The Importance of Heterogeneity to the Epidemiology of Tuberculosis

James McCracken Trauer, Peter J. Dodd, M. Gabriela M. Gomes, Gabriela B. Gomez, Rein M G J Houben, Emma McBryde, Yayehirad Alemu Melsew, Nicolas A. Menzies, Nimalan Arinaminpathy, Sourya Shrestha, David W. Dowdy

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Although less well-recognised than for other infectious diseases, heterogeneity is a defining feature of TB epidemiology. To advance toward TB elimination, this heterogeneity must be better understood and addressed. Drivers of heterogeneity in TB epidemiology act at the level of the infectious host, organism, susceptible host, environment and distal determinants. These effects may be amplified by social mixing patterns, while the variable latent period between infection and disease may mask heterogeneity in transmission. Reliance on notified cases may lead to misidentification of the most affected groups, as case detection is often poorest where prevalence is highest. Assuming average rates apply across diverse groups and ignoring the effects of cohort selection may result in misunderstanding of the epidemic and the anticipated effects of control measures. Given this substantial heterogeneity, interventions targeting high-risk groups based on location, social determinants or comorbidities could improve efficiency, but raise ethical and equity considerations
Original languageEnglish
Pages (from-to)159-166
Number of pages8
JournalClinical Infectious Diseases
Volume69
Issue number1
DOIs
Publication statusPublished - 18 Jun 2019

Cite this

Trauer, J. M., Dodd, P. J., Gomes, M. G. M., Gomez, G. B., Houben, R. M. G. J., McBryde, E., ... Dowdy, D. W. (2019). The Importance of Heterogeneity to the Epidemiology of Tuberculosis. Clinical Infectious Diseases, 69(1), 159-166. https://doi.org/10.1093/cid/ciy938
Trauer, James McCracken ; Dodd, Peter J. ; Gomes, M. Gabriela M. ; Gomez, Gabriela B. ; Houben, Rein M G J ; McBryde, Emma ; Melsew, Yayehirad Alemu ; Menzies, Nicolas A. ; Arinaminpathy, Nimalan ; Shrestha, Sourya ; Dowdy, David W. / The Importance of Heterogeneity to the Epidemiology of Tuberculosis. In: Clinical Infectious Diseases. 2019 ; Vol. 69, No. 1. pp. 159-166.
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abstract = "Although less well-recognised than for other infectious diseases, heterogeneity is a defining feature of TB epidemiology. To advance toward TB elimination, this heterogeneity must be better understood and addressed. Drivers of heterogeneity in TB epidemiology act at the level of the infectious host, organism, susceptible host, environment and distal determinants. These effects may be amplified by social mixing patterns, while the variable latent period between infection and disease may mask heterogeneity in transmission. Reliance on notified cases may lead to misidentification of the most affected groups, as case detection is often poorest where prevalence is highest. Assuming average rates apply across diverse groups and ignoring the effects of cohort selection may result in misunderstanding of the epidemic and the anticipated effects of control measures. Given this substantial heterogeneity, interventions targeting high-risk groups based on location, social determinants or comorbidities could improve efficiency, but raise ethical and equity considerations",
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Trauer, JM, Dodd, PJ, Gomes, MGM, Gomez, GB, Houben, RMGJ, McBryde, E, Melsew, YA, Menzies, NA, Arinaminpathy, N, Shrestha, S & Dowdy, DW 2019, 'The Importance of Heterogeneity to the Epidemiology of Tuberculosis' Clinical Infectious Diseases, vol. 69, no. 1, pp. 159-166. https://doi.org/10.1093/cid/ciy938

The Importance of Heterogeneity to the Epidemiology of Tuberculosis. / Trauer, James McCracken; Dodd, Peter J.; Gomes, M. Gabriela M.; Gomez, Gabriela B.; Houben, Rein M G J; McBryde, Emma; Melsew, Yayehirad Alemu; Menzies, Nicolas A.; Arinaminpathy, Nimalan; Shrestha, Sourya ; Dowdy, David W.

In: Clinical Infectious Diseases, Vol. 69, No. 1, 18.06.2019, p. 159-166.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Gomez, Gabriela B.

AU - Houben, Rein M G J

AU - McBryde, Emma

AU - Melsew, Yayehirad Alemu

AU - Menzies, Nicolas A.

AU - Arinaminpathy, Nimalan

AU - Shrestha, Sourya

AU - Dowdy, David W.

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AB - Although less well-recognised than for other infectious diseases, heterogeneity is a defining feature of TB epidemiology. To advance toward TB elimination, this heterogeneity must be better understood and addressed. Drivers of heterogeneity in TB epidemiology act at the level of the infectious host, organism, susceptible host, environment and distal determinants. These effects may be amplified by social mixing patterns, while the variable latent period between infection and disease may mask heterogeneity in transmission. Reliance on notified cases may lead to misidentification of the most affected groups, as case detection is often poorest where prevalence is highest. Assuming average rates apply across diverse groups and ignoring the effects of cohort selection may result in misunderstanding of the epidemic and the anticipated effects of control measures. Given this substantial heterogeneity, interventions targeting high-risk groups based on location, social determinants or comorbidities could improve efficiency, but raise ethical and equity considerations

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