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WHO rapid communication on updated guidance for the management of TB in children and adolescents


Our TB-CRE Chief Investigator Prof Steve Graham contributed to drafting the recent important updates to WHO guidance on the management of tuberculosis (TB) in children and adolescents. The updates include new recommendations on diagnostic options, treatment regimens, treatment decision algorithms, and optimal models of care for the delivery of child and adolescent TB services.

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2020 / 2021 Publications by theme:

Developing efficient active TB case finding strategies, new models of care to reduce TB mortality and improve outcomes, TB importation into Australia

Household contact/community screening and treatment of LTBI, and developing optimal approaches for LTBI management in Australia

Drug resistance surveillance, clinical trials, personalised treatment of TB and the role of Whole Genome Sequencing (WGS), Pharmacokinetics, and vaccine development

Child and adolescent TB, co-morbidities

Theme 1: FInd and treat 

Find and Treat Papers

Theme 2: Prevent 

Theme 2 Prevent

Theme 3: Emerging Drug-Resistant TB

Theme 3: Emerging Drug-Resistant TB

Theme 4: Vulnerable Populations

Theme 4: Vulnerable Populations

2020 Publications (early)

TB-CRE Investigator TB-related publications

Pittet LF, Tebruegge M, Dutta B, Donath S, Messina N, Casalaz D, Hanekom WA, Britton WJ, Robins-Browne R, Curtis N and Ritz N (2020). "Mycobacterium ulcerans-specific immune response after immunisation with bacillus Calmette-Guérin (BCG) vaccine." Vaccine 39(4): 652-657.


Velen K, Nhung NV, Anh NT, Cuong PD, Hoa NB, Cuong NK, Dung NH, Sy DN, Britton WJ, Marks GB, Fox GJ (2020). "Risk Factors for Tuberculosis (TB) Among Household Contacts of Patients With Smear-Positive TB in 8 Provinces of Vietnam: A Nested Case-Control Study". Clinical Infectious Diseases.

Counoupas C, Ferrell KC, Ashhurst A, Bhattacharyya ND, Nagalingam G, Stewart EL, Feng CG, Petrovsky N, Britton WJ, Triccas JA. (2020) "Mucosal delivery of a multistage subunit vaccine promotes development of lung-resident memory T cells and affords interleukin-17-dependent protection against pulmonary tuberculosis". npj Vaccines; 5: 105.

Ho J, Bokil NJ, Nguyen PTB, Nguyen TA, Liu MY, Hare N, Fox GJ, Saunders BM, Marks GB, Britton WJ (2020). "A transcriptional blood signature distinguishes early tuberculosis disease from latent tuberculosis infection and uninfected individuals in a Vietnamese cohort". Journal of Infection; 81: 72-80.

Nguyen B., Fox G.J., Mason P.H., Denholm J.T. (2020) "Preventive Therapy for Multidrug Resistant Latent Tuberculosis Infection: An Ethical Imperative with Ethical Barriers to Implementation?". In: Jamrozik E., Selgelid M. (eds) Ethics and Drug Resistance: Collective Responsibility for Global Public Health. Public Health Ethics Analysis, vol 5. Springer, Cham.

A. Bainomugisa, C. Gilpin, C. Coulter, and B. J. Maris (2020) "New Xpert MTB/XDR: added value and future in the field." Eur Respir J 2020; 56: 2003616.

Bhattacharyya ND, Counoupas C, Daniel L, Zhang G, Cook SJ, Cootes TA, Stifter SA, Bowen DG, Triccas JA, Bertolino P, Britton WJ, Feng CG (2020). "TCR affinity controls the dynamics but not the functional specification of the Th1 response to mycobacteria". bioRxiv: 2020.2010.2025.353763.

Quan DH, Counoupas C, Nagalingam G, Pinto R, Petrovsky N, Britton WJ, Triccas JA (2020). "Advax adjuvant formulations promote protective immunity against aerosol Mycobacterium tuberculosis in the absence of deleterious inflammation and reactogenicity". bioRxiv: 2020.2010.2001.323105.

Bachmann, N. L., R. Salamzade, A. L. Manson, R. Whittington, V. Sintchenko, A. M. Earl and B. J. Marais (2019). "Key Transitions in the Evolution of Rapid and Slow Growing Mycobacteria Identified by Comparative Genomics." Front Microbiol 10: 3019.

Abidi, S., J. Achar, M. M. Assao Neino, D. Bang, A. Benedetti, S. Brode, J. R. Campbell, E. C. Casas, F. Conradie, G. Dravniece, P. du Cros, D. Falzon, E. Jaramillo, C. Kuaban, Z. Lan, C. Lange, P. Z. Li, M. Makhmudova, A. K. J. Maug, D. Menzies, G. B. Migliori, A. Miller, B. Myrzaliev, N. Ndjeka, J. Noeske, N. Parpieva, A. Piubello, V. Schwoebel, W. Sikhondze, R. Singla, M. B. Souleymane, A. Trébucq, A. Van Deun, K. Viney, K. Weyer, B. J. Zhang and F. Ahmad Khan (2020). "Standardised shorter regimens versus individualised longer regimens for rifampin- or multidrug-resistant tuberculosis." Eur Respir J 55(3).

Al Abri, S., T. Kasaeva, G. B. Migliori, D. Goletti, D. Zenner, J. Denholm, A. Al Maani, D. M. Cirillo, T. Schön, T. Lillebæk, A. Al-Jardani, U. Y. Go, H. M. Dias, S. Tiberi, F. Al Yaquobi, F. A. Khamis, P. Kurup, M. Wilson, Z. Memish, A. Al Maqbali, M. Akhtar, C. Wejse and E. Petersen (2020). "Tools to implement the World Health Organization End TB Strategy: Addressing common challenges in high and low endemic countries." Int J Infect Dis 92s: S60-s68.

Alene, K. A., K. Viney, D. J. Gray, E. S. McBryde, Z. Xu and A. C. A. Clements (2020). "Development of a risk score for prediction of poor treatment outcomes among patients with multidrug-resistant tuberculosis." PLoS One 15(1): e0227100.

Biermann, O., S. Atkins, K. Lönnroth, M. Caws and K. Viney (2020). "'Power plays plus push': experts' insights into the development and implementation of active tuberculosis case-finding policies globally, a qualitative study." BMJ Open 10(6): e036285.

Chakaya, J. M., A. D. Harries and G. B. Marks (2020). "Ending tuberculosis by 2030-Pipe dream or reality?" Int J Infect Dis 92s: S51-s54.

Chakaya, J. M., B. Marais, P. du Cros, F. Ntoumi, S. Mfinanga, N. Kapata, S. E. Hasnain, R. Nathavitharana and A. Zumla (2020). "Programmatic versus personalised approaches to managing the global epidemic of multidrug-resistant tuberculosis." Lancet Respir Med 8(4): 334-335.

Dale, K. D., J. M. Trauer, P. J. Dodd, R. Houben and J. T. Denholm (2020). "Estimating Long-term Tuberculosis Reactivation Rates in Australian Migrants." Clin Infect Dis 70(10): 2111-2118.

Degeling, C., J. Carroll, J. Denholm, B. Marais and A. Dawson (2020). "Ending TB in Australia: Organizational challenges for regional tuberculosis programs." Health Policy 124(1): 106-112.

Denholm, J., A. M. Baker and M. Timlin (2020). "Latent tuberculosis in the general practice context." Aust J Gen Pract 49(3): 107-110.

Fox, G. J., C. B. Nguyen, T. A. Nguyen, P. T. Tran, B. J. Marais, S. M. Graham, B. H. Nguyen, K. Velen, D. W. Dowdy, P. Mason, W. J. Britton, M. A. Behr, A. Benedetti, D. Menzies, V. N. Nguyen and G. B. Marks (2020). "Levofloxacin versus placebo for the treatment of latent tuberculosis among contacts of patients with multidrug-resistant tuberculosis (the VQUIN MDR trial): a protocol for a randomised controlled trial." BMJ Open 10(1): e033945.

Fox, G. J., L. Redwood, V. Chang and J. Ho (2020). "The effectiveness of individual and environmental infection control measures in reducing the transmission of Mycobacterium tuberculosis: a systematic review." Clin Infect Dis.

Ganmaa, D., B. Uyanga, X. Zhou, G. Gantsetseg, B. Delgerekh, D. Enkhmaa, D. Khulan, S. Ariunzaya, E. Sumiya, B. Bolortuya, J. Yanjmaa, T. Enkhtsetseg, A. Munkhzaya, M. Tunsag, P. Khudyakov, J. A. Seddon, B. J. Marais, O. Batbayar, G. Erdenetuya, B. Amarsaikhan, D. Spiegelman, J. Tsolmon and A. R. Martineau (2020). "Vitamin D Supplements for Prevention of Tuberculosis Infection and Disease." N Engl J Med 383(4): 359-368.

Goroh, M. M. D., G. S. Rajahram, R. Avoi, C. H. A. Van Den Boogaard, T. William, A. P. Ralph and C. Lowbridge (2020). "Epidemiology of tuberculosis in Sabah, Malaysia, 2012-2018." Infect Dis Poverty 9(1): 119.

Goroh, M. M. D., C. H. A. van den Boogaard, M. Y. Ibrahim, N. O. Tha, Swe, F. Robinson, K. A. Lukman, M. S. Jeffree, T. William and A. P. Ralph (2020). "Factors Affecting Continued Participation in Tuberculosis Contact Investigation in a Low-Income, High-Burden Setting." Trop Med Infect Dis 5(3).

Gröschel, M. I., J. A. Seddon, S. A. Prabowo, G. B. Migliori, S. M. Graham, M. van den Boom and M. Dara (2020). "European guidance on drug-resistant tuberculosis in children and adolescents." Lancet Child Adolesc Health 4(1): 9-11.

Hawkins, P., W. Tran, G. Nagalingam, C. Y. Cheung, A. Giltrap, G. Cook, W. Britton and R. J. Payne (2020). "Total Synthesis and Antimycobacterial Activity of Ohmyungsamycin A, Deoxyecumicin, and Ecumicin." Chemistry.

Ho, J., N. J. Bokil, P. T. B. Nguyen, T. A. Nguyen, M. Y. Liu, N. Hare, G. J. Fox, B. M. Saunders, G. B. Marks and W. J. Britton (2020). "A transcriptional blood signature distinguishes early tuberculosis disease from latent tuberculosis infection and uninfected individuals in a Vietnamese cohort." J Infect 81(1): 72-80.

Howard-Jones, A. R. and B. J. Marais (2020). "Tuberculosis in children: screening, diagnosis and management." Curr Opin Pediatr 32(3): 395-404.

Huynh, J., G. Thwaites, B. J. Marais and H. S. Schaaf (2020). "Tuberculosis treatment in children: The changing landscape." Paediatr Respir Rev.

K.J, S., B. A, H. G.K and G. S.M (2020). "Tuberculosis in pregnant women and neonates: A meta-review of current evidence." Paediatric Respiratory Reviews.

Karmakar, M., C. H. M. Rodrigues, K. Horan, J. T. Denholm and D. B. Ascher (2020). "Structure guided prediction of Pyrazinamide resistance mutations in pncA." Sci Rep 10(1): 1875.

Kim, H. Y., S. K. Heysell, S. Mpagama, B. J. Marais and J. W. Alffenaar (2020). "Challenging the management of drug-resistant tuberculosis." Lancet 395(10226): 783.

Kim, H. Y., S. Srivastava, H. K. Ak, B. J. Marais and J. W. Alffenaar (2020). "Optimal Dose or Optimal Exposure? Consideration for Linezolid in Tuberculosis Treatment." Antimicrob Agents Chemother 64(7).

Kim, H. Y., S. Srivastava, H. Kumar Ak, B. J. Marais and J. W. Alffenaar (2020). "Optimal dose or optimal exposure? Consideration for linezolid in tuberculosis treatment." Antimicrob Agents Chemother.

Kuddus, M. A., M. T. Meehan, L. J. White, E. S. McBryde and A. I. Adekunle (2020). "Modeling drug-resistant tuberculosis amplification rates and intervention strategies in Bangladesh." PLoS One 15(7): e0236112.

Lisboa, M., I. Fronteira, P. H. Mason and M. Martins (2020). "National TB program shortages as potential factor for poor-quality TB care cascade: Healthcare workers' perspective from Beira, Mozambique." PLoS One 15(2): e0228927.

Lisboa, M., I. Fronteira, P. H. Mason and M. Martins (2020). "Using hospital auxiliary worker and 24-h TB services as potential tools to overcome in-hospital TB delays: a quasi-experimental study." Hum Resour Health 18(1): 28.

Lowbridge, C., S. A. M. Fadhil, G. D. Krishnan, E. Schimann, R. M. Karuppan, N. Sriram, G. S. Rajahram, J. Menon, A. Patel, T. William, D. C. Paul and A. P. Ralph (2020). "How can gastro-intestinal tuberculosis diagnosis be improved? A prospective cohort study." BMC Infect Dis 20(1): 255.

Majumdar, S. S., R. Triasih and S. M. Graham (2020). "Scaling up tuberculosis preventive therapy for contacts in high transmission settings." Lancet Glob Health 8(5): e617-e618.

Marais, B. J. (2020). "Improved urine LAM tests - the answer for child TB diagnosis?" Clin Infect Dis.

Marais, B. J. (2020). "Good outcomes in babies with in-utero bedaquiline exposure." Clin Infect Dis.

Marais, B. J., F. Amanullah, A. Gupta, M. C. Becerra, K. Snow, E. Ngadaya, M. Sharma, A. C. Hesseling, M. Chakaya and A. Zumla (2020). "Tuberculosis in children, adolescents, and women." Lancet Respir Med 8(4): 335-337.

Marais, B. J., J. Chakaya, S. Swaminathan, G. J. Fox, N. Z. Ehtesham, F. Ntoumi, L. Zijenah, M. Maurer and A. Zumla (2020). "Tackling long-term morbidity and mortality after successful tuberculosis treatment." Lancet Infect Dis 20(6): 641-642.

Marais, B. J., M. Nicol and H. J. Zar (2020). "Key advances and remaining challenges in childhood and adolescent tuberculosis." Paediatr Respir Rev.

Marks, G. B., N. V. Nguyen and G. J. Fox (2020). "Community-wide Screening for Tuberculosis. Reply." N Engl J Med 382(12): 1186.

Martinez, L., O. Cords, C. R. Horsburgh, J. R. Andrews, C. Acuna-Villaorduna, S. Desai Ahuja, N. Altet, O. Augusto, D. Baliashvili, S. Basu, M. Becerra, M. Bonnet, W. Henry Boom, M. Borgdorff, F. Boulahbal, A. C. C. Carvalho, J. A. Cayla, T. Chakhaia, P.-C. Chan, T. Cohen, J. Croda, S. Datta, H. Del Corral, J. T. Denholm, R. Dietze, C. C. Dobler, S. Donkor, U. Egere, J. J. Ellner, M. Espinal, C. A. Evans, C.-T. Fang, K. Fielding, G. J. Fox, L. F. García, A. L. García-Basteiro, S. Geis, S. M. Graham, L. Grandjean, D. Hannoun, M. Hatherill, A. M. Hauri, A. C. Hesseling, P. C. Hill, L.-M. Huang, H. Huerga, R. Hussain, L. Jarlsberg, E. C. Jones-López, S. Kato, M. Kato-Maeda, B. Kampmann, H. L. Kirchner, A. Kritski, C. Lange, C.-H. Lee, L.-N. Lee, M.-R. Lee, A. C. Lemos, C. Lienhardt, D.-L. Ling, Q. Liu, N. C. Lo, R. Long, E. Lopez-Varela, P. Lu, M. Magee, L. L. Malone, A. M. Mandalakas, N. A. Martinson, R. Mazahir, M. B. Murray, E. M. Netto, L. Otero, J. Parsonnet, A. Reingold, H. S. Schaaf, J. A. Seddon, S. Sharma, J. Singh, S. Singh, R. Sloot, G. Sotgiu, C. M. Stein, N. T. Iqbal, R. Triasih, L. Trieu, M. F. S. Van Der Loeff, P. Van Der Stuyft, C. Van Schalkwyk, R. Vashishtha, L. M. Verhagen, J. A. Villalba, J.-Y. Wang, C. C. Whalen, T. Yoshiyama, H. J. Zar, J.-P. Zellweger and L. Zhu (2020). "The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis." The Lancet 395(10228): 973-984.

Mason, P. H., C. Lyttleton, G. B. Marks and G. J. Fox (2020). "The technological imperative in tuberculosis care and prevention in Vietnam." Glob Public Health 15(2): 307-320.

Melsew, Y. A., A. I. Adekunle, A. C. Cheng, E. S. McBryde, R. Ragonnet and J. M. Trauer (2020). "Heterogeneous infectiousness in mathematical models of tuberculosis: A systematic review." Epidemics 30: 100374.

Migliori, G. B., S. Tiberi, A. Zumla, E. Petersen, J. M. Chakaya, C. Wejse, M. Muñoz Torrico, R. Duarte, J. W. Alffenaar, H. S. Schaaf, B. J. Marais, D. M. Cirillo, R. Alagna, A. Rendon, E. Pontali, A. Piubello, J. Figueroa, G. Ferlazzo, A. García-Basteiro, R. Centis, D. Visca, L. D'Ambrosio and G. Sotgiu (2020). "MDR/XDR-TB management of patients and contacts: Challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network." Int J Infect Dis 92s: S15-s25.

Ragonnet, R., J. A. Flegg, S. L. Brilleman, E. W. Tiemersma, Y. A. Melsew, E. S. McBryde and J. M. Trauer (2020). "Revisiting the Natural History of Pulmonary Tuberculosis: a Bayesian Estimation of Natural Recovery and Mortality rates." Clin Infect Dis.

Reuter, A., J. A. Seddon, B. J. Marais and J. Furin (2020). "Preventing tuberculosis in children: A global health emergency." Paediatr Respir Rev.

Schwoebel, V., K. G. Koura, M. Adjobimey, S. Gnanou, A. G. Wandji, J. C. Gody, C. Delacourt, A. Detjen, S. M. Graham, E. Masserey, P. Mselatti, A. Roggi and A. Trébucq (2020). "Tuberculosis contact investigation and short-course preventive therapy among young children in Africa." Int J Tuberc Lung Dis 24(4): 452-460.

Snow, K. J., A. T. Cruz, J. A. Seddon, R. A. Ferrand, S. S. Chiang, J. A. Hughes, B. Kampmann, S. M. Graham, P. J. Dodd, R. M. Houben, J. T. Denholm, S. M. Sawyer and K. Kranzer (2020). "Adolescent tuberculosis." Lancet Child Adolesc Health 4(1): 68-79.

Swaminathan, A., P. du Cros, J. Achar, J. Kliescikova, S. Mirgayosieva and B. Pirmahmadzoda (2020). "A case report of a child with probable drug resistant tuberculous pericarditis with a review of challenges involved in diagnosis, treatment and follow up of children with DR-TB pericarditis." BMC Infect Dis 20(1): 298.

Yeong, C., A. L. Byrne, J. G. Cho, V. Sintchenko, T. Crighton and B. J. Marais (2020). "Use of GeneXpert MTB/RIF on a single pooled sputum specimen to exclude pulmonary tuberculosis among hospital inpatients placed in respiratory isolation." Int J Infect Dis 92: 175-180.

Zumla, A., G. Ippolito, F. Ntoumi, V. Seyfert-Margolies, T. J. Nagu, D. Cirillo, J. M. Chakaya, B. Marais and M. Maeurer (2020). "Host-directed therapies and holistic care for tuberculosis." Lancet Respir Med 8(4): 337-340.

Zumla, A., D. Yeboah-Manu, A. L. Michel, E. I. Azhar, J. B. Torrelles, S. I. Cadmus, S. L. Kendall, J. M. Chakaya, B. Marais and R. Kock (2020). "Zoonotic tuberculosis-a call for an open One Health debate." Lancet Infect Dis 20(6): 642-644.

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