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Nelson KN, Shah NS, Cranmer LM, Vasudevan L, Bednarczyk RA. An effective vaccine is only the first step: the need to create and sustain demand for TB vaccines. Int J Tuberc Lung Dis 2023; 27:718-720. [PMID: 37749838 PMCID: PMC10519388 DOI: 10.5588/ijtld.23.0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- K N Nelson
- Department of Epidemiology, Emory University Rollins School of Public Health
| | - N S Shah
- Department of Epidemiology, Emory University Rollins School of Public Health, Department of Global Health, Emory University Rollins School of Public Health, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - L M Cranmer
- Department of Epidemiology, Emory University Rollins School of Public Health, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - L Vasudevan
- Department of Global Health, Emory University Rollins School of Public Health
| | - R A Bednarczyk
- Department of Epidemiology, Emory University Rollins School of Public Health, Department of Global Health, Emory University Rollins School of Public Health
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Peterson ML, Gandhi NR, Clennon J, Nelson KN, Morris N, Ismail N, Allana S, Campbell A, Brust JCM, Auld SC, Mathema B, Mlisana K, Moodley P, Shah NS. Extensively drug-resistant tuberculosis 'hotspots' and sociodemographic associations in Durban, South Africa. Int J Tuberc Lung Dis 2020; 23:720-727. [PMID: 31315705 DOI: 10.5588/ijtld.18.0575] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
<sec> <title>BACKGROUND</title> In KwaZulu-Natal, South Africa, the incidence of extensively drug-resistant tuberculosis (XDR-TB) is driven by the transmission of resistant strains. As data suggest that cases may be spatially clustered, we sought to identify 'hotspots' and describe these communities. </sec> <sec> <title>METHODS</title> We enrolled XDR-TB patients diagnosed from 2011 to 2014 in eThekwini. Global positioning system (GPS) coordinates for participant homes were collected and hotspots were identified based on population-adjusted XDR-TB incidence. The sociodemographic features of hotspots were characterised using census data. For a subset of participants, we mapped non-home XDR-TB congregate locations and compared these with results including only homes. </sec> <sec> <title>RESULTS</title> Among 132 participants, 75 (57%) were female and 87 (66%) lived in urban or suburban locations. Fifteen of 197 census tracts were identified as XDR-TB hotspots with ≥95% confidence. Four spatial mapping methods identified one large hotspot in northeastern eThekwini. Hotspot communities had higher proportions of low educational attainment (12% vs. 9%) and unemployment (29.3% vs. 20.4%), and lower proportion of homes with flush toilets (36.4% vs. 68.9%). The case density shifted towards downtown Durban when congregate locations (e.g., workplaces) for 43 (33%) participants were mapped. </sec> <sec> <title>CONCLUSIONS</title> In eThekwini, XDR-TB case homes were clustered into hotspots with more poverty indicators than non-hotspots. Prevention efforts targeting hotspot communities and congregate settings may be effective in reducing community transmission. </sec>.
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Affiliation(s)
- M L Peterson
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - N R Gandhi
- Emory University Rollins School of Public Health, Atlanta, Georgia, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J Clennon
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - K N Nelson
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - N Morris
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg
| | - N Ismail
- National Institute for Communicable Diseases, Johannesburg, University of Pretoria, Pretoria, South Africa
| | - S Allana
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - A Campbell
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - J C M Brust
- Albert Einstein College of Medicine, Bronx, New York
| | - S C Auld
- Emory University Rollins School of Public Health, Atlanta, Georgia, Emory University School of Medicine, Atlanta, Georgia, USA
| | - B Mathema
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - K Mlisana
- National Health Laboratory Service, Durban, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - P Moodley
- National Health Laboratory Service, Durban
| | - N S Shah
- Emory University Rollins School of Public Health, Atlanta, Georgia, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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