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Published on: February 17, 2014
How host heterogeneity governs tuberculosis reinfection?
M Gabriela M Gomes1, Ricardo Aguas, João S Lopes
1Instituto Gulbenkian de Ciência, Apartado 14, 2781-901 Oeiras, Portugal. ggomes@igc.gulbenkian.pt
Proceedings. Biological Sciences
|February 24, 2012
Summary
Distinguishing tuberculosis (TB) relapse from reinfection is key for control. Molecular data suggest reinfection rates are higher than new TB cases, likely due to individual risk heterogeneity, not increased susceptibility.
Area of Science:
- Epidemiology
- Infectious Disease Dynamics
- Molecular Epidemiology
Background:
- Recurrent tuberculosis (TB) arises from either relapse of latent infection or exogenous reinfection.
- Accurate discrimination between these sources is vital for effective TB control strategies.
- Molecular genotyping of Mycobacterium tuberculosis provides tools to assess reinfection's role in recurrent disease.
Purpose of the Study:
- To estimate epidemiological parameters of TB transmission using a mathematical model.
- To investigate the mechanisms underlying observed rates of reinfection.
- To understand how individual risk heterogeneity influences population-level reinfection rates.
Main Methods:
- Fitting a mathematical model of TB transmission to data from 14 molecular epidemiology studies.
- Conducting a meta-analysis of reinfection and new TB case rates.
- Formulating and testing two alternative mechanisms for reinfection: increased susceptibility versus differential host recruitment.
Main Results:
- Meta-analysis indicated higher rates of reinfection post-treatment compared to new TB incidence.
- A model incorporating differential host recruitment (heterogeneity in individual risk) better explained the data than increased susceptibility.
- Population-level reinfection rates appear inflated due to this phenomenon, especially at lower transmission intensities.
Conclusions:
- Individual risk heterogeneity, not increased susceptibility, likely drives inflated population-level reinfection rates in tuberculosis.
- This population phenomenon means reinfection rates may seem higher at the group level than the individual level.
- Transmission intensity modulates this effect, with differential host recruitment being less significant during high TB incidence.
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