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

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Existing tuberculosis (TB) classification systems lack explanatory power for the spectrum of disease presentation.
• A new International Consensus framework for Early TB (ICE-TB) was developed in 2022-2023.
• ICE-TB categorizes TB infection and disease into five states based on pathology, infectiousness, and symptoms.

Purpose of the Study:

• To explore the utility and challenges of the ICE-TB framework for public health applications.
• To re-analyze existing TB notification data using the ICE-TB framework.

Main Methods:

• Utilized the ICE-TB framework.
• Re-analyzed 2022 notification data from a low-incidence setting.

Main Results:

• Existing data allowed reclassification of active TB disease states.
• Data did not systematically capture Mycobacterium tuberculosis infection or subclinical TB.
• Fifty percent of TB notifications could be classified as 'Clinical, infectious', requiring further subclassification.

Conclusions:

• Current TB classification and diagnostic approaches have limitations.
• Development of new TB management tools should prioritize person-centered and programmatic needs.