Profiling Mycobacterium tuberculosis transmission and the resulting disease burden in the five highest tuberculosis burden countries

Ragonnet, Romain, Trauer, James M., Geard, Nicholas, Scott, Nick, and McBryde, Emma S. (2019) Profiling Mycobacterium tuberculosis transmission and the resulting disease burden in the five highest tuberculosis burden countries. BMC Medicine, 17. 208.

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Background: Tuberculosis (TB) control efforts are hampered by an imperfect understanding of TB epidemiology. The true age distribution of disease is unknown because a large proportion of individuals with active TB remain undetected. Understanding of transmission is limited by the asymptomatic nature of latent infection and the pathogen’s capacity for late reactivation. A better understanding of TB epidemiology is critically needed to ensure effective use of existing and future control tools.

Methods: We use an agent-based model to simulate TB epidemiology in the five highest TB burden countries—India, Indonesia, China, the Philippines and Pakistan—providing unique insights into patterns of transmission and disease. Our model replicates demographically realistic populations, explicitly capturing social contacts between individuals based on local estimates of age-specific contact in household, school and workplace settings. Time-varying programmatic parameters are incorporated to account for the local history of TB control.

Results: We estimate that the 15–19-year-old age group is involved in more than 20% of transmission events in India, Indonesia, the Philippines and Pakistan, despite representing only 5% of the local TB incidence. According to our model, childhood TB represents around one fifth of the incident TB cases in these four countries. In China, three quarters of incident TB were estimated to occur in the ≥ 45-year-old population. The calibrated per-contact transmission risk was found to be similar in each of the five countries despite their very different TB burdens.

Conclusions: Adolescents and young adults are a major driver of TB in high-incidence settings. Relying only on the observed distribution of disease to understand the age profile of transmission is potentially misleading.

Item ID: 61215
Item Type: Article (Research - C1)
ISSN: 1741-7015
Keywords: Tuberculosis, Transmission profile, Infectious disease, Social mixing
Copyright Information: © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Funders: Australian Government Department of Education, Skills and Employment
Projects and Grants: Research Training Program (RTP) Scholarship
Date Deposited: 18 Dec 2019 07:52
FoR Codes: 42 HEALTH SCIENCES > 4202 Epidemiology > 420202 Disease surveillance @ 100%
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