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Elaydi S, Lozi R. Global dynamics of discrete mathematical models of tuberculosis. JOURNAL OF BIOLOGICAL DYNAMICS 2024; 18:2323724. [PMID: 38493487 DOI: 10.1080/17513758.2024.2323724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
In this paper, we develop discrete models of Tuberculosis (TB). This includes SEI endogenous and exogenous models without treatment. These models are then extended to a SEIT model with treatment. We develop two types of net reproduction numbers, one is the traditional R 0 which is based on the disease-free equilibrium, and a new net reproduction number R 0 ( E ∗ ) based on the endemic equilibrium. It is shown that the disease-free equilibrium is globally asymptotically stable if R 0 ≤ 1 and unstable if R 0 > 1 . Moreover, the endemic equilibrium is locally asymptotically stable if R 0 ( E ∗ ) < 1 < R 0 .
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Affiliation(s)
- Saber Elaydi
- Department of Mathematics, Trinity University, San Antonio, TX, USA
| | - René Lozi
- Department of Mathematics, Laboratory J.A. Dieudonné, CNRS, Université Côte d'Azur, France
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Greenhalgh T, MacIntyre CR, Baker MG, Bhattacharjee S, Chughtai AA, Fisman D, Kunasekaran M, Kvalsvig A, Lupton D, Oliver M, Tawfiq E, Ungrin M, Vipond J. Masks and respirators for prevention of respiratory infections: a state of the science review. Clin Microbiol Rev 2024; 37:e0012423. [PMID: 38775460 DOI: 10.1128/cmr.00124-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Shovon Bhattacharjee
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - Abrar A Chughtai
- School of Population Health, University of New South Wales, Sydney, Australia
| | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amanda Kvalsvig
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah Lupton
- Centre for Social Research in Health and Social Policy Research Centre, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia
| | - Matt Oliver
- Professional Standards Advocate, Edmonton, Canada
| | - Essa Tawfiq
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Ungrin
- Faculty of Veterinary Medicine; Department of Biomedical Engineering, Schulich School of Engineering; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Joe Vipond
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Douglas KO, Punu G, Van Vliet N. Prioritization of zoonoses of wildlife origin for multisectoral one health collaboration in Guyana, 2022. One Health 2024; 18:100730. [PMID: 38644970 PMCID: PMC11031778 DOI: 10.1016/j.onehlt.2024.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/10/2024] [Indexed: 04/23/2024] Open
Abstract
Background The human population in Guyana, located on the South American continent, is vulnerable to zoonotic diseases due to an appreciable reliance on Neotropical wildlife as a food source and for trade. An existing suboptimal health surveillance system may affect the effective monitoring of important zoonotic diseases. To effectively address this deficit, a One Health zoonotic disease prioritization workshop was conducted to identify nationally significant zoonoses. Methods Prioritization of zoonotic diseases was conducted for the first time in Guyana & Caribbean region using literature review, prioritization criteria and a risk prioritization tool in combination with a consultative One Health workshop. This involved multisectoral experts from varied disciplines of social, human, animal, and environmental health to prioritize zoonotic diseases using a modified semi-quantitative One Health Zoonotic Disease Prioritization (OHZDP) tool. The inclusion and exclusion criteria were applied to pathogen hazards in existence among wildlife in Guyana during the hazard identification phase. Results In total, fifty zoonoses were chosen for prioritization. Based on their weighted score, prioritized diseases were ranked in order of relative importance using a one-to-five selection scale. In Guyana, this zoonotic disease prioritization method is the first significant step toward bringing together specialists from the fields of human, animal, and environmental health. Following discussion of the OHZDP Tool output among disease experts, a final zoonotic disease list, including tuberculosis, leptospirosis, gastroenteritis, rabies, coronavirus, orthopoxvirus, viral hemorrhagic fevers, and hepatitis were identified as the top eight priority zoonoses in Guyana. Conclusions This represents the first prioritization of nationally significant zoonotic diseases in Guyana and the English-speaking Caribbean. This One Health strategy to prioritize these eight zoonoses of wildlife origin is a step that will support future tracking and monitoring for disease prevalence among humans and wildlife and can be used as a decision-making guide for policymakers and stakeholders in Guyana.
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Affiliation(s)
- Kirk O. Douglas
- Centre for Biosecurity Studies, The University of the West Indies, Cave Hill Campus, Cave Hill BB11000, Barbados
| | - Govindra Punu
- Center for International Forestry Research (CIFOR), Jalan CIFOR Situ Gede, Bogor Barat, Bogor 16115, Jawa Barat, Indonesia
| | - Nathalie Van Vliet
- Center for International Forestry Research (CIFOR), Jalan CIFOR Situ Gede, Bogor Barat, Bogor 16115, Jawa Barat, Indonesia
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Assebe LF, Erena AK, Fikadu L, Alemu B, Baruda YS, Jiao B. Cost-effectiveness of TB diagnostic technologies in Ethiopia: a modelling study. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:43. [PMID: 38773636 PMCID: PMC11106958 DOI: 10.1186/s12962-024-00544-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/16/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major threat to public health, particularly in countries where the disease is highly prevalent, such as Ethiopia. Early diagnosis and treatment are the main components of TB prevention and control. Although the national TB guideline recommends the primary use of rapid TB diagnostics whenever feasible, there is limited evidence available that assess the efficiency of deploying various diagnostic tools in the country. Hence, this study aims to evaluate the cost-effectiveness of rapid TB/MDR-TB diagnostic tools in Ethiopia. METHODS A hybrid Markov model for a hypothetical adult cohort of presumptive TB cases was constructed. The following TB diagnostic tools were evaluated: X-pert MTB/RIF, Truenat, chest X-ray screening followed by an X-pert MTB/RIF, TB-LAMP, and smear microscopy. Cost-effectiveness was determined based on incremental costs ($) per Disability-adjusted Life Years (DALY) averted, using a threshold of one times Gross Domestic Product (GDP) per capita ($856). Data on starting and transition probabilities, costs, and health state utilities were derived from secondary sources. The analysis is conducted from the health system perspective, and a probabilistic sensitivity analysis is performed. RESULT The incremental cost-effectiveness ratio for X-pert MTB/RIF, compared to the next best alternative, is $276 per DALY averted, making it a highly cost-effective diagnostic tool. Additionally, chest X-ray screening followed an X-pert MTB/RIF test is less cost-effective, with an ICER of $1666 per DALY averted. Introducing X-pert MTB/RIF testing would enhance TB detection and prevent 9600 DALYs in a cohort of 10,000 TB patients, with a total cost of $3,816,000. CONCLUSION The X-pert MTB/RIF test is the most cost-effective diagnostic tool compared to other alternatives. The use of this diagnostic tool improves the early detection and treatment of TB cases. Increased funding for this diagnostic tool will enhance access, reduce the TB detection gaps, and improve treatment outcomes.
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Affiliation(s)
- Lelisa Fekadu Assebe
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | | | - Lemmessa Fikadu
- Health system strengthening through Performance Based Financing Project, Cordaid, Bahir dar, Ethiopia
| | - Bizuneh Alemu
- Department of Health Promotion and disease prevention, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Yirgalem Shibiru Baruda
- Department of Global Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Boshen Jiao
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Das S, Srivastava PK, Biswas P. Exploring Hopf-bifurcations and endemic bubbles in a tuberculosis model with behavioral changes and treatment saturation. CHAOS (WOODBURY, N.Y.) 2024; 34:013126. [PMID: 38252782 DOI: 10.1063/5.0179351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
To manage risks and minimize the transmission of contagious diseases, individuals may reduce their contact with each other and take other precautions as much as possible in their daily lives and workplaces. As a result, the transmission of the infection reduces due to the behavioral changes. These behavioral changes are incorporated into models by introducing saturation in disease incidence. In this article, we propose and analyze a tuberculosis model that incorporates saturated exogenous reinfection and treatment. The stability analysis of the model's steady states is rigorously examined. We observe that the disease-free equilibrium point and the endemic equilibrium point (EEP) are globally asymptotically stable if the basic reproduction number (R0) is less than 1 and greater than 1, respectively, only when exogenous reinfection is not present (p=0) and when treatment is available for all (ω=0). However, even when R0 is less than 1, tuberculosis may persist at a specific level in the presence of exogenous reinfection and treatment saturation, leading to a backward bifurcation in the system. The existence and direction of Hopf-bifurcations are also discussed. Furthermore, we numerically validate our analytical results using different parameter sets. In the numerical examples, we study Hopf-bifurcations for parameters such as β, p, α, and ω. In one example, we observe that increasing β leads to the loss of stability of the unique EEP through a forward Hopf-bifurcation. If β is further increased, the unique EEP restores its stability, and the bifurcation diagram exhibits an interesting structure known as an endemic bubble. The existence of an endemic bubble for the saturation constant ω is also observed.
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Affiliation(s)
- Saduri Das
- National Institute of Technology Silchar, Silchar 788010, Assam, India
| | | | - Pankaj Biswas
- National Institute of Technology Silchar, Silchar 788010, Assam, India
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Lisson Y, Lal A, Marais BJ, Glynn-Robinson A. Tuberculosis in elderly Australians: a 10-year retrospective review. Western Pac Surveill Response J 2024; 15:1-10. [PMID: 38249315 PMCID: PMC10796269 DOI: 10.5365/wpsar.2024.15.1.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Objective This report describes the epidemiology of active tuberculosis (TB) in elderly Australians (≥ 65 years) with analysis of the factors associated with TB disease and successful treatment outcomes. Methods A retrospective study of TB cases reported to the National Notifiable Diseases Surveillance System over a 10-year period from 2011 to 2020 was conducted. Cases were stratified by sex, age, risk factors, drug resistance, treatment type and outcome. Notification rates and incidence rate ratios with 95% confidence intervals were calculated and factors associated with treatment success analysed using multivariable logistic regression. Results A total of 2231 TB cases among elderly people were reported over the study period, with a 10-year mean incidence rate of 6.2 per 100 000 population. The median age of cases was 75 years (range 65-100 years); most were male (65%) and born overseas (85%). Multivariable analysis found that successful treatment outcome was strongly associated with younger age, while unsuccessful treatment outcome was associated with being diagnosed within the first 2 years of arrival in Australia, ever having resided in an aged-care facility and resistance to fluoroquinolones. Discussion Compared to other low-incidence settings in the Western Pacific Region, TB incidence in elderly people is low and stable in Australia, with most cases occurring among recent migrants from TB-endemic settings. Continued efforts to reduce TB importation and address migrant health, especially among elderly people, are important.
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Affiliation(s)
- Yasmin Lisson
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Office of Health Protection and Response Division, Australian Government Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
| | - Aparna Lal
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ben J Marais
- Centre for Research Excellence in Tuberculosis, University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Glynn-Robinson
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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Rohrig A, Morrison J, Kleinwaks G, Pugh J, McShane H, Savulescu J. Exploring the ethics of tuberculosis human challenge models. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109234. [PMID: 38159935 DOI: 10.1136/jme-2023-109234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/28/2023] [Indexed: 01/03/2024]
Abstract
We extend recent conversation about the ethics of human challenge trials to tuberculosis (TB). TB challenge studies could accelerate vaccine development, but ethical concerns regarding risks to trial participants and third parties have been a limiting factor. We analyse the expected social value and risks of different challenge models, concluding that if a TB challenge trial has between a 10% and a 50% chance of leading to the authorisation and near-universal delivery of a more effective vaccine 3-5 years earlier, then the trial would save between 26 400 and 1 100 000 lives over the next 10 years. We also identify five important ethical considerations that differentiate TB from recent human challenge trials: an exceptionally high disease burden with no highly effective vaccine; heightened third party risk following the trial, and, partly for that reason, uniquely stringent biosafety requirements for the trial; risks associated with best available TB treatments; and difficulties with TB disease detection. We argue that there is good reason to consider conducting challenge trials with attenuated strains like Bacillus Calmette-Guérin or attenuated Mycobacterium tuberculosis.
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Affiliation(s)
- Abie Rohrig
- Columbia University, New York, New York, USA
- 1Day Sooner, Baltimore, Maryland, USA
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | | | | | - Jonathan Pugh
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Helen McShane
- Jenner Institute, University of Oxford Nuffield Department of Medicine, Oxford, Oxfordshire, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Biomedical Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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Brumwell A, Tso J, Pingali V, Millones AK, Jimenez J, Calderon RI, Barreda N, Lecca L, Nicholson T, Brooks M. A costing framework to compare tuberculosis infection tests. BMJ Glob Health 2023; 8:e012297. [PMID: 38035732 PMCID: PMC10689396 DOI: 10.1136/bmjgh-2023-012297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/07/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE To develop a framework to estimate the practical costs incurred from, and programmatic impact related to, tuberculosis (TB) infection testing-tuberculin skin tests (TST) versus interferon gamma release assay (IGRA)-in a densely populated high-burden TB area. METHODS We developed a seven-step framework that can be tailored to individual TB programmes seeking to compare TB infection (TBI) diagnostics to inform decision-making. We present methodology to estimate (1) the prevalence of TBI, (2) true and false positives and negatives for each test, (3) the cost of test administration, (4) the cost of false negatives, (5) the cost of treating all that test positive, (6) the per-test cost incurred due to treatment and misdiagnosis and (7) the threshold at which laboratory infrastructure investments for IGRA are outweighed by system-wide savings incurred due to IGRA utilisation. We then applied this framework in a densely populated, peri-urban district in Lima, Peru with high rates of Bacillus Calmette-Guérin (BCG) vaccination. FINDINGS The lower sensitivity of TST compared with IGRA is a major cost driver, leading to health system and societal costs due to misdiagnosis. Additionally, patient and staff productivity costs were greater for TST because it requires two patient visits compared with only one for IGRA testing. When the framework was applied to the Lima setting, we estimate that IGRA-associated benefits outweigh infrastructural costs after performing 672 tests. CONCLUSIONS Given global shortages of TST and concerns about costs of IGRA testing and laboratory capacity building, this costing framework can provide public health officials and TB programmes guidance for decision-making about TBI testing locally. This framework was designed to be adaptable for use in different settings with available data. Diagnostics that increase accuracy or mitigate time to treatment should be thought of as an investment instead of an expenditure.
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Affiliation(s)
- Amanda Brumwell
- Advance Access & Delivery, Inc, Durham, North Carolina, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jade Tso
- Advance Access & Delivery, Inc, Durham, North Carolina, USA
- School of Medicine, University of California Davis, Davis, California, USA
| | - Viswanath Pingali
- Economics, Indian Institute of Management Ahmedabad, Ahmedabad, Gujarat, India
| | | | | | - Roger I Calderon
- Socios En Salud Sucursal Peru, Lima, Peru
- Grupo de Investigación en Bioquímica y Biología Sintética, Universidad Nacional Federico Villarreal, San Miguel, Peru
| | | | - Leonid Lecca
- Socios En Salud Sucursal Peru, Lima, Peru
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tom Nicholson
- Advance Access & Delivery, Inc, Durham, North Carolina, USA
- Center for International Development, Duke University Sanford School of Public Policy, Durham, North Carolina, USA
| | - Meredith Brooks
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Liu AB, Lee D, Jalihal AP, Hanage WP, Springer M. Quantitatively assessing early detection strategies for mitigating COVID-19 and future pandemics. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.08.23291050. [PMID: 37398047 PMCID: PMC10312821 DOI: 10.1101/2023.06.08.23291050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Researchers and policymakers have proposed systems to detect novel pathogens earlier than existing surveillance systems by monitoring samples from hospital patients, wastewater, and air travel, in order to mitigate future pandemics. How much benefit would such systems offer? We developed, empirically validated, and mathematically characterized a quantitative model that simulates disease spread and detection time for any given disease and detection system. We find that hospital monitoring could have detected COVID-19 in Wuhan 0.4 weeks earlier than it was actually discovered, at 2,300 cases (standard error: 76 cases) compared to 3,400 (standard error: 161 cases). Wastewater monitoring would not have accelerated COVID-19 detection in Wuhan, but provides benefit in smaller catchments and for asymptomatic or long-incubation diseases like polio or HIV/AIDS. Monitoring of air travel provides little benefit in most scenarios we evaluated. In sum, early detection systems can substantially mitigate some future pandemics, but would not have changed the course of COVID-19.
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Affiliation(s)
- Andrew Bo Liu
- Department of Systems Biology, Harvard Medical School; Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School; Boston, MA, USA
| | - Daniel Lee
- Department of Biomedical Informatics, Harvard Medical School; Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard; Cambridge, MA, USA
| | | | - William P. Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health; Boston, MA, USA
| | - Michael Springer
- Department of Systems Biology, Harvard Medical School; Boston, MA, USA
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Adepoju VA, Onyezue OI. Ending the TB pandemic: the urgency of a new and improved TB vaccine and the World Health Organization's TB Vaccine Accelerator Council. Breathe (Sheff) 2023; 19:230036. [PMID: 37719240 PMCID: PMC10501705 DOI: 10.1183/20734735.0036-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/20/2023] [Indexed: 09/19/2023] Open
Abstract
We support the World Health Organization (WHO) recent decision to create a council to accelerate the development of a tuberculosis (TB) vaccine. With over 10 million new cases and 1.4 million deaths in 2020 alone, new and improved vaccines are urgently needed. Recent advancements in TB vaccine research offer hope, but a lack of funding, coordination and understanding of immune responses have impeded progress. A TB Vaccine Accelerator Council aims to bring together resources and expertise to overcome these obstacles and speed up development. Support and investment in research are crucial to ultimately eradicate TB and achieve the WHO goal of ending TB by 2035.
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Affiliation(s)
- Victor Abiola Adepoju
- Department of HIV and Infectious Diseases, Jhpiego (an affiliate of Johns Hopkins University), Abuja, Nigeria
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11
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Romanyukha AA, Karkach AS, Borisov SE, Belilovsky EM, Sannikova TE. Identification of growing tuberculosis incidence clusters in a region with a decrease in tuberculosis prevalence in Moscow (2000-2019). J Glob Health 2023; 13:04052. [PMID: 37224511 DOI: 10.7189/jogh.13.04052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Background The control of tuberculosis (TB) may benefit from a prospective identification of areas where the incidence may increase in addition to the traditionally identified foci of high incidence. We aimed to identify residential areas with growing tuberculosis incidence rates and assess their significance and stability. Methods We analysed the changes in TB incidence rates using case data georeferenced with spatial granularity to apartment buildings in the territory of Moscow from 2000 to 2019. We identified sparsely distributed areas with significant increases in the incidence rate inside residential areas. We tested the stability of found growth areas to case underreporting via stochastic modelling. Results For 21 350 cases with smear- or culture-positive pulmonary TB among residents from 2000 to 2019, we identified 52 small-scale clusters of growing incidence rate responsible for 1% of all registered cases. We tested clusters of disease growth for underreporting and found them to be relatively unstable to resampling with case drop-out, but their spatial displacement was small. Territories with a stable increase in TB incidence rate were identified and compared to the rest of the city, which is characterised by a significant decrease in incidence. Conclusions Identified areas with a tendency for an increase in the TB incidence rate may be important targets for disease control services.
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Affiliation(s)
- Alexei A Romanyukha
- Marchuk Institute of Numerical Mathematics, Russian Academy of Sciences, Moscow, Russia
- Moscow State University, Moscow, Russia
| | - Arseny S Karkach
- Marchuk Institute of Numerical Mathematics, Russian Academy of Sciences, Moscow, Russia
| | - Sergey E Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, Moscow Department of Public Health, Moscow, Russia
| | - Evgeny M Belilovsky
- Moscow Research and Clinical Center for Tuberculosis Control, Moscow Department of Public Health, Moscow, Russia
| | - Tatiana E Sannikova
- Marchuk Institute of Numerical Mathematics, Russian Academy of Sciences, Moscow, Russia
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Lyu X, Luo Z, Shao L, Awbi H, Lo Piano S. Safe CO 2 threshold limits for indoor long-range airborne transmission control of COVID-19. BUILDING AND ENVIRONMENT 2023; 234:109967. [PMID: 36597420 PMCID: PMC9801696 DOI: 10.1016/j.buildenv.2022.109967] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/16/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
CO2-based infection risk monitoring is highly recommended during the current COVID-19 pandemic. However, the CO2 monitoring thresholds proposed in the literature are mainly for spaces with fixed occupants. Determining CO2 threshold is challenging in spaces with changing occupancy due to the co-existence of quanta and CO2 remaining from previous occupants. Here, we propose a new calculation framework for deriving safe excess CO2 thresholds (above outdoor level), C t, for various spaces with fixed/changing occupancy and analyze the uncertainty involved. We categorized common indoor spaces into three scenarios based on their occupancy conditions, e.g., fixed or varying infection ratios (infectors/occupants). We proved that the rebreathed fraction-based model can be applied directly for deriving C t in the case of a fixed infection ratio (Scenario 1 and Scenario 2). In the case of varying infection ratios (Scenario 3), C t derivation must follow the general calculation framework due to the existence of initial quanta/excess CO2. Otherwise, C t can be significantly biased (e.g., 260 ppm) when the infection ratio varies greatly. C t can vary significantly based on specific space factors such as occupant number, physical activity, and community prevalence, e.g., 7 ppm for gym and 890 ppm for lecture hall, indicating C t must be determined on a case-by-case basis. An uncertainty of up to 6 orders of magnitude for C t was found for all cases due to uncertainty in emissions of quanta and CO2, thus emphasizing the role of accurate emissions data in determining C t.
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Affiliation(s)
- Xiaowei Lyu
- School of the Built Environment, University of Reading, UK
| | - Zhiwen Luo
- Welsh School of Architecture, Cardiff University, UK
| | - Li Shao
- School of the Built Environment, University of Reading, UK
| | - Hazim Awbi
- School of the Built Environment, University of Reading, UK
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López MG, Campos-Herrero MI, Torres-Puente M, Cañas F, Comín J, Copado R, Wintringer P, Iqbal Z, Lagarejos E, Moreno-Molina M, Pérez-Lago L, Pino B, Sante L, García de Viedma D, Samper S, Comas I. Deciphering the Tangible Spatio-Temporal Spread of a 25-Year Tuberculosis Outbreak Boosted by Social Determinants. Microbiol Spectr 2023; 11:e0282622. [PMID: 36786614 PMCID: PMC10100973 DOI: 10.1128/spectrum.02826-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
Outbreak strains of Mycobacterium tuberculosis are promising candidates as targets in the search for intrinsic determinants of transmissibility, as they are responsible for many cases with sustained transmission; however, the use of low-resolution typing methods and restricted geographical investigations represent flaws in assessing the success of long-lived outbreak strains. We can now address the nature of outbreak strains by combining large genomic data sets and phylodynamic approaches. We retrospectively sequenced the whole genome of representative samples assigned to an outbreak circulating in the Canary Islands (the GC strain) since 1993, which accounts for ~20% of local tuberculosis cases. We selected a panel of specific single nucleotide polymorphism (SNP) markers for an in-silico search for additional outbreak-related sequences within publicly available tuberculosis genomic data. Using this information, we inferred the origin, spread, and epidemiological parameters of the GC strain. Our approach allowed us to accurately trace the historical and more recent dispersion of the GC strain. We provide evidence of a highly successful nature within the Canarian archipelago but limited expansion abroad. Estimation of epidemiological parameters from genomic data disagree with a distinctive biology of the GC strain. With the increasing availability of genomic data allowing for the accurate inference of strain spread and critical epidemiological parameters, we can now revisit the link between Mycobacterium tuberculosis genotypes and transmission, as is routinely carried out for SARS-CoV-2 variants of concern. We demonstrate that social determinants rather than intrinsically higher bacterial transmissibility better explain the success of the GC strain. Importantly, our approach can be used to trace and characterize strains of interest worldwide. IMPORTANCE Infectious disease outbreaks represent a significant problem for public health. Tracing outbreak expansion and understanding the main factors behind emergence and persistence remain critical to effective disease control. Our study allows researchers and public health authorities to use Whole-Genome Sequencing-based methods to trace outbreaks, and shows how available epidemiological information helps to evaluate the factors underpinning outbreak persistence. Taking advantage of all the freely available information placed in public repositories, researchers can accurately establish the expansion of an outbreak beyond original boundaries, and determine the potential risk of a strain to inform health authorities which, in turn, can define target strategies to mitigate expansion and persistence. Finally, we show the need to evaluate strain transmissibility in different geographic contexts to unequivocally associate spread to local or pathogenic factors, an important lesson taken from genomic surveillance of SARS-CoV-2.
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Affiliation(s)
- Mariana G. López
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia (IBV), CSIC, Valencia, Spain
| | - Ma Isolina Campos-Herrero
- Servicio de Microbiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Manuela Torres-Puente
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia (IBV), CSIC, Valencia, Spain
| | - Fernando Cañas
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Jessica Comín
- Instituto Aragonés de Ciencias de la Salud, Fundación IIS Aragón, Zaragoza, Spain
| | - Rodolfo Copado
- Hospital José Molina Orosa, Las Palmas de Gran Canaria, Spain
| | - Penelope Wintringer
- European Molecular Biology Laboratory – European Bioinformatics Institute, Hinxton, UK
| | - Zamin Iqbal
- European Molecular Biology Laboratory – European Bioinformatics Institute, Hinxton, UK
| | - Eduardo Lagarejos
- Servicio de Microbiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Miguel Moreno-Molina
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia (IBV), CSIC, Valencia, Spain
| | - Laura Pérez-Lago
- Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Berta Pino
- Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Laura Sante
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Darío García de Viedma
- Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Sofía Samper
- Instituto Aragonés de Ciencias de la Salud, Fundación IIS Aragón, Zaragoza, Spain
- CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Iñaki Comas
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia (IBV), CSIC, Valencia, Spain
- CIBER Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
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14
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Smith JP, Cohen T, Dowdy D, Shrestha S, Gandhi NR, Hill AN. Quantifying Mycobacterium tuberculosis Transmission Dynamics Across Global Settings: A Systematic Analysis. Am J Epidemiol 2023; 192:133-145. [PMID: 36227246 PMCID: PMC10144641 DOI: 10.1093/aje/kwac181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/23/2022] [Accepted: 10/10/2022] [Indexed: 01/11/2023] Open
Abstract
The degree to which individual heterogeneity in the production of secondary cases ("superspreading") affects tuberculosis (TB) transmission has not been systematically studied. We searched for population-based or surveillance studies in which whole genome sequencing was used to estimate TB transmission and in which the size distributions of putative TB transmission clusters were enumerated. We fitted cluster-size-distribution data to a negative binomial branching process model to jointly infer the transmission parameters $R$ (the reproduction number) and the dispersion parameter, $k$, which quantifies the propensity of superspreading in a population (generally, lower values of $k$ ($<1.0$) suggest increased heterogeneity). Of 4,796 citations identified in our initial search, 9 studies from 8 global settings met the inclusion criteria (n = 5 studies of all TB; n = 4 studies of drug-resistant TB). Estimated $R$ values (range, 0.10-0.73) were below 1.0, consistent with declining epidemics in the included settings; estimated $k$ values were well below 1.0 (range, 0.02-0.48), indicating the presence of substantial individual-level heterogeneity in transmission across all settings. We estimated that a minority of cases (range, 2%-31%) drive the majority (80%) of ongoing TB transmission at the population level. Identifying sources of heterogeneity and accounting for them in TB control may have a considerable impact on mitigating TB transmission.
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Affiliation(s)
- Jonathan P Smith
- Correspondence to Dr. Jonathan Smith, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510 (e-mail: )
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15
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Leavitt SV, Jenkins HE, Sebastiani P, Lee RS, Horsburgh CR, Tibbs AM, White LF. Estimation of the generation interval using pairwise relative transmission probabilities. Biostatistics 2022; 23:807-824. [PMID: 33527996 PMCID: PMC9291635 DOI: 10.1093/biostatistics/kxaa059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022] Open
Abstract
The generation interval (the time between infection of primary and secondary cases) and its often used proxy, the serial interval (the time between symptom onset of primary and secondary cases) are critical parameters in understanding infectious disease dynamics. Because it is difficult to determine who infected whom, these important outbreak characteristics are not well understood for many diseases. We present a novel method for estimating transmission intervals using surveillance or outbreak investigation data that, unlike existing methods, does not require a contact tracing data or pathogen whole genome sequence data on all cases. We start with an expectation maximization algorithm and incorporate relative transmission probabilities with noise reduction. We use simulations to show that our method can accurately estimate the generation interval distribution for diseases with different reproductive numbers, generation intervals, and mutation rates. We then apply our method to routinely collected surveillance data from Massachusetts (2010-2016) to estimate the serial interval of tuberculosis in this setting.
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Affiliation(s)
- Sarah V Leavitt
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; Epidemiology Division, University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, ON M5T 3M7, Canada; Department of Epidemiology, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; and Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108
| | - Helen E Jenkins
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; Epidemiology Division, University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, ON M5T 3M7, Canada; Department of Epidemiology, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; and Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108
| | - Paola Sebastiani
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; Epidemiology Division, University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, ON M5T 3M7, Canada; Department of Epidemiology, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; and Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108
| | - Robyn S Lee
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; Epidemiology Division, University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, ON M5T 3M7, Canada; Department of Epidemiology, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; and Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108
| | - C Robert Horsburgh
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; Epidemiology Division, University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, ON M5T 3M7, Canada; Department of Epidemiology, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; and Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108
| | - Andrew M Tibbs
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; Epidemiology Division, University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, ON M5T 3M7, Canada; Department of Epidemiology, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; and Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108
| | - Laura F White
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; Epidemiology Division, University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, ON M5T 3M7, Canada; Department of Epidemiology, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118; and Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108
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16
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Nyamathi A, Morisky D, Wall SA, Yadav K, Shin S, Hall E, Chang AH, White K, Arce N, Parsa T, Salem BE. Nurse-led intervention to decrease drug use among LTBI positive homeless adults. Public Health Nurs 2022; 39:778-787. [PMID: 35014087 DOI: 10.1111/phn.13044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND People experiencing homelessness (PEH) are disproportionately diagnosed with active tuberculosis. While promoting latent tuberculosis infection (LTBI) treatment has been a call to action, PEH engaging in substance use often experience challenges in completing LTBI treatment. METHODS In this non-randomized single arm study, we tested an innovative, community-based, nurse-led community health worker (RN-CHW) model, on reducing drug use among 50 PEH, residing in homeless shelters or living on the streets in Los Angeles. Follow-up was at 3- and 6- months. RESULTS Findings revealed significant and ongoing decrease in any drug use (odds ratio [OR] = 0.30; 95% confidence interval [CI] = 0.14-0.68); p = .004), amphetamine use (OR = 0.14; 95% CI = 0.02-0.81; p = .029), cannabis use (OR = 0.26; 95% CI = 0.12-0.57; p = .001) and methamphetamine use (OR = 0.30; 95% CI = 0.10-0.90; p = .031) at 6-month follow-up. CONCLUSIONS To our knowledge, this pilot study is the first to evaluate the impact a RN-CHW delivered intervention on reduction in drug use among PEH enrolled in a LTBI intervention. LTBI interventions may serve as an entryway into reduction in drug use among this underserved population.
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Affiliation(s)
- Adeline Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, California
| | - Donald Morisky
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Sarah Akure Wall
- School of Nursing, University of California, Los Angeles, California
| | - Kartik Yadav
- Sue & Bill Gross School of Nursing, University of California, Irvine, California
| | - Sangshuk Shin
- Sue & Bill Gross School of Nursing, University of California, Irvine, California
| | - Elizabeth Hall
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Alicia H Chang
- Los Angeles County Department of Public Health, Tuberculosis Control Program, Los Angeles, California
| | - Kathryn White
- Los Angeles Christian Health Centers, Los Angeles, California
| | - Nicholas Arce
- School of Social Ecology, University of California, Irvine, California
| | - Therese Parsa
- School of Nursing, University of California, Los Angeles, California
| | - Benissa E Salem
- School of Nursing, University of California, Los Angeles, California
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17
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Tran J, Green ON, Modahl L. Chest Manifestations of Mycobacterium Tuberculosis Complex - Clinical and Imaging Features. Semin Roentgenol 2022; 57:67-74. [DOI: 10.1053/j.ro.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/01/2021] [Indexed: 11/11/2022]
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18
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Early reports of epidemiological parameters of the COVID-19 pandemic. Western Pac Surveill Response J 2021; 12:65-81. [PMID: 34540315 PMCID: PMC8421745 DOI: 10.5365/wpsar.2020.11.3.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background The emergence of a new pathogen requires a rapid assessment of its transmissibility, to inform appropriate public health interventions. Methods The peer-reviewed literature published between 1 January and 30 April 2020 on COVID-19 in PubMed was searched. Estimates of the incubation period, serial interval and reproduction number for COVID-19 were obtained and compared. Results A total of 86 studies met the inclusion criteria. Of these, 33 estimated the mean incubation period (4–7 days) and 15 included estimates of the serial interval (mean 4–8 days; median length 4–5 days). Fifty-two studies estimated the reproduction number. Although reproduction number estimates ranged from 0.3 to 14.8, in 33 studies (63%), they fell between 2 and 3. Discussion Studies calculating the incubation period and effective reproduction number were published from the beginning of the pandemic until the end of the study period (30 April 2020); however, most of the studies calculating the serial interval were published in April 2020. The calculated incubation period was similar over the study period and in different settings, whereas estimates of the serial interval and effective reproduction number were setting-specific. Estimates of the serial interval were shorter at the end of the study period as increasing evidence of pre-symptomatic transmission was documented and as jurisdictions enacted outbreak control measures. Estimates of the effective reproduction number varied with the setting and the underlying model assumptions. Early analysis of epidemic parameters provides vital information to inform the outbreak response.
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19
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Wang CC, Prather KA, Sznitman J, Jimenez JL, Lakdawala SS, Tufekci Z, Marr LC. Airborne transmission of respiratory viruses. Science 2021; 373:eabd9149. [PMID: 34446582 PMCID: PMC8721651 DOI: 10.1126/science.abd9149] [Citation(s) in RCA: 457] [Impact Index Per Article: 152.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has revealed critical knowledge gaps in our understanding of and a need to update the traditional view of transmission pathways for respiratory viruses. The long-standing definitions of droplet and airborne transmission do not account for the mechanisms by which virus-laden respiratory droplets and aerosols travel through the air and lead to infection. In this Review, we discuss current evidence regarding the transmission of respiratory viruses by aerosols-how they are generated, transported, and deposited, as well as the factors affecting the relative contributions of droplet-spray deposition versus aerosol inhalation as modes of transmission. Improved understanding of aerosol transmission brought about by studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requires a reevaluation of the major transmission pathways for other respiratory viruses, which will allow better-informed controls to reduce airborne transmission.
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Affiliation(s)
- Chia C Wang
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China.
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA
- Aerosol Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
| | - Kimberly A Prather
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA.
| | - Josué Sznitman
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa 32000, Israel
| | - Jose L Jimenez
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa 32000, Israel
- Department of Chemistry and CIRES, University of Colorado, Boulder, CO 80309, USA
| | - Seema S Lakdawala
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Zeynep Tufekci
- School of Information and Department of Sociology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Linsey C Marr
- Aerosol Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
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20
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Wang CC, Prather KA, Sznitman J, Jimenez JL, Lakdawala SS, Tufekci Z, Marr LC. Airborne transmission of respiratory viruses. Science 2021. [PMID: 34446582 DOI: 10.1126/science:abd9149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The COVID-19 pandemic has revealed critical knowledge gaps in our understanding of and a need to update the traditional view of transmission pathways for respiratory viruses. The long-standing definitions of droplet and airborne transmission do not account for the mechanisms by which virus-laden respiratory droplets and aerosols travel through the air and lead to infection. In this Review, we discuss current evidence regarding the transmission of respiratory viruses by aerosols-how they are generated, transported, and deposited, as well as the factors affecting the relative contributions of droplet-spray deposition versus aerosol inhalation as modes of transmission. Improved understanding of aerosol transmission brought about by studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requires a reevaluation of the major transmission pathways for other respiratory viruses, which will allow better-informed controls to reduce airborne transmission.
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Affiliation(s)
- Chia C Wang
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China.
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA
- Aerosol Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
| | - Kimberly A Prather
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA.
| | - Josué Sznitman
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa 32000, Israel
| | - Jose L Jimenez
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa 32000, Israel
- Department of Chemistry and CIRES, University of Colorado, Boulder, CO 80309, USA
| | - Seema S Lakdawala
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Zeynep Tufekci
- School of Information and Department of Sociology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Linsey C Marr
- Aerosol Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
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21
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Quantifying transmission fitness costs of multi-drug resistant tuberculosis. Epidemics 2021; 36:100471. [PMID: 34256273 DOI: 10.1016/j.epidem.2021.100471] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 01/14/2020] [Accepted: 05/17/2021] [Indexed: 11/22/2022] Open
Abstract
As multi-drug resistant tuberculosis (MDR-TB) continues to spread, investigating the transmission potential of different drug-resistant strains becomes an ever more pressing topic in public health. While phylogenetic and transmission tree inferences provide valuable insight into possible transmission chains, phylodynamic inference combines evolutionary and epidemiological analyses to estimate the parameters of the underlying epidemiological processes, allowing us to describe the overall dynamics of disease spread in the population. In this study, we introduce an approach to Mycobacterium tuberculosis (M. tuberculosis) phylodynamic analysis employing an existing computationally efficient model to quantify the transmission fitness costs of drug resistance with respect to drug-sensitive strains. To determine the accuracy and precision of our approach, we first perform a simulation study, mimicking the simultaneous spread of drug-sensitive and drug-resistant tuberculosis (TB) strains. We analyse the simulated transmission trees using the phylodynamic multi-type birth-death model (MTBD, (Kühnert et al., 2016)) within the BEAST2 framework and show that this model can estimate the parameters of the epidemic well, despite the simplifying assumptions that MTBD makes compared to the complex TB transmission dynamics used for simulation. We then apply the MTBD model to an M. tuberculosis lineage 4 dataset that primarily consists of MDR sequences. Some of the MDR strains additionally exhibit resistance to pyrazinamide - an important first-line anti-tuberculosis drug. Our results support the previously proposed hypothesis that pyrazinamide resistance confers a transmission fitness cost to the bacterium, which we quantify for the given dataset. Importantly, our sensitivity analyses show that the estimates are robust to different prior distributions on the resistance acquisition rate, but are affected by the size of the dataset - i.e. we estimate a higher fitness cost when using fewer sequences for analysis. Overall, we propose that MTBD can be used to quantify the transmission fitness cost for a wide range of pathogens where the strains can be appropriately divided into two or more categories with distinct properties.
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22
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Leavitt SV, Lee RS, Sebastiani P, Horsburgh CR, Jenkins HE, White LF. Estimating the relative probability of direct transmission between infectious disease patients. Int J Epidemiol 2021; 49:764-775. [PMID: 32211747 DOI: 10.1093/ije/dyaa031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/07/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Estimating infectious disease parameters such as the serial interval (time between symptom onset in primary and secondary cases) and reproductive number (average number of secondary cases produced by a primary case) are important in understanding infectious disease dynamics. Many estimation methods require linking cases by direct transmission, a difficult task for most diseases. METHODS Using a subset of cases with detailed genetic and/or contact investigation data to develop a training set of probable transmission events, we build a model to estimate the relative transmission probability for all case-pairs from demographic, spatial and clinical data. Our method is based on naive Bayes, a machine learning classification algorithm which uses the observed frequencies in the training dataset to estimate the probability that a pair is linked given a set of covariates. RESULTS In simulations, we find that the probabilities estimated using genetic distance between cases to define training transmission events are able to distinguish between truly linked and unlinked pairs with high accuracy (area under the receiver operating curve value of 95%). Additionally, only a subset of the cases, 10-50% depending on sample size, need to have detailed genetic data for our method to perform well. We show how these probabilities can be used to estimate the average effective reproductive number and apply our method to a tuberculosis outbreak in Hamburg, Germany. CONCLUSIONS Our method is a novel way to infer transmission dynamics in any dataset when only a subset of cases has rich contact investigation and/or genetic data.
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Affiliation(s)
- Sarah V Leavitt
- School of Public Health, Department of Biostatistics, Boston University, Boston, MA, USA
| | - Robyn S Lee
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,University of Toronto Dalla Lana School of Public Health Epidemiology Division, Toronto, ON, Canada
| | - Paola Sebastiani
- School of Public Health, Department of Biostatistics, Boston University, Boston, MA, USA
| | - C Robert Horsburgh
- School of Public Health, Department of Epidemiology, Boston University, Boston, MA, USA
| | - Helen E Jenkins
- School of Public Health, Department of Biostatistics, Boston University, Boston, MA, USA
| | - Laura F White
- School of Public Health, Department of Biostatistics, Boston University, Boston, MA, USA
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23
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Oh MD. Airborne transmission of coronavirus disease 2019: a clinician's perspective. Korean J Intern Med 2021; 36:467-470. [PMID: 32872727 PMCID: PMC7969067 DOI: 10.3904/kjim.2020.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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24
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Oga-Omenka C, Tseja-Akinrin A, Boffa J, Heitkamp P, Pai M, Zarowsky C. Commentary: Lessons from the COVID-19 global health response to inform TB case finding. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 9:100487. [PMID: 33607520 PMCID: PMC7580683 DOI: 10.1016/j.hjdsi.2020.100487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022]
Abstract
The coronavirus disease 2019 (COVID-19) has emerged as a serious threat to global public health, demanding urgent action and causing unprecedented worldwide change in a short space of time. This disease has devastated economies, infringed on individual freedoms, and taken an unprecedented toll on healthcare systems worldwide. As of 1 April 2020, over a million cases of COVID-19 have been reported in 204 countries and territories, resulting in more than 51,000 deaths. Yet, against the backdrop of the COVID-19 pandemic, lies an older, insidious disease with a much greater mortality. Tuberculosis (TB) is the leading cause of death by a single infectious agent and remains a potent threat to millions of people around the world. We discuss the differences between the two pandemics at present, consider the potential impact of COVID-19 on TB case management, and explore the opportunities that the COVID-19 response presents for advancing TB prevention and control now and in future.
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Affiliation(s)
- Charity Oga-Omenka
- École de Santé Publique de l'Université de Montréal (ESPUM), Canada; McGill International TB Center, Montreal, Canada; Centre de Recherche en Santé Publique, Université de Montréal (CReSP), Canada.
| | | | - Jody Boffa
- McGill International TB Center, Montreal, Canada; Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Petra Heitkamp
- McGill International TB Center, Montreal, Canada; TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
| | - Madhukar Pai
- McGill International TB Center, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Christina Zarowsky
- École de Santé Publique de l'Université de Montréal (ESPUM), Canada; Centre de Recherche en Santé Publique, Université de Montréal (CReSP), Canada; School of Public Health, University of the Western Cape, Bellville South Africa, South Africa
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25
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Genotyping indicates marked heterogeneity of tuberculosis transmission in the United States, 2009–2018. Epidemiol Infect 2021. [PMCID: PMC8506451 DOI: 10.1017/s0950268821002041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Heterogeneity in the number of secondary tuberculosis (TB) cases per source case, the effective reproductive number, R, is important in modelling prevention strategies' impact on incidence. We estimated mean R (Rm) and calculate the dispersion parameter of this distribution, k, using surveillance and genotyping data for U.S. cases during 2009–2018. We modelled transmission assuming cases in a cluster have matching genotypes and share characteristics related to geography, temporal proximity (i.e. serial interval) and time since U.S. arrival among non-U.S.-born persons. Complete data were available for 55 330/85 958 cases. Varying the serial interval and geographic proximity used to derive clusters, we consistently estimated Rm<1.0 and k < 0.08; the low value of k indicates a small number of source cases produce a disproportionate number of secondary cases. U.S. TB reproductive number has a highly skewed distribution, indicating a minority of source cases disproportionately contribute to transmission.
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Maheshwari P, Albert R. Network model and analysis of the spread of Covid-19 with social distancing. APPLIED NETWORK SCIENCE 2020; 5:100. [PMID: 33392389 PMCID: PMC7770744 DOI: 10.1007/s41109-020-00344-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/08/2020] [Indexed: 05/16/2023]
Abstract
The first mitigation response to the Covid-19 pandemic was to limit person-to-person interaction as much as possible. This was implemented by the temporary closing of many workplaces and people were required to follow social distancing. Networks are a great way to represent interactions among people and the temporary severing of these interactions. Here, we present a network model of human-human interactions that could be mediators of disease spread. The nodes of this network are individuals and different types of edges denote family cliques, workplace interactions, interactions arising from essential needs, and social interactions. Each individual can be in one of four states: susceptible, infected, immune, and dead. The network and the disease parameters are informed by the existing literature on Covid-19. Using this model, we simulate the spread of an infectious disease in the presence of various mitigation scenarios. For example, lockdown is implemented by deleting edges that denote non-essential interactions. We validate the simulation results with the real data by matching the basic and effective reproduction numbers during different phases of the spread. We also simulate different possibilities of the slow lifting of the lockdown by varying the transmission rate as facilities are slowly opened but people follow prevention measures like wearing masks etc. We make predictions on the probability and intensity of a second wave of infection in each of these scenarios.
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Affiliation(s)
- Parul Maheshwari
- Department of Physics, The Pennsylvania State University, University Park, PA 16802 USA
| | - Réka Albert
- Department of Physics, The Pennsylvania State University, University Park, PA 16802 USA
- Biology Department, The Pennsylvania State University, University Park, PA 16802 USA
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27
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MacIntyre CR, Ananda-Rajah MR. Scientific evidence supports aerosol transmission of SARS-COV-2. Antimicrob Resist Infect Control 2020; 9:202. [PMID: 33339522 PMCID: PMC7747188 DOI: 10.1186/s13756-020-00868-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/11/2020] [Indexed: 01/06/2023] Open
Affiliation(s)
- C Raina MacIntyre
- Biosecurity Research Program, Kirby Institute, UNSW Medicine, Sydney, Australia.
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28
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Ma Y, Jenkins HE, Sebastiani P, Ellner JJ, Jones-López EC, Dietze R, Horsburgh, Jr. CR, White LF. Using Cure Models to Estimate the Serial Interval of Tuberculosis With Limited Follow-up. Am J Epidemiol 2020; 189:1421-1426. [PMID: 32458995 PMCID: PMC7731991 DOI: 10.1093/aje/kwaa090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/26/2022] Open
Abstract
Serial interval (SI), defined as the time between symptom onset in an infector and infectee pair, is commonly used to understand infectious diseases transmission. Slow progression to active disease, as well as the small percentage of individuals who will eventually develop active disease, complicate the estimation of the SI for tuberculosis (TB). In this paper, we showed via simulation studies that when there is credible information on the percentage of those who will develop TB disease following infection, a cure model, first introduced by Boag in 1949, should be used to estimate the SI for TB. This model includes a parameter in the likelihood function to account for the study population being composed of those who will have the event of interest and those who will never have the event. We estimated the SI for TB to be approximately 0.5 years for the United States and Canada (January 2002 to December 2006) and approximately 2.0 years for Brazil (March 2008 to June 2012), which might imply a higher occurrence of reinfection TB in a developing country like Brazil.
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Affiliation(s)
- Yicheng Ma
- Correspondence to Dr. Yicheng Ma, Department of Biostatistics, 801 Massachusetts Avenue, Boston, MA 02118 (e-mail: )
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29
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Long R, King M, Doroshenko A, Heffernan C. Tuberculosis and COVID-19 in Canada. EClinicalMedicine 2020; 27:100584. [PMID: 33106784 PMCID: PMC7578696 DOI: 10.1016/j.eclinm.2020.100584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Richard Long
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Room 8334A, Aberhart Centre, 11402, Alberta T6G 2J3, Canada
| | - Malcolm King
- The Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada
| | - Alexander Doroshenko
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Room 8334A, Aberhart Centre, 11402, Alberta T6G 2J3, Canada
| | - Courtney Heffernan
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Room 8334A, Aberhart Centre, 11402, Alberta T6G 2J3, Canada
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30
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Danielsen AS, Elstrøm P, Arnesen TM, Gopinathan U, Kacelnik O. Targeting TB or MRSA in Norwegian municipalities during 'the refugee crisis' of 2015: a framework for priority setting in screening. ACTA ACUST UNITED AC 2020; 24. [PMID: 31552819 PMCID: PMC6761574 DOI: 10.2807/1560-7917.es.2019.24.38.1800676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction In 2015, there was an increase in the number of asylum seekers arriving in Europe. Like in other countries, deciding screening priorities for tuberculosis (TB) and meticillin-resistant Staphylococcus aureus (MRSA) was a challenge. At least five of 428 municipalities chose to screen asylum seekers for MRSA before TB; the Norwegian Institute for Public Health advised against this. Aim To evaluate the MRSA/TB screening results from 2014 to 2016 and create a generalised framework for screening prioritisation in Norway through simulation modelling. Methods This is a register-based cohort study of asylum seekers using data from the Norwegian Surveillance System for Communicable Diseases from 2014 to 2016. We used survey data from municipalities that screened all asylum seekers for MRSA and denominator data from the Directorate of Immigration. A comparative risk assessment model was built to investigate the outcomes of prioritising between TB and MRSA in screening regimes. Results Of 46,090 asylum seekers, 137 (0.30%) were diagnosed with active TB (notification rate: 300/100,000 person-years). In the municipalities that screened all asylum seekers for MRSA, 13 of 1,768 (0.74%) were found to be infected with MRSA. The model estimated that screening for MRSA would prevent eight MRSA infections while prioritising TB screening would prevent 24 cases of active TB and one death. Conclusion Our findings support the decision to advise against screening for MRSA before TB among newly arrived asylum seekers. The model was an effective tool for comparing screening priorities and can be applied to other scenarios in other countries.
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Affiliation(s)
- Anders Skyrud Danielsen
- Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - Petter Elstrøm
- Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - Trude Margrete Arnesen
- Department of Tuberculosis, Blood Borne and Sexually Transmitted Infections, Norwegian Institute of Public Health, Oslo, Norway
| | - Unni Gopinathan
- Cluster for Global Health, Norwegian Institute of Public Health & Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Oliver Kacelnik
- Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
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31
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Nelson KN, Gandhi NR, Mathema B, Lopman BA, Brust JCM, Auld SC, Ismail N, Omar SV, Brown TS, Allana S, Campbell A, Moodley P, Mlisana K, Shah NS, Jenness SM. Modeling Missing Cases and Transmission Links in Networks of Extensively Drug-Resistant Tuberculosis in KwaZulu-Natal, South Africa. Am J Epidemiol 2020; 189:735-745. [PMID: 32242216 PMCID: PMC7443195 DOI: 10.1093/aje/kwaa028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 02/26/2020] [Indexed: 11/14/2022] Open
Abstract
Patterns of transmission of drug-resistant tuberculosis (TB) remain poorly understood, despite over half a million incident cases worldwide in 2017. Modeling TB transmission networks can provide insight into drivers of transmission, but incomplete sampling of TB cases can pose challenges for inference from individual epidemiologic and molecular data. We assessed the effect of missing cases on a transmission network inferred from Mycobacterium tuberculosis sequencing data on extensively drug-resistant TB cases in KwaZulu-Natal, South Africa, diagnosed in 2011-2014. We tested scenarios in which cases were missing at random, missing differentially by clinical characteristics, or missing differentially by transmission (i.e., cases with many links were under- or oversampled). Under the assumption that cases were missing randomly, the mean number of transmissions per case in the complete network needed to be larger than 20, far higher than expected, to reproduce the observed network. Instead, the most likely scenario involved undersampling of high-transmitting cases, and models provided evidence for super-spreading. To our knowledge, this is the first analysis to have assessed support for different mechanisms of missingness in a TB transmission study, but our results are subject to the distributional assumptions of the network models we used. Transmission studies should consider the potential biases introduced by incomplete sampling and identify host, pathogen, or environmental factors driving super-spreading.
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Affiliation(s)
- Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Neel R Gandhi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- School of Medicine, Emory University, Atlanta, Georgia
| | - Barun Mathema
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - James C M Brust
- Albert Einstein College of Medicine and Montefiore Medical Center, New York, New York
| | - Sara C Auld
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- School of Medicine, Emory University, Atlanta, Georgia
| | - Nazir Ismail
- National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Medical Microbiology, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Shaheed Vally Omar
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Tyler S Brown
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Salim Allana
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Angie Campbell
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Pravi Moodley
- National Health Laboratory Service, Johannesburg, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Koleka Mlisana
- National Health Laboratory Service, Johannesburg, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - N Sarita Shah
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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32
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Brooks-Pollock E, Danon L, Korthals Altes H, Davidson JA, Pollock AMT, van Soolingen D, Campbell C, Lalor MK. A model of tuberculosis clustering in low incidence countries reveals more transmission in the United Kingdom than the Netherlands between 2010 and 2015. PLoS Comput Biol 2020; 16:e1007687. [PMID: 32218567 PMCID: PMC7141699 DOI: 10.1371/journal.pcbi.1007687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 04/08/2020] [Accepted: 01/16/2020] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis (TB) remains a public health threat in low TB incidence countries, through a combination of reactivated disease and onward transmission. Using surveillance data from the United Kingdom (UK) and the Netherlands (NL), we demonstrate a simple and predictable relationship between the probability of observing a cluster and its size (the number of cases with a single genotype). We demonstrate that the full range of observed cluster sizes can be described using a modified branching process model with the individual reproduction number following a Poisson lognormal distribution. We estimate that, on average, between 2010 and 2015, a TB case generated 0.41 (95% CrI 0.30,0.60) secondary cases in the UK, and 0.24 (0.14,0.48) secondary cases in the NL. A majority of cases did not generate any secondary cases. Recent transmission accounted for 39% (26%,60%) of UK cases and 23%(13%,37%) of NL cases. We predict that reducing UK transmission rates to those observed in the NL would result in 538(266,818) fewer cases annually in the UK. In conclusion, while TB in low incidence countries is strongly associated with reactivated infections, we demonstrate that recent transmission remains sufficient to warrant policies aimed at limiting local TB spread.
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Affiliation(s)
- Ellen Brooks-Pollock
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Leon Danon
- College of Engineering and Mathematical Sciences, University of Exeter, Exeter, United Kingdom
- The Alan Turing Institute, London, United Kingdom
| | - Hester Korthals Altes
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | | | - Dick van Soolingen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Departments of Clinical Microbiology and Pulmonary Diseases, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Colin Campbell
- TB Section, Public Health England, London, United Kingdom
| | - Maeve K. Lalor
- TB Section, Public Health England, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
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Ray A, Sharma S, Sadasivam B. Exploring an unsung stigma factor in COVID-19. J Family Med Prim Care 2020; 9:5400-5401. [PMID: 33409231 PMCID: PMC7773111 DOI: 10.4103/jfmpc.jfmpc_1497_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 12/02/2022] Open
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Reiss MJ. Science Education in the Light of COVID-19: The Contribution of History, Philosophy and Sociology of Science. SCIENCE & EDUCATION 2020; 29:1079-1092. [PMID: 32836877 PMCID: PMC7346578 DOI: 10.1007/s11191-020-00143-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In this position paper, I examine how the history, philosophy and sociology of science (HPS) can contribute to science education in the era of the COVID-19 pandemic. I discuss shortcomings in the ways that history is often used in school science, and examine how knowledge of previous pandemics might help in teaching about COVID-19. I look at the potential of issues to do with measurement in the context of COVID-19 (e.g. measurement of mortality figures) to introduce school students to issues about philosophy of science, and I show how COVID-19 has the affordance to broaden and deepen the moral philosophy that students typically meet in biology lessons. COVID-19 also provides opportunities to introduce students to sociological ways of thinking, examining data and questioning human practices. It can also enable students to see how science, economics and politics inter-relate. In the final part of the paper, I suggest that there are strong arguments in favour of an interdisciplinary approach in tackling zoonoses like COVID-19 and that there is much to be said for such interdisciplinarity in school science lessons when teaching about socio-scientific issues and issues intended to raise scientific literacy.
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Affiliation(s)
- Michael J. Reiss
- UCL Institute of Education, University College London, London, UK
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