50. [5] McPherson ME, Leslie D, Sievers A, Patel M, Kelly H. Epidemiology of laboratory confirmed tuberculosis in Victoria, 1990 to 2004. Comm Dis Intell 2008;32:237-41. [6] Churchyard GJ, Fielding KL, Lewis JJ, et al. A trial of mass isoniazid preventive therapy for tuberculosis control. N Engl J Med 2014;370:301-10.
S1201-9712(17)30087-5 http://dx.doi.org/doi:10.1016/j.ijid.2017.03.004 IJID 2893
To appear in:
International Journal of Infectious Diseases
Author: C.C. Dobler PII: DOI: Reference:
S1201-9712(17)30087-5 http://dx.doi.org/doi:10.1016/j.ijid.2017.03.004 IJID 2893
To appear in:
International Journal of Infectious Diseases
Author: B.J. Marais PII: DOI: Reference:
S1201-9712(17)30087-5 http://dx.doi.org/doi:10.1016/j.ijid.2017.03.004 IJID 2893
To appear in:
International Journal of Infectious Diseases
Author: J.T. Denholm PII: DOI: Reference:
S1201-9712(17)30087-5 http://dx.doi.org/doi:10.1016/j.ijid.2017.03.004 IJID 2893
To appear in:
International Journal of Infectious Diseases
Received date: Accepted date:
3-3-2017 6-3-2017
Please cite this article as: Denholm J.T.Response to: Socio-political prescriptions for LTBI are required to prevent re-activation of TB.International Journal of Infectious Diseases http://dx.doi.org/10.1016/j.ijid.2017.03.004
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Response to: Socio-political prescriptions for LTBI are required to prevent re-activation of TB
Fox GJ1, Dobler CC1,2, Marais BJ3, Denholm JT4, 5
1
Sydney Medical School, University of Sydney, Sydney, Australia;
2
South Western Sydney Clinical
School, University of New South Wales, Sydney, Australia; 3The Children’s Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia;
4
Victorian Tuberculosis Program, Melbourne Health, Victoria Australia;
5
Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria, Australia
Correspondence to: Dr Greg J Fox Room 574 Blackburn Building University of Sydney Sydney, Australia, 2006 Tel: +61-412912538 E-mail: [email protected]
References: 3
Abstract: The importance of addressing the conditions that predispose individuals and populations to develop tuberculosis is increasingly being recognised. Accurate quantification of preventive therapy’s protective effect and the provision of pragmatic guidance for clinical care and public
health intervention is important. However, this approach must be nested within a socio-political context which addresses associated disadvantage and inequality.
Keywords: Latent tuberculosis infection; tuberculosis; prevention; therapy;
We thank Coussens and colleagues for highlighting the importance of addressing the broader social and political context within which tuberculosis (TB) occurs. While our review focused upon the contribution of antibiotic therapy to the prevention of TB, we strongly agree that a biomedical approach must be nested within a broader understanding of the socio-political drivers of the epidemic. It is well recognized that TB serves as an “indicator disease” of global poverty and inequality [1]. The importance of social interventions to preventing incident TB has long been recognised. In the pre-antibiotic era, the “Papworth Experiment” (1918 to 1943) found that a combination of initiatives to improve employment, housing and nutrition reduced the incidence of TB in children [2]. Conversely, rapid increases in TB occurred in the aftermath of the first and second World Wars, when European populations faced widespread deprivation [3].
The importance of addressing the conditions that predispose individuals and populations to develop TB is increasingly being recognised. The post-2015 WHO “End TB” Strategy laudably acknowledges the need for both effective biomedical and public health responses and a broader focus upon poverty alleviation, human rights, ethics and equity [1,4].
Our manuscript specifically focussed on the available biomedical evidence for, and
optimal approaches to, the use of preventive therapy. Biomedical approaches do play an important role in certain high-risk individuals. Preventive therapy has been shown to reduce morbidity among appropriately selected individuals. We believe that accurate quantification of preventive therapy’s protective effect, and the provision of pragmatic guidance for clinical and public health interventions, are important.
However, we respectfully disagree with Coussens et.al. that the use of preventive therapy itself in any way “buttress[es] the impoverished social conditions” of tuberculosis patients, or implicitly condones widening social inequality.
We also
question the assertion that individuals who migrate from high to low-burden settings may be more likely to develop TB on account of their migration. Data from Australia suggest that the converse is true [5]. This is likely on account of reduced exposure in their new environment, although the ‘healthy migrant phenomenon’ may also contribute.
As we described, preventive therapy may not have sustained benefits in an environment where disease transmission remains unchecked [6].
Hence, mass
administration of preventive therapy in a population cannot currently be recommended. Nevertheless, we agree with Coussens that population-wide interventions should be couched in a broader understanding of the context that sustains the disease. This is a salient reminder, at a time where growing the global TB epidemic has strong socio-political dimensions. Nevertheless, this does not reduce the relevance of pragmatic patient and population-centred care.
Conflicts of interest: None to declare
References [1] Lonnroth K, Castro KG, Chakaya JM, et al. Tuberculosis control and elimination 2010-50: cure, care, and social development. Lancet 2010;375:1814-29. [2] Bhargava A, Pai M, Bhargava M, Marais BJ, Menzies D. Can social interventions prevent tuberculosis?: the Papworth experiment (1918-1943) revisited. Am J Respir Crit Care Med 2012;186:442-9. [3] Daniel TM. The history of tuberculosis. Respir Med 2006;100:1862-70. [4] Lonnroth K, Raviglione M. The WHO's new End TB Strategy in the post-2015 era of the Sustainable Development Goals. Trans R Soc Trop Med Hyg 2016;110:148-50. [5] McPherson ME, Leslie D, Sievers A, Patel M, Kelly H. Epidemiology of laboratory confirmed tuberculosis in Victoria, 1990 to 2004. Comm Dis Intell 2008;32:237-41. [6] Churchyard GJ, Fielding KL, Lewis JJ, et al. A trial of mass isoniazid preventive therapy for tuberculosis control. N Engl J Med 2014;370:301-10.