Construction of a mathematical model for tuberculosis transmission in highly endemic regions of the Asia-Pacific

Trauer, James M., Denholm, Justin T., and McBryde, Emma S. (2014) Construction of a mathematical model for tuberculosis transmission in highly endemic regions of the Asia-Pacific. Journal of Theoretical Biology, 358. pp. 74-84.

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We present a mathematical model to simulate tuberculosis (TB) transmission in highly endemic regions of the Asia-Pacific, where epidemiology does not appear to be primarily driven by HIV-coinfection. The ten-compartment deterministic model captures many of the observed phenomena important to disease dynamics, including partial and temporary vaccine efficacy, declining risk of active disease following infection, the possibility of reinfection both during the infection latent period and after treatment, multidrug resistant TB (MDR-TB) and de novo resistance during treatment. We found that the model could not be calibrated to the estimated incidence rate without allowing for reinfection during latency, and that even in the presence of a moderate fitness cost and a lower value of R0, MDR-TB becomes the dominant strain at equilibrium. Of the modifiable programmatic parameters, the rate of detection and treatment commencement was the most important determinant of disease rates with each respective strain, while vaccination rates were less important. Improved treatment of drug-susceptible TB did not result in decreased rates of MDR-TB through prevention of de novo resistance, but rather resulted in a modest increase in MDR-TB through strain replacement. This was due to the considerably greater relative contribution of community transmission to MDR-TB incidence, by comparison to de novo amplification of resistance in previously susceptible strains.

Item ID: 39741
Item Type: Article (Research - C1)
ISSN: 1095-8541
Keywords: models—theoretical; tuberculosis—multidrug resistant; disease transmission—infectious; latent tuberculosis; BCG vaccine
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This is an open access article under the CC BY-NC-SA license (

Funders: National Health and Medical Research Council of Australia (NHMRC), Australian Government
Date Deposited: 09 Sep 2015 03:43
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110309 Infectious Diseases @ 40%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 40%
16 STUDIES IN HUMAN SOCIETY > 1605 Policy and Administration > 160508 Health Policy @ 20%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 60%
92 HEALTH > 9203 Indigenous Health > 920309 Pacific Peoples Health - Health System Performance (incl. Effectiveness of Interventions) @ 20%
92 HEALTH > 9202 Health and Support Services > 920207 Health Policy Evaluation @ 20%
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