INTRODUCTION Tuberculosis is the second leading cause of infectious-disease death worldwide, after AIDS. Most tuberculosis patients in Cuba have pulmonary TB and recovery rates are high. When TB chemotherapy fails, the most common adverse outcome is death.

OBJECTIVE Determine survival patterns in a cohort of pulmonary TB patients in Cuba.

METHODS A retrospective cohort study was conducted of pulmonary TB patients who were notified and treated in Cuba in 2009 and 2010. Time elapsed between diagnosis and death was examined. Patient survival was analyzed with the Kaplan–Meier method and comparisons were made with the log-rank estimator; an adjusted Cox model was used to analyze risk of death.

RESULTS The study included 1339 patients, of whom 71.7% were aged 25–64 years and 77.4% were men. Infectious pulmonary tuberculosis was the most common form (75.6%). Only a small number of patients (5.7%) presented TB/HIV coinfection. Ninety-four deaths were reported, 55% during the first 60 days of treatment. Lower survival rates were observed among men (HR 1.87, 95% CI 1.02–3.45), patients coinfected with HIV/AIDS (HR 6.25, 95% CI 3.46–11.31), and patients aged ≥48 years (HR 3.93, 95% CI 2.41–6.40).

CONCLUSION The preponderance of deaths early in TB treatment course may be related to diagnostic and/or treatment delays. Older age at diagnosis, male sex and TB/HIV coinfection increase risk of death.

KEYWORDS Pulmonary tuberculosis, HIV/AIDS, mortality, survival, case fatality, Cuba

INTRODUCTION Following a tripling of tuberculosis incidence in Cuba between 1991 and 1994 (from 4.7 to 14.7 per 100,000), the National TB Control Program was revamped in 1995 and the National Reference Center for Childhood TB and Provincial Childhood TB Commissions were created as a strategy for addressing this emerging health problem.

OBJECTIVE Assess the impact of Cuba’s new strategy for TB control in children aged <15 years during the period 1995–2005.

METHODS A descriptive review of health services and systems was conducted in Cuba, examining 157 cases of TB diagnosed in children aged <15 years during the period 1995–2005 and comparing impact and process indicators for selected years (1995, 2000, and 2005). Impact indicators included reduction in: a) incidence; b) serious forms (peritoneal, meningeal, miliary, combined); c) mortality; and d) case outcomes (cure, death, treatment drop-out, treatment failure). Process indicators were proportion of cases with: a) microbiological tests; b) knowledge of infection source; c) diagnoses obtained through adult case contact tracing; d) time to diagnosis <60 days; and e) post-mortem diagnoses.

RESULTS During the period 1995–2005, TB rates in children aged <15 years fell by 50% (from 1.0 to 0.5 per 100,000), more evident in children <10 years. The Havana rate was three times the national rate. Diagnosis was post-mortem in three serious cases (1.9%); there were four deaths (2.5%), none after 2000. Only seven children (4.5%) had serious forms, none after 2002. Except for cases diagnosed post-mortem, all children received treatment directly supervised by health personnel. Cure rate was 99.4%; there were no treatment drop-outs or chronic cases; one relapse was reported (0.6%). Knowledge of infection source increased to 90% over the selected years. Microbiological tests were conducted in 90% of cases, with isolation in 30.9%. No isolate was drug‑resistant, nor were there reports of infectious contacts with resistance. We found no HIV coinfection. At the end of the study, time to diagnosis of ≥60 days persisted in 40% of cases.

CONCLUSIONS Creation of a National Reference Center for Childhood TB and Provincial Childhood TB Commissions has contributed to improved TB diagnosis and control in children aged <15 years, achieving incidence similar to that during the period prior to TB re-emergence and to those of some developed countries. Improvements are needed in the work and systematic training of health personnel, especially at the primary health care level, in order to eliminate TB as a national health problem by 2015.

KEYWORDS Tuberculosis, tuberculosis/diagnosis, tuberculosis/epidemiology, tuberculosis/mortality, tuberculosis/prevention and control, tuberculosis/therapy, child health services, Cuba

Translated from the Spanish and reprinted with permission from the Revista Cubana de Higiene y Epidemiología, Vol 48 No 18, Jan–Apr 2010.
Original available at: http://bvs.sld.cu/revistas/hie/vol_48_1_10/hie02110.htm

ABSTRACT

OBJECTIVE Determine point prevalence of febrile syndromes and compare with prevalence reported by habitual clinical and seroepidemiologic dengue surveillance system in Havana City.

METHODS In October 2007, a descriptive, cross-sectional study was carried out in a representative sample, calculating prevalences of febrile syndromes and undifferentiated febrile syndromes. Chi-square analysis was used for rate comparisons.

RESULTS Point prevalences of febrile syndromes and undifferentiated febrile syndromes were 352.6 and 144.2 times greater, respectively, than those reported by the habitual clinical and seroepidemiologic dengue surveillance system; these differences were statistically significant (p < 0.001).

CONCLUSIONS Point prevalence of febrile syndromes was far greater than prevalence reported by the habitual clinical and seroepidemiologic dengue surveillance system, an indication of underreporting.

KEYWORDS fever, undifferentiated fever, dengue, dengue fever, dengue/epidemiology, seroepidemiologic studies, Cuba