Tuberculosis

Protective impacts of household-based tuberculosis contact tracing are robust across endemic incidence levels and community contact patterns

Screening household members of newly detected tuberculosis cases is an efficient method for finding previously undiagnosed cases in high-burden settings. Despite the intuitive appeal of this approach, randomized trials examining the population-level effects of these interventions in settings with sustained community transmission have shown mixed results. One explanation for these inconclusive findings is that household transmission is responsible for a varying proportion of overall tuberculosis burden between locations, with the impact of household transmission being a function of both the overall incidence and the relative intensity of disease-transmitting contacts in the community and the household. In this manuscript, we use an individual-based network model to explore how local incidence levels and patterns of community contact impact the effectiveness of household-based approaches for interrupting tuberculosis transmission. Our analyses suggest that protective benefits of household-based interventions are maintained across a wide range of epidemiological settings. Our findings provide evidence for the robustness of household-based interventions and suggest that variable results from trials may be primarily due to implementation challenges rather than inherent limitations of these interventions.

Prenatal and early-life exposure to the Great Chinese Famine increased the risk of tuberculosis in adulthood across two generations

Global food security is a major driver of population health, and food system collapse may have complex and long-lasting effects on health outcomes. We examined the effect of prenatal exposure to the Great Chinese Famine (1958–1962)—the largest famine …

Children as sentinels of tuberculosis transmission: disease mapping of programmatic data

Background: Identifying hotspots of tuberculosis transmission can inform spatially targeted active case-finding interventions. While national tuberculosis programs maintain notification registers which represent a potential source of data to …

Is a More Data-driven Approach the Future of Tuberculosis Transmission Modeling?

In their paper in this issue of Clinical Infectious Diseases, Nelson et al [1] bring the powerful toolkit of exponential random graph models (ERGMs) to the analysis of transmission networks derived from whole-genome sequence (WGS) data collected …

Preferential observation of large infectious disease outbreaks leads to consistent overestimation of intervention efficacy

Data from infectious disease outbreaks in congregate settings are often used to elicit clues about which types of interventions may be useful in other facilities. This is commonly done using before-and-after comparisons in which the infectiousness of …

Evidence for heterogeneity in China’s progress against pulmonary tuberculosis: uneven reductions in a major center of ongoing transmission, 2005–2017

Background: China contributed 8.9% of all incident cases of tuberculosis globally in 2017, and understanding the spatiotemporal distribution of pulmonary tuberculosis (PTB) in major transmission foci in the country is critical to ongoing efforts to …

Identifying hotspots of multidrug-resistant tuberculosis transmission using spatial and molecular genetic data

Background: We aimed to identify and determine the etiology of "hotspots" of concentrated multidrug-resistant tuberculosis (MDR-tuberculosis) risk in Lima, Peru. Methods: From 2009 to 2012, we conducted a prospective cohort study among households of …

Age-specific risks of tuberculosis infection from household- and community-exposures suggest opportunities for interventions in a high-burden setting

We analyzed data from a large population-based prospective cohort study of household contacts of tuberculosis patients in Lima, Peru, to estimate the importance of within-household transmission relative to community-based transmission. We identified …

Protective effects of Bacillus Calmette-Guerin vaccination and isoniazid preventive therapy among the household contacts of diagnosed tuberculosis cases: A cohort study

Rationale: Individuals living with patients with tuberculosis (TB) are at elevated risk of infection and disease, with children at greatest risk. The World Health Organization recommends isoniazid preventive therapy (IPT) for HIV-positive contacts …