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Rickman HM, Phiri MD, Feasey HRA, Mbale H, Nliwasa M, Semphere R, Chagaluka G, Fielding K, Mwandumba HC, Horton KC, Nightingale ES, Henrion MYR, Mbendera K, Mpunga JA, Corbett EL, MacPherson P. Tuberculosis Immunoreactivity Surveillance in Malawi (Timasamala)-A protocol for a cross-sectional Mycobacterium tuberculosis immunoreactivity survey in Blantyre, Malawi. PLoS One 2024; 19:e0291215. [PMID: 38787869 PMCID: PMC11125513 DOI: 10.1371/journal.pone.0291215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/28/2024] [Indexed: 05/26/2024] Open
Abstract
Tuberculosis (TB) transmission and prevalence are dynamic over time, and heterogeneous within populations. Public health programmes therefore require up-to-date, accurate epidemiological data to appropriately allocate resources, target interventions, and track progress towards End TB goals. Current methods of TB surveillance often rely on case notifications, which are biased by access to healthcare, and TB disease prevalence surveys, which are highly resource-intensive, requiring many tens of thousands of people to be tested to identify high-risk groups or capture trends. Surveys of "latent TB infection", or immunoreactivity to Mycobacterium tuberculosis (Mtb), using tests such as interferon-gamma release assays (IGRAs) could provide a way to identify TB transmission hotspots, supplementing information from disease notifications, and with greater spatial and temporal resolution than is possible to achieve in disease prevalence surveys. This cross-sectional survey will investigate the prevalence of Mtb immunoreactivity amongst young children, adolescents and adults in Blantyre, Malawi, a high HIV-prevalence city in southern Africa. Through this study we will estimate the annual risk of TB infection (ARTI) in Blantyre and explore individual- and area-level risk factors for infection, as well as investigating geospatial heterogeneity of Mtb infection (and its determinants), and comparing these to the distribution of TB disease case-notifications. We will also evaluate novel diagnostics for Mtb infection (QIAreach QFT) and sampling methodologies (convenience sampling in healthcare settings and community sampling based on satellite imagery), which may increase the feasibility of measuring Mtb infection at large scale. The overall aim is to provide high-resolution epidemiological data and provide new insights into methodologies which may be used by TB programmes globally.
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Affiliation(s)
- Hannah M. Rickman
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Mphatso D. Phiri
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helena R. A. Feasey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Hannah Mbale
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Marriott Nliwasa
- Helse Nord TB Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Robina Semphere
- Helse Nord TB Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - George Chagaluka
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Henry C. Mwandumba
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Katherine C. Horton
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily S. Nightingale
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marc Y. R. Henrion
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kuzani Mbendera
- Malawi National Tuberculosis and Leprosy Control Programme, Lilongwe, Malawi
| | - James A. Mpunga
- Malawi National Tuberculosis and Leprosy Control Programme, Lilongwe, Malawi
| | - Elizabeth L. Corbett
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Peter MacPherson
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Havumaki J, Warren JL, Zelner J, Menzies NA, Calderon R, Contreras C, Lecca L, Becerra MC, Murray M, Cohen T. Spatially-targeted tuberculosis screening has limited impact beyond household contact tracing in Lima, Peru: A model-based analysis. PLoS One 2023; 18:e0293519. [PMID: 37903091 PMCID: PMC10615320 DOI: 10.1371/journal.pone.0293519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/15/2023] [Indexed: 11/01/2023] Open
Abstract
Mathematical models have suggested that spatially-targeted screening interventions for tuberculosis may efficiently accelerate disease control, but empirical data supporting these findings are limited. Previous models demonstrating substantial impacts of these interventions have typically simulated large-scale screening efforts and have not attempted to capture the spatial distribution of tuberculosis in households and communities at a high resolution. Here, we calibrate an individual-based model to the locations of case notifications in one district of Lima, Peru. We estimate the incremental efficiency and impact of a spatially-targeted interventions used in combination with household contact tracing (HHCT). Our analysis reveals that HHCT is relatively efficient with a median of 40 (Interquartile Range: 31.7 to 49.9) household contacts required to be screened to detect a single case of active tuberculosis. However, HHCT has limited population impact, producing a median incidence reduction of only 3.7% (Interquartile Range: 5.8% to 1.9%) over 5 years. In comparison, spatially targeted screening (which we modeled as active case finding within high tuberculosis prevalence areas 100 m2 grid cell) is far less efficient, requiring evaluation of ≈12 times the number of individuals as HHCT to find a single individual with active tuberculosis. Furthermore, the addition of the spatially targeted screening effort produced only modest additional reductions in tuberculosis incidence over the 5 year period (≈1.3%) in tuberculosis incidence. In summary, we found that HHCT is an efficient approach for tuberculosis case finding, but has limited population impact. Other screening approaches which target areas of high tuberculosis prevalence are less efficient, and may have limited impact unless very large numbers of individuals can be screened.
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Affiliation(s)
- Joshua Havumaki
- Department of Epidemiology of Microbial Diseases, Yale University, New Haven, CT, United States of America
| | - Joshua L. Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
| | - Jon Zelner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States of America
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Nicolas A. Menzies
- Department of Global Health and Population, Harvard T. H. Chan, School of Public Health, Boston, MA, United States of America
| | - Roger Calderon
- Socios en Salud Sucursal Peru, Lima, Peru
- Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Leonid Lecca
- Department of Global Health and Population, Harvard T. H. Chan, School of Public Health, Boston, MA, United States of America
- Socios en Salud Sucursal Peru, Lima, Peru
| | - Mercedes C. Becerra
- Department of Global Health and Population, Harvard T. H. Chan, School of Public Health, Boston, MA, United States of America
| | - Megan Murray
- Department of Global Health and Population, Harvard T. H. Chan, School of Public Health, Boston, MA, United States of America
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale University, New Haven, CT, United States of America
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Khundi M, Carpenter JR, Nliwasa M, Cohen T, Corbett EL, MacPherson P. Effectiveness of spatially targeted interventions for control of HIV, tuberculosis, leprosy and malaria: a systematic review. BMJ Open 2021; 11:e044715. [PMID: 34257091 PMCID: PMC8278879 DOI: 10.1136/bmjopen-2020-044715] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 06/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As infectious diseases approach global elimination targets, spatial targeting is increasingly important to identify community hotspots of transmission and effectively target interventions. We aimed to synthesise relevant evidence to define best practice approaches and identify policy and research gaps. OBJECTIVE To systematically appraise evidence for the effectiveness of spatially targeted community public health interventions for HIV, tuberculosis (TB), leprosy and malaria. DESIGN Systematic review. DATA SOURCES We searched Medline, Embase, Global Health, Web of Science and Cochrane Database of Systematic Reviews between 1 January 1993 and 22 March 2021. STUDY SELECTION The studies had to include HIV or TB or leprosy or malaria and spatial hotspot definition, and community interventions. DATA EXTRACTION AND SYNTHESIS A data extraction tool was used. For each study, we summarised approaches to identifying hotpots, intervention design and effectiveness of the intervention. RESULTS Ten studies, including one cluster randomised trial and nine with alternative designs (before-after, comparator area), satisfied our inclusion criteria. Spatially targeted interventions for HIV (one USA study), TB (three USA) and leprosy (two Brazil, one Federated States of Micronesia) each used household location and disease density to define hotspots followed by community-based screening. Malaria studies (one each from India, Indonesia and Kenya) used household location and disease density for hotspot identification followed by complex interventions typically combining community screening, larviciding of stagnant water bodies, indoor residual spraying and mass drug administration. Evidence of effect was mixed. CONCLUSIONS Studies investigating spatially targeted interventions were few in number, and mostly underpowered or otherwise limited methodologically, affecting interpretation of intervention impact. Applying advanced epidemiological methodologies supporting more robust hotspot identification and larger or more intensive interventions would strengthen the evidence-base for this increasingly important approach. PROSPERO REGISTRATION NUMBER CRD42019130133.
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Affiliation(s)
- McEwen Khundi
- Public Health, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - James R Carpenter
- Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- MRC Clinical Trials Unit, University College London, London, UK
| | - Marriott Nliwasa
- Helse Nord Tuberculosis Initiative, University of Malawi College of Medicine, Blantyre, Malawi
| | - Ted Cohen
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Elizabeth L Corbett
- Public Health, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter MacPherson
- Public Health, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Moonan PK, Zetola NM, Tobias JL, Basotli J, Boyd R, Click ES, Dima M, Fane O, Finlay AM, Ogopotse M, Wen XJ, Modongo C, Oeltmann JE. A Neighbor-Based Approach to Identify Tuberculosis Exposure, the Kopanyo Study. Emerg Infect Dis 2021; 26:1010-1013. [PMID: 32310058 PMCID: PMC7181937 DOI: 10.3201/eid2605.191568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Contact investigation is one public health measure used to prevent tuberculosis by identifying and treating persons exposed to Mycobacterium tuberculosis. Contact investigations are a major tenet of global tuberculosis elimination efforts, but for many reasons remain ineffective. We describe a novel neighbor-based approach to reframe contact investigations.
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Bonnewell JP, Farrow L, Dicks KV, Cox GM, Stout JE. Geographic analysis of latent tuberculosis screening: A health system approach. PLoS One 2020; 15:e0242055. [PMID: 33166372 PMCID: PMC7652260 DOI: 10.1371/journal.pone.0242055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/27/2020] [Indexed: 11/18/2022] Open
Abstract
Background Novel approaches are required to better focus latent tuberculosis infection (LTBI) efforts in low-prevalence regions. Geographic information systems, used within large health systems, may provide one such approach. Methods A retrospective, cross-sectional design was used to integrate US Census and Duke Health System data between January 1, 2010 and October 31, 2017 and examine the relationships between LTBI screening and population tuberculosis risk (assessed using the surrogate measure of proportion of persons born in tuberculosis-endemic regions) by census tract. Results The median proportion of Duke patients screened per census tract was 0.01 (range 0–0.1, interquartile range 0.01–0.03). The proportion of Duke patients screened within a census tract significantly but weakly correlated with the population risk. Furthermore, patients residing in census tracts with higher population tuberculosis risk were more likely to be screened with TST than with an IGRA (p<0.001). Conclusion The weak correlation between patient proportion screened for LTBI and our surrogate marker of population tuberculosis risk suggests that LTBI screening efforts should be better targeted. This type of geography-based analysis may serve as an easily obtainable benchmark for LTBI screening in health systems with low tuberculosis prevalence.
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Affiliation(s)
- John P. Bonnewell
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Laura Farrow
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kristen V. Dicks
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Gary M. Cox
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Jason E. Stout
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail:
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Renardy M, Kirschner DE. Evaluating vaccination strategies for tuberculosis in endemic and non-endemic settings. J Theor Biol 2019; 469:1-11. [PMID: 30851550 PMCID: PMC6447051 DOI: 10.1016/j.jtbi.2019.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/25/2019] [Accepted: 02/27/2019] [Indexed: 01/06/2023]
Abstract
According to the World Health Organization, tuberculosis (TB) is the leading cause of death from infectious disease worldwide (WHO, 2017). While there is no effective vaccine against adult pulmonary TB, more than a dozen vaccine candidates are in the clinical trial pipeline. These include both pre-exposure vaccines to prevent initial infections and post-exposure vaccines to prevent reactivation of latent disease. Many epidemiological models have been used to study TB, but most have not included a continuous age structure and the possibility of both pre- and post-exposure vaccination. Incorporating age-dependent death rates, disease properties, and social contact data allows for more realistic modeling of disease spread. We propose a continuous age-structured model for the epidemiology of tuberculosis with pre- and post-exposure vaccination. We use uncertainty and sensitivity analysis to make predictions about the efficacy of different vaccination strategies in a non-endemic setting (United States) and an endemic setting (Cambodia). In particular, we determine optimal age groups to target for pre-exposure and post-exposure vaccination in both settings. We find that the optimal age groups tend to be younger for Cambodia than for the US, and that post-exposure vaccination has a significantly larger effect than pre-exposure vaccination in the US.
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Affiliation(s)
- Marissa Renardy
- University of Michigan, Department of Microbiology and Immunology, USA.
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Cudahy PGT, Andrews JR, Bilinski A, Dowdy DW, Mathema B, Menzies NA, Salomon JA, Shrestha S, Cohen T. Spatially targeted screening to reduce tuberculosis transmission in high-incidence settings. THE LANCET. INFECTIOUS DISEASES 2019; 19:e89-e95. [PMID: 30554997 PMCID: PMC6401264 DOI: 10.1016/s1473-3099(18)30443-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/07/2018] [Accepted: 07/11/2018] [Indexed: 12/21/2022]
Abstract
As the leading infectious cause of death worldwide and the primary proximal cause of death in individuals living with HIV, tuberculosis remains a global concern. Existing tuberculosis control strategies that rely on passive case-finding appear insufficient to achieve targets for reductions in tuberculosis incidence and mortality. Active case-finding strategies aim to detect infectious individuals earlier in their infectious period to reduce onward transmission and improve treatment outcomes. Empirical studies of active case-finding have produced mixed results and determining how to direct active screening to those most at risk remains a topic of intense research. Our systematic review of literature evaluating the effects of geographically targeted tuberculosis screening interventions found three studies in low tuberculosis incidence settings, but none conducted in high tuberculosis incidence countries. We discuss open questions related to the use of spatially targeted approaches for active screening in countries where tuberculosis incidence is highest.
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Affiliation(s)
- Patrick G T Cudahy
- Section of Infectious Disease, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alyssa Bilinski
- Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Cambridge, MA, USA
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Barun Mathema
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Joshua A Salomon
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Sourya Shrestha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ted Cohen
- Department of Epidemiology (Microbial Diseases), Yale University School of Public Health, New Haven, CT, USA
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Mullins J, Lobato MN, Bemis K, Sosa L. Spatial clusters of latent tuberculous infection, Connecticut, 2010-2014. Int J Tuberc Lung Dis 2018; 22:165-170. [PMID: 29506612 PMCID: PMC7201424 DOI: 10.5588/ijtld.17.0223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING In the United States, tuberculosis (TB) control is increasingly focusing on the identification of persons with latent tuberculous infection (LTBI). OBJECTIVE To characterize the local epidemiology of LTBI in Connecticut, USA. METHODS We used spatial analyses 1) to identify census tract-level clusters of reported LTBI and TB disease in Connecticut, 2) to compare persons and populations in clusters with those not in clusters, and 3) to compare persons with LTBI to those with TB disease. RESULTS Significant census tract-level spatial clusters of LTBI and TB disease were identified. Compared with persons with LTBI in non-clustered census tracts, those in clustered census tracts were more likely to be foreign-born and less likely to be of white non-Hispanic ethnicity. Populations in census tract clusters of high LTBI prevalence had greater crowding, persons living in poverty, and persons lacking health care insurance than populations not in clustered census tracts. Persons with LTBI were less likely than those with TB disease to be of Asian ethnicity, and persons with LTBI were more likely than those with TB disease to reside in a clustered census tract. CONCLUSIONS Characterizing fine-scale populations at risk for LTBI supports effective and culturally accessible screening and treatment programs.
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Affiliation(s)
- J Mullins
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA; University of Saint Joseph, West Hartford, Connecticut, Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - M N Lobato
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA; University of Saint Joseph, West Hartford, Connecticut, Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - K Bemis
- Connecticut Department of Public Health, Hartford, Connecticut, USA; Cook County Department of Public Health, Forest Park, Illinois, USA
| | - L Sosa
- Connecticut Department of Public Health, Hartford, Connecticut, USA
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Stopka TJ, Goulart MA, Meyers DJ, Hutcheson M, Barton K, Onofrey S, Church D, Donahue A, Chui KKH. Identifying and characterizing hepatitis C virus hotspots in Massachusetts: a spatial epidemiological approach. BMC Infect Dis 2017; 17:294. [PMID: 28427355 PMCID: PMC5399408 DOI: 10.1186/s12879-017-2400-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022] Open
Abstract
Background Hepatitis C virus (HCV) infections have increased during the past decade but little is known about geographic clustering patterns. Methods We used a unique analytical approach, combining geographic information systems (GIS), spatial epidemiology, and statistical modeling to identify and characterize HCV hotspots, statistically significant clusters of census tracts with elevated HCV counts and rates. We compiled sociodemographic and HCV surveillance data (n = 99,780 cases) for Massachusetts census tracts (n = 1464) from 2002 to 2013. We used a five-step spatial epidemiological approach, calculating incremental spatial autocorrelations and Getis-Ord Gi* statistics to identify clusters. We conducted logistic regression analyses to determine factors associated with the HCV hotspots. Results We identified nine HCV clusters, with the largest in Boston, New Bedford/Fall River, Worcester, and Springfield (p < 0.05). In multivariable analyses, we found that HCV hotspots were independently and positively associated with the percent of the population that was Hispanic (adjusted odds ratio [AOR]: 1.07; 95% confidence interval [CI]: 1.04, 1.09) and the percent of households receiving food stamps (AOR: 1.83; 95% CI: 1.22, 2.74). HCV hotspots were independently and negatively associated with the percent of the population that were high school graduates or higher (AOR: 0.91; 95% CI: 0.89, 0.93) and the percent of the population in the “other” race/ethnicity category (AOR: 0.88; 95% CI: 0.85, 0.91). Conclusion We identified locations where HCV clusters were a concern, and where enhanced HCV prevention, treatment, and care can help combat the HCV epidemic in Massachusetts. GIS, spatial epidemiological and statistical analyses provided a rigorous approach to identify hotspot clusters of disease, which can inform public health policy and intervention targeting. Further studies that incorporate spatiotemporal cluster analyses, Bayesian spatial and geostatistical models, spatially weighted regression analyses, and assessment of associations between HCV clustering and the built environment are needed to expand upon our combined spatial epidemiological and statistical methods.
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Affiliation(s)
- Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - Michael A Goulart
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - David J Meyers
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Marga Hutcheson
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Kerri Barton
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, 350 South Street, Jamaica Plain, MA, 02130, USA
| | - Shauna Onofrey
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, 350 South Street, Jamaica Plain, MA, 02130, USA
| | - Daniel Church
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, 350 South Street, Jamaica Plain, MA, 02130, USA
| | - Ashley Donahue
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Kenneth K H Chui
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
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Abstract
In long-term care facilities (LTCFs), the elderly are apt to be infected because those with latent tuberculosis infections (LTBIs) are at an increased risk for reactivation and post-primary TB disease. We report an outbreak of TB in staff and residents in a LTCF. An outbreak investigation was conducted after two TB cases were reported from the LTCF. A tuberculin skin test (TST), bacteriological examination and chest radiograph were administered to all facility staff and residents. An outbreak is defined as at least two epidemiologically linked cases that have identical Mycobacterium tuberculosis genotype isolates. This outbreak infected eight residents and one staff member, who were confirmed to have TB in a LTCF between September 2011 and October 2012. Based on the Becker method, the latent and infectious periods were estimated at 223·6 and 55·9 days. Two initial TST-negative resident contacts were diagnosed as TB cases through comprehensive TB screening. Observing elderly people who have a negative TST after TB screening appears to be necessary, given the long latent period for controlling a TB outbreak in a LTCF. It is important to consider providing LTBI treatment for elderly contacts.
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France AM, Grant J, Kammerer JS, Navin TR. A field-validated approach using surveillance and genotyping data to estimate tuberculosis attributable to recent transmission in the United States. Am J Epidemiol 2015; 182:799-807. [PMID: 26464470 DOI: 10.1093/aje/kwv121] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 04/27/2015] [Indexed: 01/20/2023] Open
Abstract
Tuberculosis genotyping data are frequently used to estimate the proportion of tuberculosis cases in a population that are attributable to recent transmission (RT). Multiple factors influence genotype-based estimates of RT and limit the comparison of estimates over time and across geographic units. Additionally, methods used for these estimates have not been validated against field-based epidemiologic assessments of RT. Here we describe a novel genotype-based approach to estimation of RT based on the identification of plausible-source cases, which facilitates systematic comparisons over time and across geographic areas. We compared this and other genotype-based RT estimation approaches with the gold standard of field-based assessment of RT based on epidemiologic investigation in Arkansas, Maryland, and Massachusetts during 1996-2000. We calculated the sensitivity and specificity of each approach for epidemiologic evidence of RT and calculated the accuracy of each approach across a range of hypothetical RT prevalence rates plausible for the United States. The sensitivity, specificity, and accuracy of genotype-based RT estimates varied by approach. At an RT prevalence of 10%, accuracy ranged from 88.5% for state-based clustering to 94.4% with our novel approach. Our novel, field-validated approach allows for systematic assessments over time and across public health jurisdictions of varying geographic size, with an established level of accuracy.
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Alvarez GG, VanDyk DD, Aaron SD, Cameron DW, Davies N, Stephen N, Mallick R, Momoli F, Moreau K, Obed N, Baikie M, Osborne G. Taima (stop) TB: the impact of a multifaceted TB awareness and door-to-door campaign in residential areas of high risk for TB in Iqaluit, Nunavut. PLoS One 2014; 9:e100975. [PMID: 25033320 PMCID: PMC4102461 DOI: 10.1371/journal.pone.0100975] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 05/30/2014] [Indexed: 11/23/2022] Open
Abstract
Background The incidence rate of active tuberculosis (TB) disease in the Canadian Territory of Nunavut has shown a rising trend over the past 10 years. In 2010 it was 60 times greater than the national incidence rate. The objective of the Taima (translates to “stop” in Inuktitut) TB study was to implement and evaluate a public health campaign to enhance existing TB prevention efforts in Nunavut. Methods A TB awareness campaign followed by a door-to-door screening campaign was carried out in Iqaluit, Nunavut. The aim of the campaign was to raise awareness about TB, and to provide in-home screening and treatment for people living in residential areas at high risk for TB. Screening was based on geographic location rather than on individual risk factors. Results During the general awareness campaign an increase in the number of people who requested TB testing at the local public health clinic was observed. However, this increase was not sustained following cessation of the awareness campaign. Targeted TB screening in high risk residential areas in Iqaluit resulted in 224 individuals having TSTs read, and detection of 42 previously unidentified cases of latent TB, (overall yield of 18.8% or number needed to screen = 5.3). These cases of latent TB infection (LTBI) were extra cases that had not been picked up by traditional screening practices (34% relative increase within the community). This resulted in a 33% relative increase in the completion of LTBI treatment within the community. The program directly and indirectly identified 5/17 new cases of active TB disease in Iqaluit during the study period (29.5% of all incident cases). Conclusions While contact tracing investigations remain a cornerstone of TB prevention, additional awareness, screening, and treatment programs like Taima TB may contribute to the successful control of TB in Aboriginal communities.
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Affiliation(s)
- Gonzalo G. Alvarez
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- The Ottawa Hospital, Department of Medicine, Divisions of Respirology and Infectious Diseases, Ottawa, Ontario, Canada
- * E-mail:
| | - Deborah D. VanDyk
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Shawn D. Aaron
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- The Ottawa Hospital, Department of Medicine, Divisions of Respirology and Infectious Diseases, Ottawa, Ontario, Canada
| | - D. William Cameron
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- The Ottawa Hospital, Department of Medicine, Divisions of Respirology and Infectious Diseases, Ottawa, Ontario, Canada
| | - Naomi Davies
- Government of Nunavut, Department of Health, Iqaluit, Nunavut, Canada
| | - Natasha Stephen
- Government of Nunavut, Department of Health, Iqaluit, Nunavut, Canada
| | - Ranjeeta Mallick
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Franco Momoli
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Children’s Hospital of Eastern Ontario Research Institute, Center for Practice Changing Research, Ottawa, Ontario, Canada
| | - Katherine Moreau
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Children’s Hospital of Eastern Ontario Research Institute, Center for Practice Changing Research, Ottawa, Ontario, Canada
| | - Natan Obed
- Nunavut Tunngavik Inc., Department of Social and Cultural Development, Iqaluit, Nunavut, Canada
| | - Maureen Baikie
- Government of Nunavut, Department of Health, Iqaluit, Nunavut, Canada
| | - Geraldine Osborne
- Government of Nunavut, Department of Health, Iqaluit, Nunavut, Canada
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Cegielski JP, Griffith DE, McGaha PK, Wolfgang M, Robinson CB, Clark PA, Hassell WL, Robison VA, Walker KP, Wallace C. Eliminating tuberculosis one neighborhood at a time. Am J Public Health 2014; 104 Suppl 2:S214-33. [PMID: 24899457 DOI: 10.2105/ajph.2012.300781r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated a strategy for preventing tuberculosis (TB) in communities most affected by it. METHODS In 1996, we mapped reported TB cases (1985-1995) and positive tuberculin skin test (TST) reactors (1993-1995) in Smith County, Texas. We delineated the 2 largest, densest clusters, identifying 2 highest-incidence neighborhoods (180 square blocks, 3153 residents). After extensive community preparation, trained health care workers went door-to-door offering TST to all residents unless contraindicated. TST-positive individuals were escorted to a mobile clinic for radiography, clinical evaluation, and isoniazid preventive treatment (IPT) as indicated. To assess long-term impact, we mapped all TB cases in Smith County during the equivalent time period after the project. RESULTS Of 2258 eligible individuals, 1291 (57.1%) were tested, 229 (17.7%) were TST positive, and 147 were treated. From 1996 to 2006, there were no TB cases in either project neighborhood, in contrast with the preintervention decade and the continued occurrence of TB in the rest of Smith County. CONCLUSIONS Targeting high-incidence neighborhoods for active, community-based screening and IPT may hasten TB elimination in the United States.
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Affiliation(s)
- J Peter Cegielski
- J. Peter Cegielski, Melanie Wolfgang, and Valerie A. Robison are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. David E. Griffith, Patricia A. Clark, and Willis L. Hassell are with the University of Texas Health Science Center, Tyler. Paul K. McGaha and Celia B. Robinson are with the Texas Department of State Health Services, Tyler. Kerfoot P. Walker Jr is with the Smith County Public Health District, Tyler. Charles Wallace is with the Texas Department of State Health Services, Austin
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Cegielski JP, Griffith DE, McGaha PK, Wolfgang M, Robinson CB, Clark PA, Hassell WL, Robison VA, Walker KP, Wallace C. Eliminación de la tuberculosis, un vecindario por vez. Am J Public Health 2014. [DOI: 10.2105/ajph.2012.300781s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objetivos. Evaluamos una estrategia para la prevención de la tuberculosis en las comunidades más afectadas por esta enfermedad. Métodos. En 1996, trazamos un mapa de los casos de tuberculosis notificados (1985–1995) y de las personas con reacción positiva a la prueba de la tuberculina (1993–1995) en el condado de Smith, Texas, Estados Unidos de América. Definimos los dos conglomerados de mayor tamaño y densidad, identificando los dos vecindarios con mayor incidencia (180 manzanas y 3 153 residentes). Tras una preparación intensiva de la comunidad, personal sanitario capacitado ofreció a todos los residentes, de vivienda en vivienda, la posibilidad de hacerse la prueba de la tuberculina, a menos que estuviera contraindicado. A las personas con resultados positivos en esta prueba se las acompañó a un consultorio móvil para realizarles ahí radiografías, una evaluación clínica y, según fuera pertinente, proceder con el tratamiento preventivo con isoniazida. Para evaluar las repercusiones a largo plazo, trazamos un mapa de todos los casos de tuberculosis que se registraron en el condado de Smith durante el período equivalente después del proyecto. Resultados. De las 2 258 personas que cumplían los requisitos para participar, 1 291 (57,1%) se sometieron a la prueba de la tuberculina, 229 (17,7%) presentaron resultados positivos en dicha prueba y 147 fueron tratadas. De 1996 al 2006, no se registró ningún caso de tuberculosis en ninguno de los vecindarios del proyecto, a diferencia de lo ocurrido en el decenio anterior a la intervención y en el resto del condado de Smith, donde aparecieron continuamente casos de tuberculosis. Conclusiones. Dirigirse a los vecindarios con una incidencia alta para realizar el tamizaje activo en la comunidad y aplicar tratamiento preventivo con isoniazida puede acelerar la eliminación de la tuberculosis en los Estados Unidos.
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van Hest NA, Aldridge RW, de Vries G, Sandgren A, Hauer B, Hayward A, Arrazola de Oñate W, Haas W, Codecasa LR, Caylà JA, Story A, Antoine D, Gori A, Quabeck L, Jonsson J, Wanlin M, Orcau Å, Rodes A, Dedicoat M, Antoun F, van Deutekom H, Keizer S, Abubakar I. Tuberculosis control in big cities and urban risk groups in the European Union: a consensus statement. ACTA ACUST UNITED AC 2014; 19. [PMID: 24626210 DOI: 10.2807/1560-7917.es2014.19.9.20728] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In low-incidence countries in the European Union (EU), tuberculosis (TB) is concentrated in big cities, especially among certain urban high-risk groups including immigrants from TB high-incidence countries, homeless people, and those with a history of drug and alcohol misuse. Elimination of TB in European big cities requires control measures focused on multiple layers of the urban population. The particular complexities of major EU metropolises, for example high population density and social structure, create specific opportunities for transmission, but also enable targeted TB control interventions, not efficient in the general population, to be effective or cost effective. Lessons can be learnt from across the EU and this consensus statement on TB control in big cities and urban risk groups was prepared by a working group representing various EU big cities, brought together on the initiative of the European Centre for Disease Prevention and Control. The consensus statement describes general and specific social, educational, operational, organisational, legal and monitoring TB control interventions in EU big cities, as well as providing recommendations for big city TB control, based upon a conceptual TB transmission and control model.
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Affiliation(s)
- N A van Hest
- Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands
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16
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Cegielski JP, Griffith DE, McGaha PK, Wolfgang M, Robinson CB, Clark PA, Hassell WL, Robison VA, Walker KP, Wallace C. Eliminating tuberculosis one neighborhood at a time. Am J Public Health 2012; 103:1292-300. [PMID: 23078465 DOI: 10.2105/ajph.2012.300781] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated a strategy for preventing tuberculosis (TB) in communities most affected by it. METHODS In 1996, we mapped reported TB cases (1985-1995) and positive tuberculin skin test (TST) reactors (1993-1995) in Smith County, Texas. We delineated the 2 largest, densest clusters, identifying 2 highest-incidence neighborhoods (180 square blocks, 3153 residents). After extensive community preparation, trained health care workers went door-to-door offering TST to all residents unless contraindicated. TST-positive individuals were escorted to a mobile clinic for radiography, clinical evaluation, and isoniazid preventive treatment (IPT) as indicated. To assess long-term impact, we mapped all TB cases in Smith County during the equivalent time period after the project. RESULTS Of 2258 eligible individuals, 1291 (57.1%) were tested, 229 (17.7%) were TST positive, and 147 were treated. From 1996 to 2006, there were no TB cases in either project neighborhood, in contrast with the preintervention decade and the continued occurrence of TB in the rest of Smith County. CONCLUSIONS Targeting high-incidence neighborhoods for active, community-based screening and IPT may hasten TB elimination in the United States.
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Affiliation(s)
- J Peter Cegielski
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.
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Goswami ND, Hecker EJ, Vickery C, Ahearn MA, Cox GM, Holland DP, Naggie S, Piedrahita C, Mosher A, Torres Y, Norton BL, Suchindran S, Park PH, Turner D, Stout JE. Geographic information system-based screening for TB, HIV, and syphilis (GIS-THIS): a cross-sectional study. PLoS One 2012; 7:e46029. [PMID: 23056227 PMCID: PMC3462803 DOI: 10.1371/journal.pone.0046029] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 08/27/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the feasibility and case detection rate of a geographic information systems (GIS)-based integrated community screening strategy for tuberculosis, syphilis, and human immunodeficiency virus (HIV). DESIGN Prospective cross-sectional study of all participants presenting to geographic hot spot screenings in Wake County, North Carolina. METHODS The residences of tuberculosis, HIV, and syphilis cases incident between 1/1/05-12/31/07 were mapped. Areas with high densities of all 3 diseases were designated "hot spots." Combined screening for tuberculosis, HIV, and syphilis were conducted at the hot spots; participants with positive tests were referred to the health department. RESULTS AND CONCLUSIONS Participants (N = 247) reported high-risk characteristics: 67% previously incarcerated, 40% had lived in a homeless shelter, and 29% had a history of crack cocaine use. However, 34% reported never having been tested for HIV, and 41% did not recall prior tuberculin skin testing. Screening identified 3% (8/240) of participants with HIV infection, 1% (3/239) with untreated syphilis, and 15% (36/234) with latent tuberculosis infection. Of the eight persons with HIV, one was newly diagnosed and co-infected with latent tuberculosis; he was treated for latent TB and linked to an HIV provider. Two other HIV-positive persons had fallen out of care, and as a result of the study were linked back into HIV clinics. Of 27 persons with latent tuberculosis offered therapy, nine initiated and three completed treatment. GIS-based screening can effectively penetrate populations with high disease burden and poor healthcare access. Linkage to care remains challenging and will require creative interventions to impact morbidity.
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Affiliation(s)
- Neela D. Goswami
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Emily J. Hecker
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Carter Vickery
- Wake County Community Services, Raleigh, North Carolina, United States of America
| | - Marshall A. Ahearn
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Gary M. Cox
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - David P. Holland
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Susanna Naggie
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Carla Piedrahita
- Wake County Human Services, Raleigh, North Carolina, United States of America
| | - Ann Mosher
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Yvonne Torres
- Wake County Human Services, Raleigh, North Carolina, United States of America
| | - Brianna L. Norton
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Sujit Suchindran
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Paul H. Park
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Debbie Turner
- Wake County Human Services, Raleigh, North Carolina, United States of America
| | - Jason E. Stout
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
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Oppong JR, Tiwari C, Ruckthongsook W, Huddleston J, Arbona S. Mapping late testers for HIV in Texas. Health Place 2012; 18:568-75. [PMID: 22356835 DOI: 10.1016/j.healthplace.2012.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 12/20/2011] [Accepted: 01/18/2012] [Indexed: 10/14/2022]
Abstract
Understanding the spatial patterns of late testing for HIV infection is critically important for designing and evaluating intervention strategies to reduce the social and economic burdens of HIV/AIDS. Traditional mapping methods that rely on frequency counts or rates in predefined areal units are known to be problematic due to issues of small numbers and visual biases. Additionally, confidentiality requirements associated with health data further restrict the ability to produce cartographic representations at fine geographic scales. While kernel density estimation methods produce stable and geographically detailed patterns of the late testing burden, the resulting pattern depends critically on the definition of the at-risk population. Using three definitions of at risk groups, we examine the cartographic representation of HIV late testers in Texas and show that the resulting spatial patterns and the interpretation of disease burdens are different based on the choice of the at-risk population. Disease mappers should exercise considerable caution in selecting the denominator population for mapping.
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Vanhomwegen J, Kwara A, Martin M, Gillani FS, Fontanet A, Mutungi P, Crellin J, Obaro S, Gosciminski M, Carter EJ, Rastogi N. Impact of immigration on the molecular epidemiology of tuberculosis in Rhode Island. J Clin Microbiol 2011; 49:834-44. [PMID: 21159930 PMCID: PMC3067685 DOI: 10.1128/jcm.01952-10] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 12/02/2010] [Indexed: 11/20/2022] Open
Abstract
While foreign-born persons constitute only 11% of the population in the state of Rhode Island, they account for more than 65% of incident tuberculosis (TB) annually. We investigated the molecular-epidemiological differences between foreign-born and U.S.-born TB patients to estimate the degree of recent transmission and identify predictors of clustering. A total of 288 isolates collected from culture-confirmed TB cases in Rhode Island between 1995 and 2004 were fingerprinted by spoligotyping and 12-locus mycobacterial interspersed repetitive units. Of the 288 fingerprinted isolates, 109 (37.8%) belonged to 36 genetic clusters. Our findings demonstrate that U.S.-born patients, Hispanics, Asian/Pacific islanders, and uninsured patients were significantly more likely to be clustered. Recent transmission among the foreign-born population was restricted and occurred mostly locally, within populations originating from the same region. Nevertheless, TB transmission between the foreign-born and U.S.-born population should not be neglected, since 80% of the mixed clusters of foreign- and U.S.-born persons arose from a foreign-born source case. We conclude that timely access to routine screening and treatment for latent TB infection for immigrants is vital for disease elimination in Rhode Island.
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Affiliation(s)
- Jessica Vanhomwegen
- WHO Supranational TB Reference Laboratory, TB & Mycobacteria Unit, Institut Pasteur de Guadeloupe, Pointe-à-Pitre, France
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Control, Stockholm, Sweden
| | - Awewura Kwara
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Melissa Martin
- Rhode Island Department of Health, Providence, Rhode Island
| | - Fizza S. Gillani
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Arnaud Fontanet
- Epidemiology and Infections Department, Institut Pasteur, Paris, France
| | - Peninnah Mutungi
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Joyce Crellin
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Stephen Obaro
- Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - E. Jane Carter
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Nalin Rastogi
- WHO Supranational TB Reference Laboratory, TB & Mycobacteria Unit, Institut Pasteur de Guadeloupe, Pointe-à-Pitre, France
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García de Viedma D, Mokrousov I, Rastogi N. Innovations in the molecular epidemiology of tuberculosis. Enferm Infecc Microbiol Clin 2011; 29 Suppl 1:8-13. [DOI: 10.1016/s0213-005x(11)70012-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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22
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Communicable Diseases, Globalization of. INTERNATIONAL ENCYCLOPEDIA OF HUMAN GEOGRAPHY 2009. [PMCID: PMC7152434 DOI: 10.1016/b978-008044910-4.00345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This article examines the spatial distribution of leading infectious causes of morbidity and mortality worldwide. Beginning with simple models explaining the spatial pattern of infectious diseases, the epidemiologic transition, and disease ecology models, the article focuses on HIV/AIDS, tuberculosis, polio, SARS, and influenza as well as sexually transmitted infections such as gonorrhea. It addresses the problem of disease strain mutation and especially drug resistance, and argues for the application of genotyping in medical geography research. The article emphasizes how migration and increased global interaction are producing a globalization of infectious diseases while at the same time, ethnic residential segregation is producing spatial concentrations of infectious disease or different strains of disease.
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Moonan PK, Weis SE. Assessing the Impact of Targeted Tuberculosis Interventions. Am J Respir Crit Care Med 2008; 177:557-8. [DOI: 10.1164/ajrccm.177.5.557a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Oppong JR, Denton CJ, Moonan PK, Weis SE. Foreign-Born Status and Geographic Patterns of Tuberculosis Genotypes in Tarrant County, Texas. THE PROFESSIONAL GEOGRAPHER : THE JOURNAL OF THE ASSOCIATION OF AMERICAN GEOGRAPHERS 2007; 59:478-491. [PMID: 26504253 PMCID: PMC4618290 DOI: 10.1111/j.1467-9272.2007.00636.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Regardless of destination, immigrants arrive with health profiles typical of people in their previous surroundings. Thus, immigrants change the epidemiological profile of destination communities, and immigrant neighborhoods may represent islands of infectious disease. Genotyping has emerged as a useful surveillance tool to track the spread of disease at the molecular level. Yet the spatial distribution of infectious disease at the molecular level associated with migration and immigrant neighborhoods has received little attention. Using molecular genotyping to characterize M. tuberculosis isolated from tuberculosis cases, this article analyzes spatial variations of unique molecular M. tuberculosis strains by zip code in Tarrant County, Texas. The results suggest that immigrant neighborhoods have higher rates of unique isolates of tuberculosis (suggestive of remote transmission) compared to neighborhoods occupied by the native-born. Neighborhoods dominated by the native-born have higher rates of clustered isolates (suggestive of recent transmission). Therefore, in addition to being culturally distinct, immigrant neighborhoods may also be pathogenically distinct from surrounding neighborhoods.
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Affiliation(s)
| | | | - Patrick K Moonan
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination; School of Public Health, University of North Texas Health Science Center of Fort Worth
| | - Stephen E Weis
- Department of Medicine, University of North Texas Health Science Center at Fort Worth; Tarrant County Public Health Department, Fort Worth; Bureau of Tuberculosis Elimination, Texas Department of Health and Human Services, Austin
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Bothamley GH. Strain typing and contact tracing—A clinician's viewpoint. Tuberculosis (Edinb) 2007; 87:173-5. [PMID: 17321217 DOI: 10.1016/j.tube.2006.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Graham H Bothamley
- NE London TB Network, Homerton University Hospital, Homerton Row, London E9 6SR, UK
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26
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Affiliation(s)
- Wing Wai Yew
- Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong, China.
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Reves R. Universal Genotyping as a Tool for Establishing Successful Partnerships for Tuberculosis Elimination. Am J Respir Crit Care Med 2006; 174:491-2. [PMID: 16931643 DOI: 10.1164/rccm.200606-756ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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