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Biomedical subjects

S E Royce

Publications and source records attributed to S E Royce.

7 recordsLinked to original sources
PubMed2003

Evaluation of tuberculosis contact investigations in California.

OBJECTIVE: To estimate the burden of tuberculosis (TB) contact investigations in California, assess outcomes and effectiveness, and identify performance gaps. METHODS: Aggregate program management reports were used to examine contact investigations conducted for pulmonary TB cases reported between 1 July 1999 and 30 June 2000 in California. Findings were compared to national objectives, and performance gaps were identified. Costs were estimated, and effectiveness of TB case detection and prevention was assessed. RESULTS: A total of 2032 acid-fast bacilli sputum smear-positive and sputum smear-negative/culture-positive cases was reported; 17774 contacts were elicited, and 15582 (88%) contacts were evaluated. TB disease and latent tuberculosis infection (LTBI) were diagnosed in 111 (<1%) and 4609 (30%) contacts, respectively; 1958 (43%) contacts with LTBI completed treatment. Costs of contact investigations were estimated at dollars 4.8 million; 81% of expected TB cases were detected, but only 35% of cases expected to occur within 2 years following the investigation were prevented. CONCLUSIONS: California's performance did not meet national objectives for contact evaluation or treatment completion; improved effectiveness of contact investigations in California is needed. Although analysis of existing contact investigation surveillance data provided a macro-level view of performance gaps, expanded surveillance data are required to inform interventions.

California↗
PubMed2003

Yield of source-case and contact investigations in identifying previously undiagnosed childhood tuberculosis.

OBJECTIVE: To determine the extent to which source-case investigations, in which a child was the index tuberculosis (TB) case, and contact investigations of adult pulmonary cases, identified children and adults with previously undiagnosed TB or latent tuberculosis infection (LTBI). METHODS: We reviewed records of 111 source-case investigations and 38 contact investigations involving 164 TB cases among children <5 years of age from eight California health jurisdictions with a case rate greater than the state average for this age group (9.6/100000). RESULTS: In source-case investigations, 141 children <5 years and 113 children 5-14 years of age were evaluated for TB disease and LTBI. Fourteen previously undiagnosed TB cases were found, including seven children <5 years of age. Source-case investigations also identified persons who might benefit from treatment for LTBI (45% had a positive tuberculin reaction). In contact investigations of adult TB cases, 202 children <5 years and 122 children 5-14 years of age were evaluated. In addition to 46 children with TB <5 years of age, the basis on which these contact investigations were selected for study, four children 5-14 years of age and 10 adults were found to have TB disease. A high percentage (41%) of contacts with a positive tuberculin reaction was found, especially among household contacts. CONCLUSIONS: Source-case investigations and contact investigations are effective for finding previously undiagnosed cases of TB. They are also useful for identifying children and adults who would possibly benefit from treatment for LTBI. Earlier detection and treatment of adults with TB could interrupt transmission and be a step toward eliminating childhood TB.

Adolescent↗
PubMed2000

Missed opportunities for preventing tuberculosis among children younger than five years of age.

OBJECTIVES: Childhood tuberculosis (TB) is an important indicator of public health success in interrupting and preventing TB transmission. To determine the frequency and types of missed opportunities for preventing TB among children <5 years of age. METHODS: We collected data from the public health records of child TB cases and their adult source cases. These children were from health jurisdictions where TB case rates in children were higher than the California average for this age group. RESULTS: We reviewed the records for 165 children reported with TB (20% confirmed by culture). These children were evaluated for TB because of signs or symptoms of illness (32%), a contact investigation (26%), screening (22%), a source case investigation (4%), and unknown reasons (16%). Excluding 4 children infected by Mycobacterium bovis, only 59 of 161 children (37%) had a source case found. Children found in a contact investigation, born in the United States, <1 year of age, or who were black were more likely to have a source case found than children who did not have one of these characteristics. Of 43 children found in a contact investigation, improvements in contact investigations may have prevented TB in 17 of these children (40%). Among the 43 adult source cases, factors that may have facilitated transmission include delayed reporting in 23%, a delayed contact investigation in 21%, and delayed or nondocumented bacteriologic sputum conversion in 42% of culture-positive cases. CONCLUSIONS: Important missed opportunities to prevent TB in children include the failure to find and appropriately manage adult source cases and failure to completely evaluate and properly treat children exposed to TB. Improvements in case detection, case management, and contact investigations are necessary to eliminate TB in children.

Adolescent↗
PubMed2000

Progress and problems in achieving the United States national target for completion of antituberculosis treatment.

SETTING: The target for antituberculosis treatment in the United States is for 90% of patients to complete therapy within 12 months. OBJECTIVE: To assess progress in achieving the US national target for tuberculosis treatment. DESIGN: A comparison of treatment outcome in two cohorts of patients with drug-susceptible tuberculosis in California-those reported in 1993-1994 (8488 patients) and 1995-1996 (7823 patients). Risk factors for delay in treatment completion (more than 12 months) were assessed. RESULTS: The percentage of cases completing treatment within 12 months increased in the 1995-1996 cohort (to 68.2%), primarily due to concomitant reductions in delays in treatment completion (to 11.1%) and defaulting (to 2.4%). Disparities in timely treatment completion narrowed over time and in nearly all subpopulations, especially in groups with lowest treatment completion in the 1993-1994 cohort. Remaining risk factors for delay in treatment completion included AIDS and older ages. A substantial percentage of patients died or moved before treatment completion. CONCLUSIONS: Despite recent improvements, completion of antituberculosis treatment in California has not reached the national target. Reaching this target will require further reductions in delays in treatment completion and deaths during treatment, and ensuring that patients who move eventually complete treatment.

Adolescent↗
PubMed1999

B notifications and the detection of tuberculosis among foreign-born recent arrivals in California.

OBJECTIVE: To evaluate the effectiveness and limitations of the B notification program for detecting tuberculosis among recent foreign-born arrivals in California. DESIGN: Retrospective cohort study. All foreign-born visa holders with a B notification who arrived in California from January 1992 through September 1995 (n = 27 412) were matched with a listing of foreign-born persons who arrived in the US during the same time period and who were reported to have active tuberculosis in California within one year of their arrival from January 1992 through September 1996 (n = 2547). RESULTS: Overall, 3.5% (95% confidence interval 3.3%, 3.8%) of all persons with a B notification were reported to have active tuberculosis within a year of arrival. Recent arrivals with a B notification and tuberculosis accounted for 38% of all foreign-born cases of tuberculosis reported within one year of arrival. Compared to recent arrivals without a B notification, those with a B notification were more likely to have pulmonary tuberculosis, less likely to have smear-positive pulmonary disease and reported with tuberculosis sooner after their arrival in the US. The B notification program was not able to identify 87% of the smear-positive pulmonary tuberculosis cases in adults, and did not identify 99% of these highly infectious cases among Latin Americans. CONCLUSIONS: Although the evaluation of persons who enter the US with B notifications has a high yield for identifying active tuberculosis cases, it was not able to identify the majority of recent arrivals with the most infectious form of tuberculosis.

Adolescent↗
PubMed1998

Movement of tuberculosis patients and the failure to complete antituberculosis treatment.

The outcomes of tuberculosis (TB) patients who move before completing antituberculosis treatment have not been described. We studied a population-based cohort of 2,576 adult patients reported as having TB in California during 1993, including 147 patients who moved from one local health jurisdiction to another within California. We determined treatment outcomes (completed, defaulted, died, other) for 131 (89%) of these 147 patients. Patients who moved defaulted more often (relative risk [RR] = 5.5, 95% confidence interval [CI] = 4.1 to 7.4) than patients who did not move. Including these patients' treatment outcomes increased the known number of defaulters by 30%, from 141 to 183 persons. Additionally, diagnosis of TB in a state prison emerged as the strongest risk factor for defaulting from treatment. Patients who moved or defaulted were more likely to abuse drugs or alcohol, to be homeless or to be associated with congregate settings such as jails and prisons. On average, patients who defaulted after moving received less than three-quarters of their recommended treatment regimens. These patients may remain infectious or become infectious again. Our findings highlight the importance of ensuring complete treatment for TB patients who move; failure to do so will adversely affect patient health and TB control, especially in many high-risk populations and settings.

Adolescent↗