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Published on: September 5, 2017
Transmission elasticity in communities hyperendemic for tuberculosis
Pieter Uys1, Ben J Marais, Simon Johnstone-Robertson
1Department of Science and Technology/National Research Foundations Centre of Excellence in Epidemiological Modeling and Analysis, Westmead, Australia.
Summary
Tuberculosis control targets need adjustment for hyperendemic areas. Reducing infectious individuals yields less transmission reduction in highly prevalent settings, requiring more stringent goals for effective tuberculosis elimination.
Area of Science:
- Epidemiology
- Infectious Disease Modeling
Background:
- Tuberculosis (TB) hyperendemic areas often miss epidemiological targets despite meeting case detection and treatment success rates.
- This study investigates the discrepancy between TB performance metrics and actual transmission reduction.
Purpose of the Study:
- To explore the relationship between TB control performance targets and the reduction of TB transmission.
- To introduce and apply the concept of transmission elasticity to understand TB control in hyperendemic settings.
Main Methods:
- Modeled TB transmission reduction by removing infectious individuals in settings with varying TB prevalence.
- Applied transmission elasticity modeling to real-world data from a hyperendemic community in Cape Town, South Africa.
Main Results:
- In hyperendemic areas, reducing infectious individuals by a percentage leads to a smaller percentage decrease in annual risk of infection (ARI) compared to non-endemic areas.
- Removing 60% of infectious individuals (meeting current targets) in a hyperendemic setting resulted in only a 50% estimated ARI reduction.
Conclusions:
- The relationship between removing infectious individuals and decreasing ARI is nonlinear, termed transmission elasticity.
- Hyperendemic TB areas require more ambitious control targets to achieve the same transmission reduction as less endemic regions.
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