TUBERCULOSIS TRANSMISSION ROUTES
Keywords:
Tuberculosis; transmissionAbstract
Tuberculosis remains a global health problem with an enormous burden of disease, estimated at 10.4 million new cases in 2015. To stop the tuberculosis epidemic, it is critical that we interrupt tuberculosis transmission. Further, the interventions required to interrupt tuberculosis transmission must be targeted to high-risk groups and settings. A simple cascade for tuberculosis transmission has been proposed in which a source case of tuberculosis generates infectious particles that survive in the air and are inhaled by a susceptible individual who may become infected and then has the potential to develop tuberculosis. Interventions that target these events will interrupt tuberculosis transmission and accelerate the decline in tuberculosis incidence and mortality. The purpose of this article is to provide a high-level overview of what is known about tuberculosis transmission, using the tuberculosis transmission cascade as a framework, and to set the scene for the articles in this series, which address specific aspects of tuberculosis transmission.
References
World Health Organization (WHO). Global tuberculosis report 2016. WHO/ HTM/TB/2016.13. Geneva, Switzerland: WHO, 2016. 2. Houben RM, Dodd PJ. The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling. PLoS Med 2016; 13:e1002152. 3. Barnagarwala T. TB hospital staff live under shadow of dreaded disease. The Indian Express. Uttar Pradesh, India: IE Online Media Services, 2014.
Lienhardt C, Glaziou P, Uplekar M, Lönnroth K, Getahun H, Raviglione M. Global tuberculosis control: lessons learnt and future prospects. Nat Rev Microbiol 2012; 10:407–16. 5. Hermans S, Horsburgh CR Jr, Wood R. A century of tuberculosis epidemiology in the Northern and Southern hemisphere: the differential impact of control interventions. PLoS One 2015; 10:e0135179. 6. Houben RM, Menzies NA, Sumner T, et al. Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models. Lancet Glob Health 2016; 4:e806–15. 7. Abu-Raddad LJ, Sabatelli L, Achterberg JT, et al. Epidemiological benefits of more-effective tuberculosis vaccines, drugs, and diagnostics. Proc Natl Acad Sci U S A 2009; 106:13980–5. 8. Dobbs TE, Kimmerling ME. Mycobacterium tuberculosis. In AIDS Therapy E-Book. Philadelphia, PA: Elsevier, 2008. 9. Wells WF. On air-borne infection. Study II. Droplets and droplet nuclei. Am J Hyg. 1934:611–8.
Riley RL, O’Grady F. Airborne infection: transmission and control. New York, NY: Macmillan, 1961.
Riley RL, Mills CC, Nyka W, et al. Aerial dissemination of pulmonary tuberculosis: a two-year study of contagion in a tuberculosis ward. Am J Hyg 1959; 70:185–96.
Riley RL, Mills CC, O’Grady F, Sultan LU, Wittstadt F, Shivpuri DN. Infectiousness of air from a tuberculosis ward. Ultraviolet irradiation of infected air: comparative infectiousness of different patients. Am Rev Respir Dis 1962; 85:511–25.
Chapman JS, Dyerly MD. Social and other factors in intrafamilial transmission of tuberculosis. Am Rev Respir Dis 1964; 90:48–60.
Dowdy DW, Azman AS, Kendall EA, Mathema B. Transforming the fight against tuberculosis: targeting catalysts of transmission. Clin Infect Dis 2014; 59:1123–9.
Zelner JL, Murray MB, Becerra MC, et al. Age-specific risks of tuberculosis infection from household and community exposures and opportunities for interventions in a high-burden setting. Am J Epidemiol 2014; 180:853–61.
Turner RD, Bothamley GH. Cough and the transmission of tuberculosis. J Infect Dis 2015; 211:1367–72.
Dharmadhikari AS, Mphahlele M, Venter K, et al. Rapid impact of effective treatment on transmission of multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2014; 18:1019–25.
Huang CC, Tchetgen ET, Becerra MC, et al. The effect of HIV-related immunosuppression on the risk of tuberculosis transmission to household contacts. Clin Infect Dis 2014; 58:765–74.
Corbett EL, Bandason T, Cheung YB, et al. Epidemiology of tuberculosis in a high HIV prevalence population provided with enhanced diagnosis of symptomatic disease. PLoS Med 2007; 4:e22.
Lawn SD, Wood R, De Cock KM, Kranzer K, Lewis JJ, Churchyard GJ. Antiretrovirals and isoniazid preventive therapy in the prevention of HIVassociated tuberculosis in settings with limited health-care resources. Lancet Infect Dis 2010; 10:489–98.
Zachariah R, Bemelmans M, Akesson A, et al. Reduced tuberculosis case notification associated with scaling up antiretroviral treatment in rural Malawi. Int J Tuberc Lung Dis 2011; 15:933–7.
Dodd PJ, Looker C, Plumb ID, et al. Age- and sex-specific social contact patterns and incidence of Mycobacterium tuberculosis infection. Am J Epidemiol 2016; 183:156–66.
Nobelprize.org. Robert Koch—Nobel Lecture. Stockholm, Sweden: Nobel Media, 2014. https://www.nobelprize.org/nobel_prizes/medicine/laureates/1905/ koch-lecture.html. Accessed 12 August 2017.
Shah NS, Yuen CM, Heo M, Tolman AW, Becerra MC. Yield of contact investigations in households of patients with drug-resistant tuberculosis: systematic review and meta-analysis. Clin Infect Dis 2014; 58:381–91.
Zelner JL, Murray MB, Becerra MC, et al. Identifying hotspots of multidrug-resistant tuberculosis transmission using spatial and molecular genetic data. J Infect Dis 2016; 213:287–94.
Andrews JR, Morrow C, Walensky RP, Wood R. Integrating social contact and environmental data in evaluating tuberculosis transmission in a South African township. J Infect Dis 2014; 210:597–603.
Yates TA, Khan PY, Knight GM, et al. The transmission of Mycobacterium tuberculosis in high burden settings. Lancet Infect Dis 2016; 16:227–38.
Andrews JR, Morrow C, Wood R. Modeling the role of public transportation in sustaining tuberculosis transmission in South Africa. Am J Epidemiol 2013; 177:556–61.
Churchyard GJ, Fielding KL, Lewis JJ, et al; Thibela TB Study Team. A trial of mass isoniazid preventive therapy for tuberculosis control. N Engl J Med 2014; 370:301–10.
Telisinghe L, Fielding KL, Malden JL, et al. High tuberculosis prevalence in a South African prison: the need for routine tuberculosis screening. PLoS One 2014; 9:e87262.
Johnstone-Robertson S, Lawn SD, Welte A, Bekker LG, Wood R. Tuberculosis in a South African prison - a transmission modelling analysis. S Afr Med J 2011; 101:809–13.
Escombe AR, Huaroto L, Ticona E, et al. Tuberculosis transmission risk and infection control in a hospital emergency department in Lima, Peru. Int J Tuberc Lung Dis 2010; 14:1120–6.
Escombe AR, Moore DA, Gilman RH, et al. Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmission. PLoS Med 2009; 6:e43.
Barrera E, Livchits V, Nardell E. F-A-S-T: a refocused, intensified, administrative tuberculosis transmission control strategy. Int J Tuberc Lung Dis 2015; 19:381–4.
Cegielski JP, Griffith DE, McGaha PK, et al. Eliminating tuberculosis one neighborhood at a time. Am J Public Health 2013; 103:1292–300.
Fox GJ, Barry SE, Britton WJ, Marks GB. Contact investigation for tuberculosis: a systematic review and meta-analysis. Eur Respir J 2013; 41:140–56.
Shanaube K. The association between the magnitude of T-cell interferon-gamma responses to Mycobacterium tuberculosis specific antigens and risk of progression to tuberculosis in household contacts tested with QuantiFERON-TB Gold In-Tube assay [dissertation]. London, UK: London School of Hygiene and Tropical Medicine, 2014.
Hanifa Y, Grant AD, Lewis J, Corbett EL, Fielding K, Churchyard G. Prevalence of latent tuberculosis infection among gold miners in South Africa. Int J Tuberc Lung Dis 2009; 13:39–46.
Cowie RL. Short course chemoprophylaxis with rifampicin, isoniazid and pyrazinamide for tuberculosis evaluated in gold miners with chronic silicosis: a double-blind placebo controlled trial. Tuber Lung Dis 1996; 77:239–43.
Comstock GW, Ferebee SH, Hammes LM. A controlled trial of community-wide isoniazid prophylaxis in Alaska. Am Rev Respir Dis 1967; 95:935–43.
Nyboe J, Farah AR, Christensen OW. Report on chemotherapy pilot project (Tunisia 9). Geneva, Switzerland: World Health Organization, 1963.
Ferebee SH. Controlled chemoprophylaxis trials in tuberculosis. A general review. Bibl Tuberc 1970; 26:28–106.
Horwitz O, Payne PG, Wilbek E. Epidemiological basis of tuberculosis eradication. 4. The isoniazid trial in Greenland. Bull World Health Organ 1966; 35:509–26.
Horwitz O, Magnus K. Epidemiologic evaluation of chemoprophylaxis against tuberculosis. Am J Epidemiol 1974; 99:333–42.
Comstock GW, Baum C, Snider DE Jr. Isoniazid prophylaxis among Alaskan Eskimos: a final report of the bethel isoniazid studies. Am Rev Respir Dis 1979; 119:827–30.
Rendleman NJ. Mandated tuberculosis screening in a community of homeless people. Am J Prev Med 1999; 17:108–13.
Corbett EL, Bandason T, Duong T, et al. Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial. Lancet 2010; 376:1244–53.
Ayles H, Muyoyeta M, Du Toit E, et al; ZAMSTAR team. Effect of household and community interventions on the burden of tuberculosis in southern Africa: the ZAMSTAR community-randomised trial. Lancet 2013; 382:1183–94.
Cavalcante SC, Durovni B, Barnes GL, et al. Community-randomized trial of enhanced DOTS for tuberculosis control in Rio de Janeiro, Brazil. Int J Tuberc Lung Dis 2010; 14:203–9.
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Overview of Knowledge About Tuberculosis Transmission • JID 2017:216 (Suppl 6) • S635
Durovni B, Saraceni V, Moulton LH, et al. Effect of improved tuberculosis screening and isoniazid preventive therapy on incidence of tuberculosis and death in patients with HIV in clinics in Rio de Janeiro, Brazil: a stepped wedge, cluster-randomised trial. Lancet Infect Dis 2013; 13:852–8.
Kranzer K, Afnan-Holmes H, Tomlin K, et al. The benefits to communities and individuals of screening for active tuberculosis disease: a systematic review. Int J Tuberc Lung Dis 2013; 17:432–46.
Small PM, Pai M. Tuberculosis diagnosis–time for a game change. N Engl J Med 2010; 363:1070–1.
Boehme CC, Nabeta P, Hillemann D, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med 2010; 363:1005–15.
Churchyard GJ, Stevens WS, Mametja LD, et al. Xpert MTB/RIF versus sputum microscopy as the initial diagnostic test for tuberculosis: a cluster-randomised trial embedded in South African roll-out of Xpert MTB/RIF. Lancet Glob Health 2015; 3:e450–7.
Theron G, Zijenah L, Chanda D, et al; TB-NEAT team. Feasibility, accuracy, and clinical effect of point-of-care Xpert MTB/RIF testing for tuberculosis in
