Drivers of tuberculosis epidemics: the role of risk factors and social determinants.

One of the major breakthroughs in the history of medicine is undoubtedly the discovery of antibiotics. Their use in animal husbandry and veterinary medicine has resulted in healthier and more productive farm animals, ensuring the welfare and health of both animals and humans. Unfortunately, from the first use of penicillin, the resistance countdown started to tick. Nowadays, the infections caused by antibiotic-resistant bacteria are increasing, and resistance to antibiotics is probably the major public health problem. Antibiotic use in farm animals has been criticized for contributing to the emergence of resistance. The use and misuse of antibiotics in farm animal settings as growth promoters or as nonspecific means of infection prevention and treatment has boosted antibiotic consumption and resistance among bacteria in the animal habitat. This reservoir of resistance can be transmitted directly or indirectly to humans through food consumption and direct or indirect contact. Resistant bacteria can cause serious health effects directly or via the transmission of the antibiotic resistance traits to pathogens, causing illnesses that are difficult to treat and that therefore have higher morbidity and mortality rates. In addition, the selection and proliferation of antibiotic-resistant strains can be disseminated to the environment via animal waste, enhancing the resistance reservoir that exists in the environmental microbiome. In this review, an effort is made to highlight the various factors that contribute to the emergence of antibiotic resistance in farm animals and to provide some insights into possible solutions to this major health issue.

/pdf/agriculture-and-food-animals-as-a-source-of-antimicrobial-3tyy7iqkqs.pdf

Agriculture and food animals as a source of antimicrobial-resistant bacteria.

Background For decades it has been assumed that postprimary tuberculosis is usually caused by reactivation of endogenous infection rather than by a new, exogenous infection. Methods We performed DNA fingerprinting with restriction-fragment–length polymorphism analysis on pairs of isolates of Mycobacterium tuberculosis from 16 compliant patients who had a relapse of pulmonary tuberculosis after curative treatment of postprimary tuberculosis. The patients lived in areas of South Africa where tuberculosis is endemic. Medical records were reviewed for clinical data. Results For 12 of the 16 patients, the restriction-fragment–length polymorphism banding patterns for the isolates obtained after the relapse were different from those for the isolates from the initial tuberculous disease. This finding indicates that reinfection was the cause of the recurrence of tuberculosis after curative treatment. Two patients had reinfections with a multidrug-resistant strain. All 15 patients who were tested for the human immu...

https://www.nejm.org/doi/pdf/10.1056/NEJM199910143411602

Exogenous Reinfection as a Cause of Recurrent Tuberculosis after Curative Treatment

https://www.tballiance.org/sites/default/files/research-papers/Burden%20of%20childhood%20tuberculosis%20in%2022%20high-burden%20countries%2C%20a%20mathematical%20modelling%20study.pdf

Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study

A high burden of malaria, tuberculosis, and HIV infection contributes to national and individual poverty. We have reviewed a broad range of evidence detailing factors at individual, household, and community levels that influence vulnerability to malaria, tuberculosis, and HIV infection and used this evidence to identify strategies that could improve resilience to these diseases. This first part of the review explores the concept of vulnerability to infectious diseases and examines how age, sex, and genetics can influence the biological response to malaria, tuberculosis, and HIV infection. We highlight factors that influence processes such as poverty, livelihoods, gender discrepancies, and knowledge acquisition and provide examples of how approaches to altering these processes may have a simultaneous effect on all three diseases.

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(04)01002-3.pdf

Vulnerability to malaria, tuberculosis, and HIV/AIDS infection and disease. Part 1: determinants operating at individual and household level.

CITATION: Beyers, N. et al. 1996. The use of a geographical information system (GIS) to evaluate the distribution of tuberculosis in a high-incidence community. South African Medical Journal, 86(1):40-44.

/pdf/the-use-of-a-geographical-information-system-gis-to-evaluate-4bike5moqa.pdf

The use of a geographical information system (GIS) to evaluate the distribution of tuberculosis in a high-incidence community

Environmental water requirements (EWRs) are set for South Africa’s estuaries to ensure that they are maintained in a state that is both achievable and commensurate with their level of conservation and economic importance. However, these EWRs are typically determined on the basis of models and scenario analyses that require extrapolation beyond existing data and experience, especially if climate change is considered. In the case of the Berg Estuary, South Africa, available data on changes in freshwater flow and water quality span a period of at least five decades (1970s–present) during which significant reduction in flows has been observed. Monitoring data also cover an extreme 3-year drought, from 2015−2017, which provided a unique opportunity to study the effects of severe freshwater starvation (zero-flow for an extended period) on this large, permanently open system. Our analyses show that mean annual runoff (MAR) under present-day conditions has been reduced to around 50% of that under reference (natural) conditions and that reduction in runoff during the low-flow season (summer) has been more severe (80–86% reduction) than for the high-flow season (39–42% reduction). The salinity gradient now extends much further upstream than under reference conditions. Hypersaline conditions along with a reverse salinity gradient were recorded in the estuary for the first time ever during the drought of 2015/17. Levels of dissolved inorganic nitrogen (NO x ) reaching the estuary from the catchment have increased dramatically (6–7 fold) over the past five decades, dissolved reactive phosphate (PO 4 ) slightly less so (2–3 fold), but ammonia (NH 4 ) hardly at all. Increases in nutrient input from the catchment in the high-flow season are also much more dramatic than in the low-flow season. The estuary is no longer compliant with gazetted EWRs and requires urgent interventions to restore the quantity and quality of freshwater it receives.

The impacts of long-term flow reductions and an extreme drought on a large, permanently open estuary, and implications for setting the ecological reserve

Aim—To study the epidemiology of childhood tuberculosis (TB) in a developing country Setting—Two urban communities of Cape Town, South Africa with a TB case notification rate of 1149/100 000 Design—Retrospective descriptive study using the national population census (1991), 10 year oYcial TB notification records, and a geographical information system Results—The case notification rate of TB in children 0‐5 years old was 3588 cases/ 100 000 children aged 0‐5 years, 35 times the case notification rate in adults Children (0‐14 years) accounted for 39% of the total case load Childhood TB case notification rate correlated with parental education (r = ˛064), annual household income (r = ˛06), and crowding (r = 032) Conclusion—Children, especially those living in poor socioeconomic conditions, form an important epidemiological group and account for a notable proportion of the morbidity caused by TB EVorts to improve TB control must therefore not only target adults (case detection and cure of infectious cases) but also children (screening of child contacts of adult cases) and the socioeconomic living conditions (Arch Dis Child 1999;80:433‐437)

https://adc.bmj.com/content/archdischild/80/5/433.full.pdf

Childhood tuberculosis in an urban population in South Africa: burden and risk factor

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The use of a geographical information system (GIS) to evaluate the distribution of tuberculosis in a high-incidence community

The impacts of long-term flow reductions and an extreme drought on a large, permanently open estuary, and implications for setting the ecological reserve

Childhood tuberculosis in an urban population in South Africa: burden and risk factor