Modelling tuberculosis transmission dynamics in Malaysia

Area of Science:

• Epidemiology
• Mathematical Modeling
• Public Health

Background:

• Tuberculosis (TB) poses a significant global health threat, necessitating interventions aligned with the WHO End TB Strategy.
• Estimating TB's reproduction number (R0) and incidence is crucial for effective control strategies.

Purpose of the Study:

• To develop and validate a compartmental model for estimating TB R0 and incidence in Malaysia.
• To identify key parameters influencing TB transmission and simulate future incidence scenarios.
• To assess the feasibility of achieving WHO End TB Strategy targets by 2035.

Main Methods:

• A Susceptible-Latent Fast-Latent Slow-Infectious-Recovered (SLFLSIR) compartmental model was developed and calibrated using national TB data (2013-2023).
• The next-generation matrix approach was used to estimate R0, with uncertainty quantified via parametric bootstrapping.
• Global sensitivity analysis identified influential parameters, and TB incidence scenarios were simulated to 2035.

Main Results:

• The calibrated model demonstrated a good fit to observed TB data.
• The estimated R0 was 1.09 (95% CI: 1.01-1.27), indicating self-sustaining transmission.
• The most intensive intervention scenario simulated a 66.21% reduction in TB incidence by 2035 (relative to 2015).

Conclusions:

• TB transmission in Malaysia is self-sustaining, with R0 slightly exceeding 1.
• While interventions can reduce incidence, achieving 2035 WHO targets necessitates integrated TB control and addressing social determinants.
• Broader public health improvements are essential for meeting ambitious TB elimination goals.