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Tadokera R, Bekker LG, Kreiswirth BN, Mathema B, Middelkoop K. TB transmission is associated with prolonged stay in a low socio-economic, high burdened TB and HIV community in Cape Town, South Africa. BMC Infect Dis 2020; 20:120. [PMID: 32041530 PMCID: PMC7011372 DOI: 10.1186/s12879-020-4828-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 01/28/2020] [Indexed: 11/16/2022] Open
Abstract
Background While several studies have assessed the associations between biological factors and tuberculosis (TB) transmission, our understanding of the associations between TB transmission and social and economic factors remains incomplete. We aimed to explore associations between community TB transmission and socio-economic factors within a high TB-HIV burdened setting. Methods We conducted a cross-sectional molecular epidemiology study among adult patients attending a routine TB clinic. Demographic and clinical data were extracted from TB registers and clinical folders; social and economic data were collected using interviewer-administered questionnaires; Mycobacterium tuberculosis isolates were genotyped and classified as clustered/non-clustered using IS6110-based Restriction Fragment Length Polymorphism. Composite “social” and “economic” scores were generated from social and economic data. Data were analyzed using StataCorp version 15.0 software. Stratified, bivariable analyses were performed using chi-squared. Wilcoxon signed rank tests; univariable and multivariable logistic regression models were developed to explore associations in the social, economic, traditional and composite TB risk factors with TB transmission. Results Of the 505 patient Mtb strains, 348(69%) cases were classified as clustered and 157(31%) were non-clustered. Clustered cases were more likely to have lived longer in the study community, (odds ratio [OR] = 1.05, 95% Confidence interval [C.I]:1.02–1.09, p = 0.006); in the same house (OR = 1.04, C.I: 0.99–1.08, p = 0.06); and had increased household crowding conditions (i.e fewer rooms used for sleeping, OR = 0.45, C.I:0.21–0.95, p = 0.04). Although a higher proportion of clustered cases had a low economic score, no statistically significant association was found between clustering and either the economic score (p = 0.13) or social score (p = 0.26). Conclusions We report a novel association between Mtb transmission and prolonged stay within a high burdened community. Transmission was also associated with fewer rooms for sleeping in a household. Increased social interaction and prolonged residence in a high burdened community are important factors linked to Mtb transmission, possibly due to increased probability of higher effective contact rates. The possible importance of degrees of poverty within low socio-economic setting warrants further study.
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Affiliation(s)
- Rebecca Tadokera
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, PO Box 13801, Mowbray Observatory, Cape Town, 7705, South Africa.,NRF/DST Centre of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, PO Box 13801, Mowbray Observatory, Cape Town, 7705, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Barry N Kreiswirth
- Public Health Research Institute Tuberculosis Center, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Barun Mathema
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, PO Box 13801, Mowbray Observatory, Cape Town, 7705, South Africa. .,Department of Medicine, University of Cape Town, Cape Town, South Africa.
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van der Heijden YF, Abdullah F, Andrade BB, Andrews JR, Christopher DJ, Croda J, Ewing H, Haas DW, Hatherill M, Horsburgh CR, Mave V, Nakaya HI, Rolla V, Srinivasan S, Sugiyono RI, Ugarte-Gil C, Hamilton C. Building capacity for advances in tuberculosis research; proceedings of the third RePORT international meeting. Tuberculosis (Edinb) 2018; 113:153-162. [PMID: 30514497 PMCID: PMC6349374 DOI: 10.1016/j.tube.2018.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
Abstract
RePORT International is a global network of research sites in India, Brazil, Indonesia, South Africa, China, and the Philippines dedicated to collaborative tuberculosis research in the context of HIV. A standardized research protocol (the Common Protocol) guides the enrollment of participants with active pulmonary tuberculosis and contacts into observational cohorts. The establishment of harmonized clinical data and bio-repositories will allow cutting-edge, large-scale advances in the understanding of tuberculosis, including identification of novel biomarkers for progression to active tuberculosis and relapse after treatment. The RePORT International infrastructure aims to support research capacity development through enabling globally-diverse collaborations. To that end, representatives from the RePORT International network sites, funding agencies, and other stakeholders gathered together in Brazil in September 2017 to present updates on relevant research findings and discuss ideas for collaboration. Presenters emphasized research involving biomarker identification for incipient tuberculosis, host immunity and pharmacogenomics, co-morbidities such as HIV and type 2 diabetes mellitus, and tuberculosis transmission in vulnerable and high-risk populations. Currently, 962 active TB participants and 670 household contacts have contributed blood, sputum, urine and microbes to in-country biorepositories. Cross-consortium collaborations have begun sharing data and specimens to analyze molecular and cytokine predictive patterns.
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Affiliation(s)
- Yuri F van der Heijden
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa.
| | - Bruno B Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, 40296-710, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, José Silveira Foundation, Salvador, 45204-040, Brazil; Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, 7925, South Africa; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA; Universidade Salvador (UNIFACS), Laureate University, Salvador, Bahia, 41720-200, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, 40290-000, Brazil.
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | | | - Julio Croda
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil, Oswaldo Cruz Foundation, Campo Grande, Brazil.
| | - Heather Ewing
- Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - David W Haas
- Departments of Medicine, Pharmacology, Pathology, Microbiology & Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA.
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease & Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, South Africa.
| | - C Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
| | - Vidya Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Helder I Nakaya
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil.
| | - Valeria Rolla
- Clinical Research Laboratory on Mycobacteria, National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Brazil.
| | - Sudha Srinivasan
- Division of AIDS, National Institute of Allergy and Infectious Diseases at the National Institutes of Health, Bethesda, MD, USA.
| | - Retna Indah Sugiyono
- INA-RESPOND, National Institute of Health Research and Development, Ministry of Health, Indonesia.
| | - Cesar Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; TB Centre, London School of Hygiene and Tropical Medicina, London, UK; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland, USA.
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McCreesh N, White RG. An explanation for the low proportion of tuberculosis that results from transmission between household and known social contacts. Sci Rep 2018; 8:5382. [PMID: 29599463 PMCID: PMC5876383 DOI: 10.1038/s41598-018-23797-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/14/2018] [Indexed: 02/05/2023] Open
Abstract
We currently have little idea where Mycobacterium tuberculosis (Mtb) transmission occurs in high incidence settings. Molecular studies suggest that only around 8-19% of transmission to adults occurs within-household, or between known social-contacts. This contrasts with findings from social-contact studies, which show that substantial proportions of contact time occur in households, workplaces and schools. A mathematical model of social-contact behaviour and Mtb transmission was developed, incorporating variation in susceptibility and infectiousness. Three types of contact were simulated: household, repeated (individuals outside household contacted repeatedly with daily-monthly frequency) and non-repeated. The model was parameterised using data from Cape Town, South Africa, on mean and variance in contact numbers and contact durations, by contact type, and fitted to an estimate of overdispersion in numbers of secondary cases ('superspreading') in Cape Town. Household, repeated, and non-repeated contacts contributed 36%, 13%, and 51% of contact time, and 13%, 8%, and 79% of disease, respectively. Results suggest contact saturation, exacerbated by long disease durations and superspreading, cause the high proportion of transmission between non-repeated contacts. Household and social-contact tracing is therefore unlikely to reach most tuberculosis cases. A better understanding of transmission locations, and methods to identify superspreaders, are urgently required to improve tuberculosis prevention strategies.
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Affiliation(s)
- Nicky McCreesh
- London School of Hygiene and Tropical Medicine, London, UK.
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Gaspar RS, Nunes N, Nunes M, Rodrigues VP. Temporal analysis of reported cases of tuberculosis and of tuberculosis-HIV co-infection in Brazil between 2002 and 2012. J Bras Pneumol 2017; 42:416-422. [PMID: 28117471 PMCID: PMC5344089 DOI: 10.1590/s1806-37562016000000054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/07/2016] [Indexed: 11/30/2022] Open
Abstract
Objective: To investigate the reported cases of tuberculosis and of tuberculosis-HIV co-infection in Brazil between 2002 and 2012. Methods: This was an observational study based on secondary time series data collected from the Brazilian Case Registry Database for the 2002-2012 period. The incidence of tuberculosis was stratified by gender, age group, geographical region, and outcome, as was that of tuberculosis-HIV co-infection. Results: Nationally, the incidence of tuberculosis declined by 18%, whereas that of tuberculosis-HIV co-infection increased by 3.8%. There was an overall decrease in the incidence of tuberculosis, despite a significant increase in that of tuberculosis-HIV co-infection in women. The incidence of tuberculosis decreased only in the 0- to 9-year age bracket, remaining stable or increasing in the other age groups. The incidence of tuberculosis-HIV co-infection increased by 209% in the ≥ 60-year age bracket. The incidence of tuberculosis decreased in all geographical regions except the south, whereas that of tuberculosis-HIV co-infection increased by over 150% in the north and northeast. Regarding the outcomes, patients with tuberculosis-HIV co-infection, in comparison with patients infected with tuberculosis only, had a 48% lower chance of cure, a 50% greater risk of treatment nonadherence, and a 94% greater risk of death from tuberculosis. Conclusions: Our study shows that tuberculosis continues to be a relevant public health issue in Brazil, because the goals for the control and cure of the disease have yet to be achieved. In addition, the sharp increase in the incidence of tuberculosis-HIV co-infection in women, in the elderly, and in the northern/northeastern region reveals that the population of HIV-infected individuals is rapidly becoming more female, older, and more impoverished.
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Affiliation(s)
| | - Natália Nunes
- . Curso de Medicina, Universidade Federal do Maranhão, São Luís (MA) Brasil
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McIvor A, Koornhof H, Kana BD. Relapse, re-infection and mixed infections in tuberculosis disease. Pathog Dis 2017; 75:3003284. [PMID: 28334088 DOI: 10.1093/femspd/ftx020] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/16/2017] [Indexed: 01/19/2023] Open
Abstract
Tuberculosis (TB) disease can be characterized by genotypic and phenotypic complexity in Mycobacterium tuberculosis bacilli within a single patient. This microbiological heterogeneity has become an area of intense study due its perceived importance in drug tolerance, drug resistance and as a surrogate measure of transmission rates. This review presents a descriptive analysis of research describing the prevalence of mixed-strain TB infections in geographically distinct locations. Despite significant variation in disease burden and a rampant human immunodeficiency virus (HIV)-TB co-epidemic, there was no difference in the prevalence range of mixed infections reported in African countries when compared to the rest of the world. The occurrence of recurrent TB was associated with a higher prevalence of mixed-strain infections, but this difference was not reported as statistically significant. These interpretations were limited by differences in the design and overall size of the studies assessed. Factors such as sputum quality, culture media, number of repeated culture steps, molecular typing methods and HIV-infection status can affect the detection of mixed-strain infection. It is recommended that future clinical studies should focus on settings with varying TB burdens, with a common sample processing protocol to gain further insight into these phenomena and develop novel transmission blocking strategies.
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Affiliation(s)
- Amanda McIvor
- DST/NRF Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg 2000, South Africa
| | - Hendrik Koornhof
- Centre for Tuberculosis, National Institute for Communicable Diseases and National Health Laboratory Service, Johannesburg, 2000, South Africa
| | - Bavesh Davandra Kana
- DST/NRF Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg 2000, South Africa.,CAPRISA, Centre for the AIDS Programme of Research in South Africa, Durban, 4001, South Africa
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Warner DF, Koch A, Mizrahi V. Diversity and disease pathogenesis in Mycobacterium tuberculosis. Trends Microbiol 2015; 23:14-21. [DOI: 10.1016/j.tim.2014.10.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/13/2014] [Accepted: 10/17/2014] [Indexed: 12/11/2022]
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Middelkoop K, Mathema B, Myer L, Shashkina E, Whitelaw A, Kaplan G, Kreiswirth B, Wood R, Bekker LG. Transmission of tuberculosis in a South African community with a high prevalence of HIV infection. J Infect Dis 2014; 211:53-61. [PMID: 25053739 DOI: 10.1093/infdis/jiu403] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In settings of high tuberculosis transmission, little is known of the interaction between human immunodeficiency virus (HIV) positive and HIV-negative tuberculosis disease and of the impact of antiretroviral treatment (ART) programs on tuberculosis transmission dynamics. METHODS Mycobacterium tuberculosis isolates were collected from patients with tuberculosis who resided in a South African township with a high burden of tuberculosis and HIV infection. Demographic and clinical data were extracted from clinic records. Isolates underwent IS6110-based restriction fragment length polymorphism analysis. Patients with unique (nonclustered) M. tuberculosis genotypes and cluster index cases (ie, the first tuberculosis case in a cluster) were defined as having tuberculosis due to reactivation of latent M. tuberculosis infection. Secondary cases in clusters were defined as having tuberculosis due to recent M. tuberculosis infection. RESULTS Overall, 311 M. tuberculosis genotypes were identified among 718 isolates from 710 patients; 224 (31%) isolates were unique strains, and 478 (67%) occurred in 87 clusters. Cluster index cases were significantly more likely than other tuberculosis cases to be HIV negative. HIV-positive patients were more likely to be secondary cases (P = .001), including patients receiving ART (P = .004). Only 8% of cases of adult-adult transmission of tuberculosis occurred on shared residential plots. CONCLUSIONS Recent infection accounted for the majority of tuberculosis cases, particularly among HIV-positive patients, including patients receiving ART. HIV-negative patients may be disproportionally responsible for ongoing transmission.
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Affiliation(s)
- Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine Department of Medicine
| | - Barun Mathema
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York Public Health Research Institute Tuberculosis Center
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town
| | | | - Andrew Whitelaw
- Division of Medical Microbiology, University of Stellenbosch National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Gilla Kaplan
- Laboratory of Mycobacterial Immunity and Pathogenesis, Public Health Research Institute, New Jersey Medical School-Rutgers, The State University of New Jersey, Newark
| | | | - Robin Wood
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine Department of Medicine
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine Department of Medicine
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