The International Consensus for Early TB framework (ICE-TB): Implications from a low-incidence setting

BACKGROUND In recent years, there has been increasing recognition of the public health significance of the spectrum of TB disease presentation, and the existing classification systems of asymptomatic infection and symptomatic TB have been limited in terms of explanatory power. Accordingly, in 2022-2...

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Bibliographic Details
Published in:The international journal of tuberculosis and lung disease 2024-08, Vol.28 (8), p.381-386
Main Authors: Denholm, J.T., Coussens, A., Houben, R.M.G.J., Horton, K.C., Wong, E.B., Kendall, E.A., Martinez, L., Musvosi, M., Zaidi, S.M.A.
Format: Article
Language:English
Subjects:
Asymptomatic infection
Classification
Classification systems
Consensus
Diagnostic Tools
Disease management
Disease Notification
Humans
Implementation
Incidence
Infections
Mycobacterium tuberculosis - isolation & purification
Mycobacterium Tuberculosis Infection
Pathology
Public Health
Subclinical Tuberculosis
Surveillance
Tuberculosis
Tuberculosis - diagnosis
Tuberculosis - epidemiology
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Summary:BACKGROUND In recent years, there has been increasing recognition of the public health significance of the spectrum of TB disease presentation, and the existing classification systems of asymptomatic infection and symptomatic TB have been limited in terms of explanatory power. Accordingly, in 2022-2023, a new International Consensus framework for Early TB (ICE-TB) was developed, categorising the spectrum of TB infection and disease into five states based on the presence or absence of macroscopic pathology, host infectiousness, and symptoms and signs. METHODS We used the ICE-TB framework to re-analyse existing notification data for 2022 within a low-incidence setting to explore the potential utility and future challenges for its public health application. RESULTS Existing notification data were sufficient to allow substantial reclassification of currently recognised active disease states, but did not systematically capture Mycobacterium tuberculosis infection or subclinical TB. Fifty percent of existing TB notifications would be classified as 'Clinical, infectious', with the potential need to consider further subclassification. CONCLUSION Our exploration highlighted limitations in existing classification systems and diagnostic approaches and should encourage researchers and programmatic implementers to emphasise person-centred and programmatic needs in the development of new tools for TB management.
ISSN:1027-3719
1815-7920
1815-7920
DOI:10.5588/ijtld.24.0081