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A team of researchers from Queen Mary University of London has introduced a groundbreaking strategy for tuberculosis (TB) screening that addresses the limitations of current detection methods. This innovative approach aims to screen for both active and dormant TB infections simultaneously, potentially saving lives, reducing transmission rates, and altering the trajectory of this enduring health crisis. The researchers aspire for this strategy to influence recommendations from global health organizations and decision-makers regarding optimal TB screening protocols.
TB remains one of the deadliest infectious diseases worldwide, with an estimated 10.8 million new cases and about 1.25 million fatalities reported in 2023. Effective screening is crucial for prompt disease detection, controlling its spread, and ultimately aiming for eradication. Notably, TB can exist in a dormant state within the body for extended periods without manifesting symptoms, yet it has the potential to activate later, particularly in individuals at heightened risk. Therefore, precise testing for both active and dormant infections is vital for successful screening initiatives.
The methods for TB testing are diverse, including chest X-rays, sputum cultures, molecular diagnostics, symptom screening, and various skin or blood tests to identify dormant TB infection (TBI). All testing modalities are aimed at accurately identifying TB while minimizing false positives, which can lead to unnecessary treatment.
Led by Dr. Dominik Zenner, a Clinical Reader in Infectious Disease Epidemiology, the research team assessed the effectiveness of different combinations of widely used TB tests. Their findings, published in the European Respiratory Journal, analyzed data from 437 original studies and systematic reviews involving 13 distinct TB testing methods. This comprehensive analysis helped estimate the capabilities of existing tests in accurately diagnosing TB and minimizing false positives.
In a departure from previous research, the study revealed that incorporating certain immunological tests for dormant TB infection enhanced TB screening algorithms. These TBI tests are particularly valuable, as they can facilitate the earlier detection of forms of TB that are harder to diagnose, such as extrapulmonary TB (which occurs outside of the lungs) or TB in pediatric populations.
This novel methodology challenges traditional TB testing protocols, which typically use TBI tests solely for identifying dormant infections. The integration of diagnostic evaluations for both dormant and active TB allows for concurrent detection of both forms of the disease. This advancement is particularly significant for policymakers and public health agencies, including the World Health Organization (WHO) and the European Centre for Disease Prevention and Control, eager to enhance TB detection efforts across broad populations.
Dr. Zenner emphasized, “Achieving global control of TB necessitates the early identification and treatment of the disease among at-risk groups. Our innovative screening algorithms demonstrate that it is possible to simultaneously screen for active and dormant TB with high accuracy, especially beneficial for migrants from regions where TB is prevalent.”
Mario Raviglione, former Director of the Global Tuberculosis Programme at the World Health Organization and currently a Professor of Global Health at the University of Milan, remarked: “This thorough and sophisticated study carries significant implications for clinical practice, public health measures, and the formulation of policy. By meticulously reviewing credible evidence and employing modern statistical methodologies, the authors have shown that adding an Interferon Gamma Release Assay (IGRA)—a blood test that gauges the immune response of white blood cells to TB antigens—alongside traditional screening methods markedly increases the accuracy for identifying active TB in migrants.”
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