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Tuberculosis among patients with sarcoidosis
30
Tubercle and Lung Disease: Supplement
106 TUBERCULOSIS
AMONG PATIENTS WITH SARCOIDOSIS
Magalif, N., Brentsone, R., Bratkovskis, M.; Tuberculosis dispensary, Riga, Latvia.
Since 1958 2400 patients with sarcoidosis have been found in Latvia. 14 of them (0.55%) fell ill with tuberculosis. That is only a slight difference from the frequency of tuberculosis patients in Latvia als a whole. Among these 14 patients only 3 (215%) showed lung tuberculosis without obvious extrapulmonary affection. 9 patients (64 %) had an exclusively extrapulmonary localization of tuberculosis: 7 patients (50% !) in bone and joints, one in central nervous system, one in genitals. Such a localization of tuberculosis strongly differs from the localization of the desease in the other patients suffering from tuberculosis. In 1992 771 persons fell ill with tuberculosis in Latvia, 683 (89 %) of them with lung tuberculosis, 30-with urogenital tuberculosis and only 7 (0.9 % !) with tuberculosis of bones and joints. The mentioned figures, perhaps, give us a clinical confirmation of well-known immunological researches, revealing high tension of immunity in the focus of sarcoidosis affection, particulary in lungs, often developing on the account of the lowered immunity in the other parts of the organism.
107 AN EPIDEMIOLOGICAL
MODEL OF TUBERCULOSIS AS A TOOL FOR COSTEFFECTIVENESS ANALYSIS
Christopher Murray, Holger Sawert; Harvard Center for Population Studies, 9 Bow Street, USA-Cambridge MA 02146
The recent worldwide upsurge of tuberculosis morbidity necessitates the determnination of the future size of the epidemic and the most efficient intervention strategies. For developing countries with restricted health budgets, determination of the cost/effectiveness ratio of intervions is crucial for rational resource allocation. To address these tasks, it is essential to construct a valid epidemiological model of the disease. We contructed a state/transfer (“transmission”) model of the disease that allows to compare the impacts of various intervention methods (vaccination, preventive treatment, curative treatment at various program output levels. Four features of the model make it particularly useful to address the current problems: Input variables can easily be changed to account for specific situations in a variety of countries. The model makes full use of the relevant projections of the HIV/AIDS epidemic. Projections for the future size of the TB epidemic thus account for the most important determinant of recent epidemiological changes. Model calculations and output are stratified by age groups, an important feature for political planning purposes. The validity of model calculations has been established by performing simulations based on the situation in the United States, where extensive and accurate epidemiological and demographic data are available. By fitting the model output to past epidemiological trends, it is possible to determine sets of model parameters that accurately reflect the epidemiology of the disease.
108 SCREENING FOR TUBERCULOSIS AMONG IMMIGRANTS AND ASYLUMSEEKERS IN THE NETHERLANDS: METHODS AND RESULTS Keizer, * S. T., Annee, ** J. A. C. M. 1 Deutekom, * H. van, WarrisVersteegen, *** A. A.; Tuberculosis departments of the *Municipal Health Service Amsterdam, P. 0. Box 20244, 1OOOHE Amsterdam, **Municipal Health Service Midden Brabant, Tilburg. ***Department of the Chief Medical Officer of Health, Rijswijk, The Netherlands.
Foreign born persons from countries where tuberculosis is highly prevalent, who intend to stay more than three months in the Netherlands are legally submitted to screening for pulmonary tuberculosis after arrival. Among them are immigrants and asylumseekers from Africa, Asia and Eastern Europe. Whereas immigrants are individually screened at the tuberculosis departments of the local public health services, asylumseekers are collectively screened with mobile mass miniature CXR-equipment since 1992. Evaluation of the results of initial screening among 12,000 immigrants in 1991 and 1992, shows a prevalence of + 300 cases of pulmonary tuberculosis per 100,000. The results of screening among 30,000 asylumseekers from 1990 through 1993, indicate a prevalence of pulmonary tuberculosis of 400 per 100,000. Sputum confirmation ist obtained in + 35-50% of cases. The highest prevalence was found among asylumseekers from Somalia and former Yougoslavia. Mass immigration has a significant impact on national case rates. The recent reversal in the decline in the number of reported tuberculosis cases in the Netherlands in largely explained by an increase in the number of foreign born persons with tuberculosis. In 1992, this number (745) for the first time surpassed the number of native born Dutch persons with tuberculosis (720). Screening for tuberculosis contributes significantly to the diagnosis of tuberculosis among foreign born persons immigrating to the Netherlands. The results justify continuation of the screening program.
109 IMMUNOGENICITY OF MYCOBACTERIUM SMEGMATIS RECOMBINANTS BEARING BCG GENES IN SUSCEPTIBLE AND RESISTANT MICE Collins, F., Falcone, V., Jacobs, FDA, Bethesda, MD.
W.; Mycobacteria Laboratory,
The effectiveness of BCG vaccination in the prevention of pulmonary tuberculosis has been a source of intense debate for the past decade. Attempts to improve the immunogenicity of BCG by means of gene cloning have been limited by a paucity of information about the protective antigens of M. tuberculosis. A large number of recombinant strains of M. smegmatis bearing random fragments of BCG DNA were passaged through C57BW6 (Beg”) and A/J (Beg’) mice. Spleens were cultured on Middlebrook 7Hll agar enriched with kannamycin and the resulting large rough colonies were compared with the corresponding vector control carrying phasmid DNA only. Recombinants were grown in protein-free ProskauerBeck-Tween medium and whole cell sonicates and culture filtrate concentrates were compared electrophoretically with corresponding preparations from BCG Pasteur. The protective qualities of these proteins were compared using suitably vaccinated mice which were then challenged
Tubercle and Lung Disease: Supplement
106 TUBERCULOSIS
AMONG PATIENTS WITH SARCOIDOSIS
Magalif, N., Brentsone, R., Bratkovskis, M.; Tuberculosis dispensary, Riga, Latvia.
Since 1958 2400 patients with sarcoidosis have been found in Latvia. 14 of them (0.55%) fell ill with tuberculosis. That is only a slight difference from the frequency of tuberculosis patients in Latvia als a whole. Among these 14 patients only 3 (215%) showed lung tuberculosis without obvious extrapulmonary affection. 9 patients (64 %) had an exclusively extrapulmonary localization of tuberculosis: 7 patients (50% !) in bone and joints, one in central nervous system, one in genitals. Such a localization of tuberculosis strongly differs from the localization of the desease in the other patients suffering from tuberculosis. In 1992 771 persons fell ill with tuberculosis in Latvia, 683 (89 %) of them with lung tuberculosis, 30-with urogenital tuberculosis and only 7 (0.9 % !) with tuberculosis of bones and joints. The mentioned figures, perhaps, give us a clinical confirmation of well-known immunological researches, revealing high tension of immunity in the focus of sarcoidosis affection, particulary in lungs, often developing on the account of the lowered immunity in the other parts of the organism.
107 AN EPIDEMIOLOGICAL
MODEL OF TUBERCULOSIS AS A TOOL FOR COSTEFFECTIVENESS ANALYSIS
Christopher Murray, Holger Sawert; Harvard Center for Population Studies, 9 Bow Street, USA-Cambridge MA 02146
The recent worldwide upsurge of tuberculosis morbidity necessitates the determnination of the future size of the epidemic and the most efficient intervention strategies. For developing countries with restricted health budgets, determination of the cost/effectiveness ratio of intervions is crucial for rational resource allocation. To address these tasks, it is essential to construct a valid epidemiological model of the disease. We contructed a state/transfer (“transmission”) model of the disease that allows to compare the impacts of various intervention methods (vaccination, preventive treatment, curative treatment at various program output levels. Four features of the model make it particularly useful to address the current problems: Input variables can easily be changed to account for specific situations in a variety of countries. The model makes full use of the relevant projections of the HIV/AIDS epidemic. Projections for the future size of the TB epidemic thus account for the most important determinant of recent epidemiological changes. Model calculations and output are stratified by age groups, an important feature for political planning purposes. The validity of model calculations has been established by performing simulations based on the situation in the United States, where extensive and accurate epidemiological and demographic data are available. By fitting the model output to past epidemiological trends, it is possible to determine sets of model parameters that accurately reflect the epidemiology of the disease.
108 SCREENING FOR TUBERCULOSIS AMONG IMMIGRANTS AND ASYLUMSEEKERS IN THE NETHERLANDS: METHODS AND RESULTS Keizer, * S. T., Annee, ** J. A. C. M. 1 Deutekom, * H. van, WarrisVersteegen, *** A. A.; Tuberculosis departments of the *Municipal Health Service Amsterdam, P. 0. Box 20244, 1OOOHE Amsterdam, **Municipal Health Service Midden Brabant, Tilburg. ***Department of the Chief Medical Officer of Health, Rijswijk, The Netherlands.
Foreign born persons from countries where tuberculosis is highly prevalent, who intend to stay more than three months in the Netherlands are legally submitted to screening for pulmonary tuberculosis after arrival. Among them are immigrants and asylumseekers from Africa, Asia and Eastern Europe. Whereas immigrants are individually screened at the tuberculosis departments of the local public health services, asylumseekers are collectively screened with mobile mass miniature CXR-equipment since 1992. Evaluation of the results of initial screening among 12,000 immigrants in 1991 and 1992, shows a prevalence of + 300 cases of pulmonary tuberculosis per 100,000. The results of screening among 30,000 asylumseekers from 1990 through 1993, indicate a prevalence of pulmonary tuberculosis of 400 per 100,000. Sputum confirmation ist obtained in + 35-50% of cases. The highest prevalence was found among asylumseekers from Somalia and former Yougoslavia. Mass immigration has a significant impact on national case rates. The recent reversal in the decline in the number of reported tuberculosis cases in the Netherlands in largely explained by an increase in the number of foreign born persons with tuberculosis. In 1992, this number (745) for the first time surpassed the number of native born Dutch persons with tuberculosis (720). Screening for tuberculosis contributes significantly to the diagnosis of tuberculosis among foreign born persons immigrating to the Netherlands. The results justify continuation of the screening program.
109 IMMUNOGENICITY OF MYCOBACTERIUM SMEGMATIS RECOMBINANTS BEARING BCG GENES IN SUSCEPTIBLE AND RESISTANT MICE Collins, F., Falcone, V., Jacobs, FDA, Bethesda, MD.
W.; Mycobacteria Laboratory,
The effectiveness of BCG vaccination in the prevention of pulmonary tuberculosis has been a source of intense debate for the past decade. Attempts to improve the immunogenicity of BCG by means of gene cloning have been limited by a paucity of information about the protective antigens of M. tuberculosis. A large number of recombinant strains of M. smegmatis bearing random fragments of BCG DNA were passaged through C57BW6 (Beg”) and A/J (Beg’) mice. Spleens were cultured on Middlebrook 7Hll agar enriched with kannamycin and the resulting large rough colonies were compared with the corresponding vector control carrying phasmid DNA only. Recombinants were grown in protein-free ProskauerBeck-Tween medium and whole cell sonicates and culture filtrate concentrates were compared electrophoretically with corresponding preparations from BCG Pasteur. The protective qualities of these proteins were compared using suitably vaccinated mice which were then challenged