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Respirology. 2018 Jun 5. doi: 10.1111/resp.13333. [Epub ahead of print]

Where is tuberculosis transmission happening? Insights from the literature, new tools to study transmission and implications for the elimination of tuberculosis.

Author information

1
Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
2
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
3
Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA.
4
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
5
Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
6
Center for TB Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
7
Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA.

Abstract

More than 10 million new cases of tuberculosis (TB) are diagnosed worldwide each year. The majority of these cases occur in low- and middle-income countries where the TB epidemic is predominantly driven by transmission. Efforts to 'end TB' will depend upon our ability to halt ongoing transmission. However, recent studies of new approaches to interrupt transmission have demonstrated inconsistent effects on reducing population-level TB incidence. TB transmission occurs across a wide range of settings, that include households and hospitals, but also community-based settings. While home-based contact investigations and infection control programmes in hospitals and clinics have a successful track record as TB control activities, there is a gap in our knowledge of where, and between whom, community-based transmission of TB occurs. Novel tools, including molecular epidemiology, geospatial analyses and ventilation studies, provide hope for improving our understanding of transmission in countries where the burden of TB is greatest. By integrating these diverse and innovative tools, we can enhance our ability to identify transmission events by documenting the opportunity for transmission-through either an epidemiologic or geospatial connection-alongside genomic evidence for transmission, based upon genetically similar TB strains. A greater understanding of locations and patterns of transmission will translate into meaningful improvements in our current TB control activities by informing targeted, evidence-based public health interventions.

KEYWORDS:

epidemiology; molecular epidemiology; public health; tuberculosis

PMID:
29869818
PMCID:
PMC6281783
[Available on 2019-12-05]
DOI:
10.1111/resp.13333
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