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Table 1.  

Characteristic† All patients, no. (%),
n = 357‡
UK-born patients, no. (%),
n = 214§
Non–UK-born patients, no. (%),
n = 83¶
Age group, y
   0–14 6 (1.7) 4 (1.9) 2 (2.4)
   15–44 106 (29.7) 39 (18.2) 54 (65.1)
   45–64 70 (19.6) 45 (21.0) 12 (14.5)
   ≥65 175 (49.0) 126 (58.9) 15 (18.1)
Male sex 196 (55.1) 130 (60.8) 37 (44.6)
Ethnicity
   White 230 (73.0) 199 (93.9) 15 (18.5)
   Black African 37 (11.8) 2 (0.9) 35 (43.2)
   Indian subcontinent 16 (5.1) 3 (1.4) 9 (11.1)
   Other 32 (10.2) 8 (3.8) 22 (27.2)
Time since entered United Kingdom, y
   <2 NA NA 10 (14.7)
   2–5 NA NA 17 (25.0)
   6–10 NA NA 20 (29.4)
   >10 NA NA 21 (30.9)
Place of residence
   Rural 86 (24.9) 62 (29.0) 9 (10.8)
   Urban 259 (75.1) 152 (71.0) 74 (89.2)
Pulmonary TB#
   Yes 199 (56.9) 131 (61.5) 38 (45.8)
   No 151 (42.3) 82 (38.5) 45 (54.2)
≥1 social risk factor** 12 (7.9) 6 (5.9) 5 (11.1)
Previous TB diagnosis 17 (6.1) 13 (6.7) 5 (5.4)

Table 1. Characteristics of patients with Mycobacterium bovis disease, England, Wales, and Northern Ireland, 2002–2014*

*IQR, interquartile range; NA, not applicable; TB, tuberculosis.
†Sex, age, and site of disease reported for all cases (excluding breakdowns by birth in or not in the United Kingdom); all other characteristics reported only for notified cases.
‡Median age (IQR) 58 (36–77) y.
§Median age (IQR) 70 (52–79) y.
¶Median age (IQR) 35 (28–58) y.
#Pulmonary TB with or without extrapulmonary TB, those recorded as “no” had exclusively extrapulmonary TB.
**Data only available from 2010 on.

Table 2.  

Characteristic M. bovis patients,
no. (%), n = 329
M. tuberculosis patients,
no. (%), n = 58,540
Univariable analysis Multivariable analysis
OR (95% CI) p value OR (95% CI) p value
Age group, y
   0–14 6 (1.8) 1,200 (2.1) 1.9 (0.8–4.3) <0.001 1.5 (0.6–3.6) <0.001
   15–44 102 (31.0) 38,558 (65.9) Referent Referent
   45–64 61 (18.5) 10,953 (18.7) 2.1 (1.5–2.9) 1.3 (0.9–2.0)
   ≥65 160 (48.6) 7,826 (13.4) 7.7 (6.0–9.9) 3.6 (2.6–5.2)
Sex
   M 179 (54.4) 33,715 (57.7) 0.9 (0.7–1.1) 0.229 0.9 (0.7–1.1) 0.287
   F 150 (45.6) 24,721 (42.3) Referent Referent
UK-born
   Yes 214 (72.1) 13,576 (24.7) 7.9 (6.1–10.1) <0.001 2.6 (1.7–4.1) <0.001
   No 83 (27.9) 71,361 (75.3) Referent Referent
Ethnicity
   White 230 (73) 11,968 (21.1) 28.0 (16.8–46.4) <0.001 14.6 (7.2–26.9) <0.001
   Black African 37 (11.8) 12,501 (22.1) 4.3 (2.4–7.7) 7.4 (3.7–14.9)
   Indian subcontinent† 16 (5.1) 23,285 (41.1) Referent Referent
   Other 32 (10.2) 8,905 (15.7) 5.2 (2.9–9.5) 7.3 (3.6–14.8)
Occupation
   Agricultural/animal contact work 20 (7.9) 116 (0.3) 32.4 (19.8–53.0) <0.001 29.5 (16.9–51.6) <0.001
   Other 232 (92.1) 43,698 (99.7) Referent Referent
Site of disease
   Pulmonary 193 (58.8) 37,580 (64.2) 0.8 (0.6–1.0) 0.048 0.4 (0.3–0.5) <0.001
   Extrapulmonary only 135 (41.2) 20,938 (35.8) Referent Referent
Place of residence
   Rural 81 (24.6) 1,944 (3.3) 9.5 (7.3–12.2) <0.001 2.8 (2.0–3.9) <0.001
   Urban 248 (75.4) 56,380 (96.7) Referent Referent

Table 2. Demographics and risk factors for patients with Mycobacterium tuberculosis and M. bovis disease, England, Wales, and Northern Ireland, 2002–2014*

*Interactions between 1) place of birth (UK-born/non–UK-born) and all of the other variables (age, sex, ethnicity, occupation, site of disease, place of residence [rural/urban]) and 2) age and site of disease or place of residence (rural/urban) were tested. No significant interactions existed in the model.
OR, odds ratio.
†Indian, Bangladeshi, and Pakistani ethnic groups.

Table 3.  

Exposure No. characteristics/no. with information recorded (%)
All patients UK-born patients Non–UK-born patients
Consumption of unpasteurized milk products 109/166 (65.7) 74/112 (66.1) 25/37 (67.6)
   In United Kingdom 66/88 (75.0) 60/64 (93.8) 1/15 (6.7)
Travel or residence in a high incidence country 77/203 (37.9) 29/126 (23.0) 44/56 (78.6)
Work related animal exposure 51/103 (49.5) 35/71 (49.3) 7/22 (31.8)
   In United Kingdom 33/37 (89.2) 28/29 (96.6) 2/4 (50.0)
Contact with human patient with TB 33/181 (18.2) 21/120 (17.5) 10/42 (23.8)
   In United Kingdom 36/38 (94.7) 19/19 (100) 6/8 (75.0)
Physical contact with wild animal 18/126 (14.3) 15/92 (16.3) 0/25 (0)
   In United Kingdom 10/13 (76.9) 7/10 (70.0) Not applicable
Physical contact with animal with TB 18/99 (18.2) 14/76 (18.4) 2/18 (11.1)
   In United Kingdom 10/1 (90.9) 9/10 (90.0) 1/1 (100)
Pet with TB† 2 2 0
Farm animal with TB† 11 9 1
No exposure† 6 6 0

Table 3. Risk factor exposures reported by patients with Mycobacterium bovis disease, England, Wales, and Northern Ireland, 2006–2014*

*TB, tuberculosis.
†Denominator not available.

CME

Epidemiology of Mycobacterium bovis Disease in Humans in England, Wales, and Northern Ireland, 2002–2014

  • Authors: Jennifer A. Davidson, MSc, BSc; Miranda G. Loutet, BSc, MSc; Catherine O'Connor, BSc, MVPH; Cathriona Kearns, BSc, PGDip; Robert M.M. Smith, PhD; Maeve K. Lalor, PhD; H. Lucy Thomas, MSc; Ibrahim Abubakar, PhD; Dominik Zenner, MD
  • CME Released: 2/15/2017
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 2/15/2018
Start Activity


Target Audience and Goal Statement

This activity is intended for infectious disease specialists, public health officials, internists, pulmonologists, and other clinicians caring for patients with or at risk for Mycobacterium bovis infection.

The goal of this activity is to describe the epidemiology of human cases of M bovis in England, Wales, and Northern Ireland from 2002-2014, based on a national cohort study.

Upon completion of this activity, participants will be able to:

  1. Identify the demographic features of Mycobacterium bovis cases in England, Wales, and Northern Ireland from 2002-2014, based on a national cohort study
  2. Compare demographic and clinical characteristics of human tuberculosis caused by M bovis and M tuberculosis notified cases
  3. Recognize potential exposures, including genotyping comparison between human cases, that may indicate acquisition of M bovis in humans


Disclosures

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Authors

  • Jennifer A. Davidson, MSc, BSc

    Public Health England, London, United Kingdom

    Disclosures

    Disclosure: Jennifer A. Davidson, MSc, BSc, has disclosed no relevant financial relationships.

  • Miranda G. Loutet, BSc, MSc

    Public Health England, London, United Kingdom

    Disclosures

    Disclosure: Miranda G. Loutet, BSc, MSc, has disclosed no relevant financial relationships.

  • Catherine O'Connor, BSc, MVPH

    Public Health England, London, United Kingdom

    Disclosures

    Disclosure: Catherine O'Connor, BSc, MVPH, has disclosed no relevant financial relationships.

  • Cathriona Kearns, BSc, PGDip

    Public Health Agency Northern Ireland, Belfast, United Kingdom

    Disclosures

    Disclosure: Cathriona Kearns, BSc, PGDip, has disclosed no relevant financial relationships.

  • Robert M.M. Smith, PhD

    Public Health Wales, Cardiff, United Kingdom

    Disclosures

    Disclosure: Robert M.M. Smith, PhD, has disclosed no relevant financial relationships.

  • Maeve K. Lalor, PhD

    Public Health England; University College London, London, United Kingdom

    Disclosures

    Disclosure: Maeve K. Lalor, PhD, has disclosed no relevant financial relationships.

  • H. Lucy Thomas, MSc

    Public Health England; University College London, London, United Kingdom

    Disclosures

    Disclosure: H. Lucy Thomas, MSc, has disclosed no relevant financial relationships.

  • Ibrahim Abubakar, PhD

    Public Health England; University College London, London, United Kingdom

    Disclosures

    Disclosure: Ibrahim Abubakar, PhD, has disclosed no relevant financial relationships.

  • Dominik Zenner, MD

    Public Health England; University College London, London, United Kingdom

    Disclosures

    Disclosure: Dominik Zenner, MD, has disclosed no relevant financial relationships.

Editor

  • P. Lynne Stockton Taylor, VMD, MS, ELS(D)

    Technical Writer-Editor, Emerging Infectious Diseases

    Disclosures

    Disclosure: P. Lynne Stockton Taylor, VMD, MS, ELS(D), has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer, Medscape, LLC

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed the following relevant financial relationships:
    Owns stock, stock options, or bonds from: Pfizer

CME Reviewer

  • Robert Morris, PharmD

    Associate CME Clinical Director, Medscape, LLC

    Disclosures

    Disclosure: Robert Morris, PharmD, has disclosed no relevant financial relationships.


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This activity has been planned and implemented through the joint providership of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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CME

Epidemiology of Mycobacterium bovis Disease in Humans in England, Wales, and Northern Ireland, 2002–2014

Authors: Jennifer A. Davidson, MSc, BSc; Miranda G. Loutet, BSc, MSc; Catherine O'Connor, BSc, MVPH; Cathriona Kearns, BSc, PGDip; Robert M.M. Smith, PhD; Maeve K. Lalor, PhD; H. Lucy Thomas, MSc; Ibrahim Abubakar, PhD; Dominik Zenner, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME Released: 2/15/2017

Valid for credit through: 2/15/2018

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Abstract and Introduction

Abstract

Despite control efforts, Mycobacterium bovis incidence among cattle remains high in parts of England, Wales, and Northern Ireland, attracting political and public health interest in potential spread from animals to humans. To determine incidence among humans and to identify associated factors, we conducted a retrospective cohort analysis of human M. bovis cases in England, Wales, and Northern Ireland during 2002–2014. We identified 357 cases and observed increased annual case numbers (from 17 to 35) and rates. Most patients were ≥65 years of age and born in the United Kingdom. The median age of UK-born patients decreased over time. For 74% of patients, exposure to risk factors accounting for M. bovis acquisition, most frequently consumption of unpasteurized milk, was known. Despite the small increase in case numbers and reduction in patient age, M. bovis infection of humans in England, Wales, and Northern Ireland remains rare.

Introduction

After the 1960s, the number of human cases of tuberculosis (TB) caused by Mycobacterium bovis decreased significantly in England, Wales, and Northern Ireland, co-inciding with widespread implementation of milk product pasteurization and national bovine TB control programs.[1–3] During the past 2 decades in these 3 countries, an average of 30 cases of M. bovis in humans occurred annually; numbers decreased in the early 2000s before again increasing.[4–6] During the same period, incidence of M. bovis in cattle herds in parts of England, Wales, and Northern Ireland increased substantially but has now plateaued.[4,7–9]

M. bovis control[2,7,10,11] attracts political, public health, and media interest because of potential spread from animals to humans, effects on animal health and trade,[1] and the role of wildlife in the transmission cycle.[12] Highly visible interventions, including wildlife management to prevent transmission to livestock, are used to attempt to control M. bovis spread,[6,9,10] thereby protecting human health.

Compared with other countries in western Europe, the rate of TB among humans in the United Kingdom is high: 9.6 cases/100,000 population (6,240 cases) in 2015.[13] Most TB cases occurred in those born abroad, who probably acquired infection before entering the United Kingdom. Although only 1.1% (42 cases) of culture-confirmed TB cases were caused by M. bovis,[6] it remains a public health priority.

The drivers of the epidemiology of M. tuberculosis are well described.[13–15] However, there is comparatively less information on the sources of M. bovis in humans, other than the recognized risks of unpasteurized milk consumption and close contact with infected cattle.[1,3] We provide an update on the demographic characteristics of humans with M. bovis disease in England, Wales, and Northern Ireland.[16] To address the gap in knowledge regarding lesser known sources of acquisition, we describe the demographic and clinical characteristics of humans with TB caused by M. bovis compared with M. tuberculosis. In addition, we describe potential human exposures that may indicate M. bovis acquisition and include a genotyping comparison of the causative organisms.