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The Importance of Heterogeneity to the Epidemiology of Tuberculosis

Published on Jun 18, 2019in Clinical Infectious Diseases9.055
· DOI :10.1093/cid/ciy938
James M. Trauer11
Estimated H-index: 11
(Monash University),
Peter J. Dodd15
Estimated H-index: 15
(University of Sheffield)
+ 8 AuthorsDavid Wesley Dowdy38
Estimated H-index: 38
(Johns Hopkins University)
Abstract
Although less well-recognised than for other infectious diseases, heterogeneity is a defining feature of TB epidemiology. To advance toward TB elimination, this heterogeneity must be better understood and addressed. Drivers of heterogeneity in TB epidemiology act at the level of the infectious host, organism, susceptible host, environment and distal determinants. These effects may be amplified by social mixing patterns, while the variable latent period between infection and disease may mask heterogeneity in transmission. Reliance on notified cases may lead to misidentification of the most affected groups, as case detection is often poorest where prevalence is highest. Assuming average rates apply across diverse groups and ignoring the effects of cohort selection may result in misunderstanding of the epidemic and the anticipated effects of control measures. Given this substantial heterogeneity, interventions targeting high-risk groups based on location, social determinants or comorbidities could improve efficiency, but raise ethical and equity considerations.
  • References (52)
  • Citations (4)
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References52
Newest
#1Debebe Shaweno (University of Melbourne)H-Index: 5
#2Malancha Karmakar (University of Melbourne)H-Index: 2
Last. Emma S. McBryde (University of Melbourne)H-Index: 28
view all 8 authors...
Tuberculosis (TB) transmission often occurs within a household or community, leading to heterogeneous spatial patterns. However, apparent spatial clustering of TB could reflect ongoing transmission or co-location of risk factors and can vary considerably depending on the type of data available, the analysis methods employed and the dynamics of the underlying population. Thus, we aimed to review methodological approaches used in the spatial analysis of TB burden. We conducted a systematic literat...
4 CitationsSource
#1Debebe Shaweno (University of Melbourne)H-Index: 5
#2James M. Trauer (Monash University)H-Index: 11
Last. Emma S. McBryde (University of Melbourne)H-Index: 28
view all 4 authors...
Geospatial tuberculosis (TB) hotspots are hubs of TB transmission both within and across community groups. We aimed to quantify the extent to which these hotspots account for the spatial spread of ...
1 CitationsSource
#1Daniel J Carter (Lond: University of London)H-Index: 2
#2Philippe Glaziou (WHO: World Health Organization)H-Index: 23
Last. Delia Boccia (Lond: University of London)H-Index: 19
view all 9 authors...
Summary Background The End TB Strategy and the Sustainable Development Goals (SDGs) are intimately linked by their common targets and approaches. SDG 1 aims to end extreme poverty and expand social protection coverage by 2030. Achievement of SDG 1 is likely to affect the tuberculosis epidemic through a range of pathways. We estimate the reduction in global tuberculosis incidence that could be obtained by reaching SDG 1. Methods We developed a conceptual framework linking key indicators of SDG 1 ...
19 CitationsSource
#1Nicky McCreesh (Lond: University of London)H-Index: 11
#2Richard G. White (Lond: University of London)H-Index: 38
We currently have little idea where Mycobacterium tuberculosis (Mtb) transmission occurs in high incidence settings. Molecular studies suggest that only around 8-19% of transmission to adults occurs within-household, or between known social-contacts. This contrasts with findings from social-contact studies, which show that substantial proportions of contact time occur in households, workplaces and schools. A mathematical model of social-contact behaviour and Mtb transmission was developed, incor...
4 CitationsSource
#1Yayehirad A. Melsew (Monash University)H-Index: 3
#2T.N. Doan (Australian Institute of Tropical Health and Medicine)H-Index: 1
Last. James M. Trauer (Monash University)H-Index: 11
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We performed a systematic review and meta-analyses of studies assessing tuberculosis (TB) patient-related risk factors for transmission of Mycobacterium tuberculosis infection. Meta-analyses were conducted for sputum smear-positivity, lung cavitation and HIV seropositivity of index patients with both crude and adjusted odds ratios (AORs) pooled using random effect models. Thirty-seven studies were included in the review. We found that demographic characteristics such as age and sex were not sign...
9 CitationsSource
#1Romain Ragonnet (Burnet Institute)H-Index: 7
#2James M. Trauer (Monash University)H-Index: 11
Last. Emma S. McBryde (University of Melbourne)H-Index: 28
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Although different structures are used in modern tuberculosis (TB) models to simulate TB latency, it remains unclear whether they are all capable of reproducing the particular activation dynamics empirically observed. We aimed to determine which of these structures replicate the dynamics of progression accurately. We reviewed 88 TB-modelling articles and classified them according to the latency structure employed. We then fitted these different models to the activation dynamics observed from 135...
8 CitationsSource
#1Debora Pedrazzoli (Lond: University of London)H-Index: 8
#2Delia Boccia (Lond: University of London)H-Index: 19
Last. Rein M. G. J. Houben (Lond: University of London)H-Index: 21
view all 9 authors...
: Despite the close link between tuberculosis (TB) and poverty, most mathematical models of TB have not addressed underlying social and structural determinants. : To review studies employing mathematical modelling to evaluate the epidemiological impact of the structural determinants of TB. : We systematically searched PubMed and personal libraries to identify eligible articles. We extracted data on the modelling techniques employed, research question, types of structural determinants modelled an...
11 CitationsSource
To evaluate the impact of the Brazilian cash transfer programme (Bolsa Familia Programme, BFP) on tuberculosis (TB) incidence in Brazil from 2004 to 2012. We studied tuberculosis surveillance data using a combination of an ecological multiple-group and time-trend design covering 2458 Brazilian municipalities. The main independent variable was BFP coverage and the outcome was the TB incidence rate. All study variables were obtained from national databases. We used fixed-effects negative binomial ...
19 CitationsSource
#1Mireia Coscolla (Swiss TPH: Swiss Tropical and Public Health Institute)H-Index: 22
Tuberculosis is caused by different groups of bacteria belonging to the Mycobacterium tuberculosis complex (MTBC). The combined action of human factors, environmental conditions and bacterial virulence determine the extent and form of human disease. MTBC virulence is a composite of different clinical phenotypes such as transmission rate and disease severity among others. Clinical phenotypes are also influenced by cellular and immunological phenotypes. MTBC phenotypes are determined by the genoty...
6 CitationsSource
#1M. Gabriela M. Gomes (USP: University of São Paulo)H-Index: 18
#2Mauricio Lima Barreto (FIOCRUZ: Oswaldo Cruz Foundation)H-Index: 56
Last. S. Bertel Squire (LSTM: Liverpool School of Tropical Medicine)H-Index: 25
view all 7 authors...
Background Diseases occur in populations whose individuals differ in essential characteristics, such as exposure to the causative agent, susceptibility given exposure, and infectiousness upon infection in the case of infectious diseases.
10 CitationsSource
Cited By4
Newest
#1J. Chikovore (Human Sciences Research Council)H-Index: 8
#2Madhukar Pai (McGill University)H-Index: 78
Last. Elizabeth L. Corbett (Lond: University of London)H-Index: 48
view all 7 authors...
Tuberculosis (TB) is treatable but is the leading infectious cause of death worldwide, with men over-represented in some key aspects of the disease burden. Men’s TB epidemiological scenario occurs within a wider public health and historical context, including their prior sidelining in health discussions. Differences are however noticeable in how some Western countries and high TB and HIV burden low and middle-income countries (LMIC) including in Africa have approached the subject(s) of men and h...
Source
#1Gabriel Carrasco-Escobar (UCSD: University of California, San Diego)H-Index: 6
#2Alvaro Schwalb (Instituto de Medicina Tropical Alexander von Humboldt)
Last. Cesar Ugarte-Gil (Instituto de Medicina Tropical Alexander von Humboldt)H-Index: 11
view all 5 authors...
Growing evidence suggests pollution and other environmental factors have a role in the development of tuberculosis (TB), however, such studies have never been conducted in Peru. Considering the association between air pollution and specific geographic areas, our objective was to determine the spatial distribution and clustering of TB incident cases in Lima and their co-occurrence with clusters of fine particulate matter (PM2.5) and poverty. We found co-occurrences of clusters of elevated concent...
Source
#1Yayehirad A. Melsew (University of Gondar)H-Index: 3
#2Adeshina I. Adekunle (Australian Institute of Tropical Health and Medicine)
Last. James M. Trauer (Monash University)H-Index: 11
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Abstract TB mathematical models employ various assumptions and approaches in dealing with the heterogeneous infectiousness of persons with active TB. We reviewed existing approaches and considered the relationship between them and existing epidemiological evidence. We searched the following electronic bibliographic databases from inception to 9 October 2018: MEDLINE, EMBASE, Biosis, Global Health and Scopus. Two investigators extracted data using a standardised data extraction tool. We included ...
Source
#1Romain Ragonnet (Monash University)H-Index: 7
#2James M. Trauer (Monash University)H-Index: 11
Last. Emma S. McBryde (University of Melbourne)H-Index: 28
view all 5 authors...
Tuberculosis (TB) control efforts are hampered by an imperfect understanding of TB epidemiology. The true age distribution of disease is unknown because a large proportion of individuals with active TB remain undetected. Understanding of transmission is limited by the asymptomatic nature of latent infection and the pathogen’s capacity for late reactivation. A better understanding of TB epidemiology is critically needed to ensure effective use of existing and future control tools. We use an agent...
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#1Bruce D. Agins (CUNY: City University of New York)H-Index: 14
#2Daniel J Ikeda (Harvard University)H-Index: 1
Last. Adithya Cattamanchi (UCSF: University of California, San Francisco)H-Index: 28
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Summary Tuberculosis is preventable, treatable, and curable, yet it has the highest mortality rate of infectious diseases worldwide. Over the past decade, services to prevent, screen, diagnose, and treat tuberculosis have been developed and scaled up globally, but progress to end the disease as a public health threat has been slow, particularly in low-income and middle-income countries. In these settings, low-quality tuberculosis prevention, diagnostic, and treatment services frustrate efforts t...
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#1M. Gabriela M. Gomes (University of Porto)H-Index: 18
#2Jessica G. King (Edin.: University of Edinburgh)H-Index: 1
Last. Ary A. Hoffmann (University of Melbourne)H-Index: 98
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#1Andrew Tomita (UKZN: University of KwaZulu-Natal)H-Index: 11
#2Catherine M. Smith (UCL: University College London)H-Index: 5
Last. Frank TanserH-Index: 41
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In HIV hyperendemic sub-Saharan African communities, particularly in southern Africa, the likelihood of achieving the Sustainable Development Goal of ending the tuberculosis (TB) epidemic by 2030 is low, due to lack of cost-effective and practical interventions in population settings. We used one of Africa’s largest population-based prospective cohorts from rural KwaZulu-Natal Province, South Africa, to measure the spatial variations in the prevalence of recently-diagnosed TB disease, and to qua...
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