Alvaro Schwalb

Tuberculosis and undernutrition: improving estimates to reinforce the policy imperative Undernutrition is a key driver of the global tuberculosis epidemic, increasing the risk of people developing tuberculosis disease and of poor outcomes in those who do.1 Each year, WHO publishes estima...

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Tuberculosis and undernutrition: improving estimates to reinforce the policy imperative

www.thelancet.com/journals/lan...

Impact of fluoroquinolone resistance on the cost-effectiveness of empiric treatment for multidrug- or rifampicin-resistant tuberculosis The WHO recommends the bedaquiline, pretomanid, and linezolid (BPaL) regimen with the additional fluoroquinolone antibiotic moxifloxacin (BPaLM) for initial treatment of multidrug- or rifampicin-resis...

When fluoroquinolone resistance status is unknown, empirical use of BPaLM (adding moxifloxacin to BPaL) is cost-effective as a replacement for BPaL even with high fluoroquinolone resistance levels! 🦠💊

doi.org/10.1371/jour...

5 million of them are about research

A global analysis of patterns of tuberculosis exposure and transmission Tuberculosis (TB) is a major public health concern and the leading infectious cause of mortality globally. The disease exhibits strong prevalence patterns by age and sex, but the implications of these...

Understanding patterns of #TB exposure and transmission is needed for targeted prevention strategies. In our latest pre-print, @petedodd24.bsky.social and I estimated the proportion of TB exposure to and transmission from sex and age groups for 177 countries.

bit.ly/4nbV492

Do no harm - re-evaluating the risks of overtreatment in community-wide tuberculosis screening Background Community-wide screening is a crucial strategy to end tuberculosis (TB), but a common concern is potential harm from overtreatment following false positive diagnoses. However, current refer...

In a new preprint (NOT PEER REVIEWED) we continue to explore the challenge of overtreatment in community screening. It seems the benefits of TB treatment far outweigh the harms, especially once we accept that sputum culture is not perfect. Important food for thought. www.medrxiv.org/content/10.1...

A plot, facetted by country, showing the percentage of TB that is urban and rural between 2000-2023

A forest plot, showing estimates of the urban to rural TB prevalence in 46 studies

Are there more people with #TB in cities or rural areas?

In a 🚨new🚨 preprint (NOT PEER REVIEWED) we modelled urban-rural TB trends from 2000-2023 in 26 countries with 4.6 billion people.

www.medrxiv.org/content/10.1...

Our systematic review of rural/urban differences in #TB prevalence shows evidence of rapidly urbanising epidemics in many settings, with differences across countries and regions.

Link to preprint below ⬇️

1/ It’s been 10 years (😮) since we reported that #TB prevalence was twice as high in men as in women.

📢 Our new preprint explores how sex differences have shifted with more recent national prevalence surveys and growing attention to #gender responsive TB prevention and care.

bit.ly/4gqP1LH

Still trying to figure out what MAHA hates more: women or vaccines.

I know many people, particularly from London's diverse communities, are feeling extremely worried following the events this weekend. It takes me back to how I felt growing up in the ’70s and ’80s, when far-right political parties marched on our streets. The leaders of the far-right are once again attempting to hijack our flag, with minorities being intimidated and fear, hatred and division being sown. As Londoners, and as proud Brits, we must unite to reject the far-right – just as we have many times before. But it’s going to take a huge effort from us all – from people of all races and backgrounds, who are willing to stand up for our British values of equality, inclusion and mutual respect. As Mayor, I'll continue to do everything I can to challenge the far-right and all those who peddle the politics of fear and division. I urge other politicians and Londoners to do the same. MAYOR OF LONDON, SADIQ KHAN

We must unite against those who seek to divide us.

Our work on modelling population-wide screening in Viet Nam is now available in PLOS Global Public Health! tinyurl.com/3ymhuj5s

Body mass index and tuberculosis risk: an updated systematic literature review and dose–response meta-analysis AbstractBackground. The relationship between nutritional status and tuberculosis is critically important but poorly understood. We extended a 2009 review c

Nutritional status is a key determinant of TB. In this updated systematic review and dose-response meta-analysis (43 cohorts inc > 26 million people) we redefined the relationship between body mass index (BMI) and TB. doi.org/10.1093/ije/...

The potential impact, cost and cost-effectiveness of tuberculosis interventions - a modelling exercise Background While a range of interventions exist for tuberculosis prevention, screening, diagnosis, and treatment, their potential population impact and cost-effectiveness are seldom directly compared,...

At a time when global resources for #TB research, development, prevention, and care are limited, which interventions should be prioritised in high burden settings?

📢 Our new pre-print compares the impact, cost, and cost-effectiveness of 9 TB interventions in 3 countries. 1/n

bit.ly/3V3vXth

BBC News headline: Frankenstein is monster success at Venice film festival

Actually, Frankenstein is a doctor success at the Venice film festival

Exploring trade-offs in diagnostic algorithm, population coverage, and duration of community screening for tuberculosis Background Current tuberculosis (TB) prevention and care strategies have failed to reduce disease burden at the pace required to meet global targets. Community screening may enable more rapid declines...

Community screening for #tuberculosis could extend the reach of #TB services, but evidence on its effectiveness is limited.

In our latest preprint, we examine the epidemiological impact of trade-offs in diagnostic algorithm, population coverage, and duration of screening. 1/n

bit.ly/3UK7pFD

A group of handdrawn fish.

Why I 🧡 the web.

drawafish.com

Just draw the fish. Trust me. 🐟

Our work estimating the potential impacts of reductions in international donor funding for #TB is now out in @lancetgh.bsky.social:

bit.ly/3TDl28T

@raclark18.bsky.social @cfmcquaid.bsky.social @alexandra-richards.bsky.social @top-j.bsky.social @reinhouben.bsky.social @richardwhite321.bsky.social

Thanks for catching that!

Wrapping up the #CausalIntroCourse.

New systematic review led by @hannahrickman.bsky.social shows annual risk of Mycobacterium #tuberculosis conversion in men and women diverges during adolescence and remains higher among men throughout adulthood.

www.thelancet.com/journals/lan...

Figure 1. Estimated number of trial endpoints in the control group of a prevention-of-disease vaccine trial in a high disease-burden setting showing number of endpoints on the y-axis and time in months on the x-axis. For bacteriologically confirmed symptomatic tuberculosis disease endpoints only, we estimate 69 endpoints, and for combined bacteriologically confirmed asymptomatic and symptomatic tuberculosis disease endpoints, we estimate 151 endpoints. Scenario assumes symptomatic disease incidence before trial screening of 300/100 000 per year and following 10 000 individuals over 3 years. Prevalent symptomatic and asymptomatic tuberculosis disease are screened out in month 0 and are not trial endpoints. Active screening occurs every 6 months for both scenarios and participants self-presenting with symptoms suggestive of tuberculosis disease would also be investigated.

In our latest personal view in @lancetrespirmed.bsky.social, we argue for the inclusion asymptomatic #tuberculosis in vaccine trial endpoints to potentially reduce the size, length, and cost of trials.

doi.org/10.1016/S221...

@lshtm-tbmod.bsky.social @tb-lshtm.bsky.social

Leaving your hair wet as well…

Course notebook for Introduction to Causal Inference course

Kicking off the #CausalIntroCourse in Leeds. Hoping this will finally give me the tools to convince my mum that walking around the house barefoot ^^doesn’t^^ cause a cold.

The facts are simple and devastating: Aid cuts have already cost lives, and the number of deaths will continue to rise. Here’s the evidence. ​

Palestinians fleeing northern Gaza on 9 November 2023 amid Israel's bombardment and siege of the enclave, and intense fighting between the Israeli military and Hamas fighters in the north. Credit: Mohammed Zaanoun/TNH

LSHTM's Director writes to UK Government about #Gaza public health catastrophe

Professor Liam Smeeth's letter to the Prime Minister & Foreign Secretary urges action to prevent a greater #PublicHealth disaster:

👉 www.lshtm.ac.uk/newsevents/n...

25th anniversary celebrations of the Introduction to Infectious Disease Our special event will celebrate the 25th anniversary of the Introduction to Infectious Disease Modelling and its Applications course, delivered by the London School of Hygiene & Tropical Medicine

Can you believe it’s already been 25 years!?

Come join us on 20 June 2025 at 4pm UK time to celebrate the 25th anniversary of the Introduction to #Infectious Disease #Modelling course delivered by @lshtm.bsky.social and @ukhsa.bsky.social!

More info 👉 www.lshtm.ac.uk/newsevents/e...

Tuberculosis and climate change: analytical framework and knowledge gaps This report explores the intersection of tuberculosis (TB) and climate change, highlighting how climate-related challenges such as food and water insecurity, displacement, and disrupted healthcare acc...

TB & climate change: @who.int report out now, building on an analytical framework we developed to explore the intersections and implications for the TB epidemic. Key message? TB should be considered a climate-sensitive disease www.who.int/publications...

I fully moved to Bluesky when we @weratedogs.com made it here. This is why.

Amid all the bad news in Global Health, perhaps some good news? A first analysis on the risk of false positive diagnoses in community-screening for tuberculosis using Xpert shows our clinic-based data is likely (very) wrong and overestimates false positives by >80%: tinyurl.com/yfecute9.

Job Opportunity at LSHTM: Research Fellow The London School of Hygiene & Tropical Medicine (LSHTM) is a world-leading centre for research and postgraduate education in public and global health. Our mission is to is to improve health and healt...

Are you interested in #TB and have experience in #modelling infectious diseases?

Come join us in the TB Modelling Group at #LSHTM!

We're advertising for a 1 year Research Fellow position, with a closing date of 30 May 2025 👉 jobs.lshtm.ac.uk/vacancy.aspx...