The importance of heterogeneity to the epidemiology of tuberculosis

Trauer, James M., Dodd, Peter J., Gomes, Gabriela M., Gomez, Gabriela B., Houben, Rein M.G.J., McBryde, Emma S., Melsew, Yayehirad A., Menzies, Nicholas A., Arinaminpathy, Nimalan, Shrestha, Sourya, and Dowdy, David W. (2018) The importance of heterogeneity to the epidemiology of tuberculosis. Clinical Infectious Diseases. (In Press)

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View at Publisher Website: https://doi.org/10.1093/cid/ciy938
 
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Abstract

Although less well-recognised than for other infectious diseases, heterogeneity is a defining feature of TB epidemiology. To advance toward TB elimination, this heterogeneity must be better understood and addressed. Drivers of heterogeneity in TB epidemiology act at the level of the infectious host, organism, susceptible host, environment and distal determinants. These effects may be amplified by social mixing patterns, while the variable latent period between infection and disease may mask heterogeneity in transmission. Reliance on notified cases may lead to misidentification of the most affected groups, as case detection is often poorest where prevalence is highest. Assuming average rates apply across diverse groups and ignoring the effects of cohort selection may result in misunderstanding of the epidemic and the anticipated effects of control measures. Given this substantial heterogeneity, interventions targeting high-risk groups based on location, social determinants or comorbidities could improve efficiency, but raise ethical and equity considerations.

Item ID: 57193
Item Type: Article (Research - C1)
ISSN: 1537-6591
Keywords: tuberculosis, heterogeneity, epidemiology, case detection, interventions
Copyright Information: Copyright © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America
Date Deposited: 05 Mar 2019 22:13
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920404 Disease Distribution and Transmission (incl. Surveillance and Response) @ 50%
92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920407 Health Protection and/or Disaster Response @ 50%
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