A new study by researchers with the Centers for Disease Control and Prevention and Harvard T.H. Chan School of Public Health has found significant and persistent racial disparities in tuberculosis (TB) incidence among US-born residents. The findings were published yesterday in the Annals of Internal Medicine.

While racial disparities have long been present in US TB incidence, because most cases occur among people from racial and ethnic minority groups born outside the United States, few studies have examined racial disparities in TB incidence specifically among the US-born population.

To do so, the researchers analyzed data from the National Tuberculosis Surveillance System on US-born patients with reported TB disease from 2011 through 2021, comparing TB incidence rates, incidence rate differences, and incidence rate ratios among different racial and ethnic minority groups. They stratified the results by sex, age-group, and whether TB disease was attributed to recent transmission.

More than 18,000 excess TB cases attributed to disparities

Among the 31,938 TB cases in US-born patients analyzed, researchers found substantially higher incidence among racial/ethnic minority populations. Compared with non-Hispanic Whites, TB incidence rate ratios were 4.4 times higher for Hispanics, 6.6 times higher for Asians, 6.8 times higher for Blacks, and 14.2 times higher for American Indian/Alaska Natives. Within each racial/ethnic population, absolute disparities in incidence rates were generally greater for males than females, while relative disparities were greater for females, younger people, and those who had TB attributed to recent transmission.

Over the course of the study period, the researchers estimate there were 6,950 excess TB cases attributable to racial/ethnic disparities among women, 11,130 among men, and 18,080 total.

The study authors say addressing these disparities is crucial for achieving health equity goals and accelerating progress toward population-level TB elimination. "Ongoing measurement of disparities will be needed to track progress toward these targets," they wrote.

In an accompanying editorial, infectious disease experts from Emory University Rollins School of Public Health suggest the data could be used to inform targeted efforts by state and local TB programs to focus on early detection and care among high-risk groups.

Treatment with the antiviral drug remdesivir does not increase the risk of adverse cardiac events in patients hospitalized with COVID-19, according to newly published results of the DisCoVeRy Trial, a randomized control trial of outcome seen in patients hospitalized for COVID-19 infections.

The study, published in Clinical Infectious Diseases, compared outcomes among 857 participants hospitalized between March 2020 and January 2021 in France, Belgium, Portugal, Austria, and Luxembourg. A total of 429 received a 9-day course of remdesivir treatment compared to those who received standard care.

By day 29 of the trial, 11.2% in the remdesivir group and 11.3% in the control group experienced an adverse cardiac event, representing no statistical difference.

No differences in deaths

The authors said there were no significant differences between groups regarding serious (hazard ratio [HR] 1.3; 95% confidence interval [CI], 0.8 to 2.4) and non-serious adverse events (HR 0.7; 95% CI: 0.4 to1.4).

There were 39 deaths in the remdesivir group and 46 in the control group, and 9 patients in each group experienced an adverse cardiac event prior to death. The adverse events were not determined to be the cause of death for any patients in the remdesivir group, and for only 1 patient in the control group.

In contrast to other studies, the authors wrote that they found "no significant differences in the arrhythmic event rates between the two groups, regardless of severity."

No significant differences in the arrhythmic event rates between the two groups, regardless of severity.

In an editorial on the study, Robert Gottlieb, MD, PhD, and Andre Kahil, MD, MPH, write that the findings of this study should, "dispel apprehension and overcome impediments to the indicated use of remdesivir, a safe antiviral therapy that reduces mortality in patients hospitalized for COVID-19."

A California Department of Public Health review of 109 cases of healthcare professionals (HCP) with lab-confirmed mpox published last week in Infection Control & Hospital Epidemiology found that 90% had nonoccupational risk factor exposures, and only 1 case was tied to workplace exposure, likely from a sharps injury.

For the analysis, the authors included laboratory-confirmed mpox cases in HCP who had onset of rash or other symptoms from May 12 to September 30, 2022. They excluded cases reported to the Los Angeles County Department of Public Health because of differences in data collection. Patients were from 19 California counties. Of the 109 infected HCP, 102 (94%) were men and 98 (90%) identified as gay, lesbian, or bisexual.

We found no evidence of [mpox virus] transmission from HCP to patients or colleagues in the workplace.

Many HCP worked in direct patient-care roles, including 34 nurses (31.2%), 20 clinical support staff members (18.3%), and 5 physicians and physicians assistants (4.6%).

One case tied to worksite

Overall, 90% of the HCP with mpox had nonoccupational-exposure risk factors. One occupationally acquired case was tied to a sharps injury while scraping a patient's mpox lesion for diagnostic testing.

The authors conclude, "We found no evidence of [mpox virus] transmission from HCP to patients or colleagues in the workplace, and we are not aware of any other reports that describe transmission from HCP to workplace contacts."