Introduction to Low Incidence Setting

What is/are Low Incidence Setting?

Low Incidence Setting - An IGRA should be strongly considered as the screening method for refugees arriving in low-incidence settings if resources are available. ^[1] BACKGROUND A high index of suspicion is needed to initiate appropriate testing for tuberculosis due to its protean symptoms, yet health-care providers in low-incidence settings are becoming less familiar with the disease as rates decline. ^[2] Most tuberculosis (TB) cases in low-incidence settings are thought to be due to reactivation of latent TB infection (LTBI) in high-risk populations [1–3]. ^[3] INTERPRETATION In a clinically representative cohort in routine practice in a low-incidence setting, transcriptomic signatures did not have adequate accuracy for diagnosis of tuberculosis, including in patients with highly probable tuberculosis where the unmet need is greatest. ^[4] For all strategies, the impact on tuberculosis incidence among migrants was modest (<15%), suggesting enhanced migrant screening will not achieve tuberculosis elimination in low-incidence settings. ^[5] BACKGROUND Diagnosis of paucibacillary tuberculosis (TB) including extrapulmonary TB is a significant challenge, particularly in high-income, low-incidence settings. ^[6] Many tuberculosis (TB) cases in low-incidence settings are attributed to reactivation of latent TB infection (LTBI) acquired overseas. ^[7] The native TB morbidity in under 5-year-olds did not increase after the BCG policy revision, suggesting that selective vaccinations can prevent TB in the most vulnerable age group in low-incidence settings. ^[8] BACKGROUND  Big cities in Europe have the highest incidence rates of TB in otherwise low incidence settings. ^[9] These findings support the use of a single 'pooled Xpert' as an effective rapid screening approach for ruling out PTB in low incidence settings. ^[10] BackgroundTreatment of latent tuberculosis infection (LTBI) in high-risk groups is an effective strategy for TB control and elimination in low incidence settings. ^[11] Addressing these factors is critical if Canada is to meet the WHO's global call to eradicate TB in all low incidence settings. ^[12] Background Population-level TB surveillance programs and research studies in low incidence settings often report all persons born outside the country in which the study is conducted as “foreign-born”–a single label for a highly diverse population with variable TB risks. ^[13] In a TB low incidence setting such as the Danish, it is important to maintain focus on preventing an unfavourable TB outcome. ^[14]