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Review
. 2019 Jun 6;16(6):e1002824.
doi: 10.1371/journal.pmed.1002824. eCollection 2019 Jun.

Treatment of latent infection to achieve tuberculosis elimination in low-incidence countries

Jonathon R Campbell  1   2 , David Dowdy  3 , Kevin Schwartzman  1   2
Affiliations
Review

Treatment of latent infection to achieve tuberculosis elimination in low-incidence countries

Jonathon R Campbell et al. PLoS Med. .

Abstract

In a Perspective for the Tuberculosis Special Issue, Kevin Schwartzman and colleagues discuss the choices and implications for personal versus public health benefits when pursuing tuberculosis elimination in low-incidence countries.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. What would it take to eliminate TB in Canada? A pictorial description.
Shown is the distribution of TB disease among risk groups. In Canada and other low-incidence countries, 70% of TB disease arises in foreign-born persons. Thus, 7 out of every 10 people in this figure would be foreign-born; in some countries, these individuals may also carry national recommendations for LTBI screening and treatment [10]. The box represents the 49 TB cases (out of every 50 now reported) that must be prevented in order to reach the elimination target of 1 case per million population [4,8]. HIV, human immunodeficiency virus; LTBI, latent TB infection; TB, tuberculosis; WHO, World Health Organization.
Fig 2
Fig 2. Risk–Benefit Considerations for Treatment of LTBI.
Shown are the expected outcomes of treatment for LTBI versus no LTBI treatment. The individual is a 75-year–old woman with a 5-year life expectancy and a positive interferon-gamma release assay who immigrated to Canada from the Philippines 15 years ago and now resides in a 100-person nursing home. Two different perspectives are taken: an individual perspective and a population perspective [21,33,36,37]. LTBI, latent TB infection; NNH, number needed to harm; NNT, number needed to treat; TB, tuberculosis.
See this image and copyright information in PMC

References

    1. WHO. WHO End TB Strategy. Geneva: WHO; 2014.
    1. Public Health Agency of Canada. Canadian Tuberculosis Standards: 7th Edition Ottawa, ON: Government of Canada; 2014.
    1. Walker TM, Lalor MK, Broda A, Ortega LS, Morgan M, Parker L, et al. Assessment of Mycobacterium tuberculosis transmission in Oxfordshire, UK, 2007–12, with whole pathogen genome sequences: an observational study. Lancet Respir Med. 2014;2: 285–292. 10.1016/S2213-2600(14)70027-X - DOI - PMC - PubMed
    1. Shea KM, Kammerer JS, Winston CA, Navin TR, Horsburgh CR. Estimated rate of reactivation of latent tuberculosis infection in the United States, overall and by population subgroup. Am J Epidemiol. 2014;179: 216–225. 10.1093/aje/kwt246 - DOI - PMC - PubMed
    1. WHO. Towards TB Elimination: An Action Framework for Low-Incidence Countries. Geneva: WHO; 2014.

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