1. Thank you for viewing this presentation. We would like to remind you that this material is the property of the author. It is provided to you by the ERS for your personal use only, as submitted by the author.  2012 by the author

2. May 23-26, 2012 in Bucharest, Romania “TB and M/XDR-TB: from clinical management to control and elimination” ERS School Exercise: Investigation of a microepidemic in adults and children Giovanni Sotgiu Martina Sester Lia D´Ambrosio Session IV: Control, elimination and research priorities

3. Exercise: Outline Description of the problem. Organization of CT activities (different groups). Discussion focused on the output (and pos/neg feedback)

4. TB Contact Tracing: definition Investigational activity aimed at identifying individuals with TB and LTBI Ultimate goal STOP transmission TB control programme

5. www.eurosurveillance.orgBorgia et al. Euro Surveill. 2011;16(40):pii=19984

6. Case description On 18 July 2011, a case of pulmonary and extra-pulmonary (splenic) TB was diagnosed in a four month old infant at the children’s hospital ‘Bambino Gesù’ in Rome, Italy Borgia et al. Euro Surveill. 2011;16(40):pii=19984

7. Let’s work together! Identify which steps should be implemented

8. Let’s work together! Prepare a questionnaire!

9. TB Contact Tracing: diagnostic algorithm Medical history Erkens et al (2010) Eur Resp J 36: 925

10. TB Contact Tracing: organization Risk assessment Erkens et al (2010) Eur Resp J 36: 925

11. TB Contact Tracing: organization Risk assessment Erkens et al (2010) Eur Resp J 36: 925

12. TB Contact Tracing: organization

13. Risk group approach: other vulnerable contacts Concentric-circles approach: evidence of recent transmission among the high priority contacts.  Contacts with TST or IGRA conversions.  Young children with a positive TST or IGRA.  Contact with TB.  The observed prevalence of infection is higher than the expected prevalence. TB Contact Tracing: organization

14. Identify the best diagnostic techniques

15. Diagnosis of active tuberculosis Patient history Chest X-ray Culture Acid-fast bacilli staining Nucleic acid amplification testing

16. APC T cell antigens/ peptides cytokine induction cytokine induction activation/ cytokine induction cytokine induction ELISAELISPOT assayFlow-cytometry cytokine activation marker Skin test Immunodiagnosis of latent M. tuberculosis infection T.SPOT.TBQuantiFERON TB gold IGRA IFN-  release assay PPD ESAT-6/CFP-10/TB7.7

17. TB Contact Tracing: organisation Identify the best diagnostic techniques, consider – Sensitivity/specificity of TST vs. IGRA – TB prevalence – Age of tested individuals – Logistics – Costs What is the scientific evidence for your decision

18. TB Contact Tracing: organization Identify the best treatment

19. Options Which regimen is universally recommended? Which alternatives do we want to consider? Is the evidence of alternative regimens sufficient?

24. Do we need a coordination? Any coordination body? Which competences represented? Which steps? Do we need international review? How to organise it? Can you estimate the costs of the operation? – Diagnostics – Treatment – Consultations – Communication – Coordination – Legal – Other?

25. M&E: how to organise it? Other specific indicators here?

26. ACSM: How to organise it?