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Sample records for estimate tuberculosis transmission

  1. A Novel Tool Improves Existing Estimates of Recent Tuberculosis Transmission in Settings of Sparse Data Collection.

    PubMed

    Kasaie, Parastu; Mathema, Barun; Kelton, W David; Azman, Andrew S; Pennington, Jeff; Dowdy, David W

    2015-01-01

    In any setting, a proportion of incident active tuberculosis (TB) reflects recent transmission ("recent transmission proportion"), whereas the remainder represents reactivation. Appropriately estimating the recent transmission proportion has important implications for local TB control, but existing approaches have known biases, especially where data are incomplete. We constructed a stochastic individual-based model of a TB epidemic and designed a set of simulations (derivation set) to develop two regression-based tools for estimating the recent transmission proportion from five inputs: underlying TB incidence, sampling coverage, study duration, clustered proportion of observed cases, and proportion of observed clusters in the sample. We tested these tools on a set of unrelated simulations (validation set), and compared their performance against that of the traditional 'n-1' approach. In the validation set, the regression tools reduced the absolute estimation bias (difference between estimated and true recent transmission proportion) in the 'n-1' technique by a median [interquartile range] of 60% [9%, 82%] and 69% [30%, 87%]. The bias in the 'n-1' model was highly sensitive to underlying levels of study coverage and duration, and substantially underestimated the recent transmission proportion in settings of incomplete data coverage. By contrast, the regression models' performance was more consistent across different epidemiological settings and study characteristics. We provide one of these regression models as a user-friendly, web-based tool. Novel tools can improve our ability to estimate the recent TB transmission proportion from data that are observable (or estimable) by public health practitioners with limited available molecular data.

  2. Strain-specific estimation of epidemic success provides insights into the transmission dynamics of tuberculosis

    PubMed Central

    Rasigade, Jean-Philippe; Barbier, Maxime; Dumitrescu, Oana; Pichat, Catherine; Carret, Gérard; Ronnaux-Baron, Anne-Sophie; Blasquez, Ghislaine; Godin-Benhaim, Christine; Boisset, Sandrine; Carricajo, Anne; Jacomo, Véronique; Fredenucci, Isabelle; Pérouse de Montclos, Michèle; Flandrois, Jean-Pierre; Ader, Florence; Supply, Philip; Lina, Gérard; Wirth, Thierry

    2017-01-01

    The transmission dynamics of tuberculosis involves complex interactions of socio-economic and, possibly, microbiological factors. We describe an analytical framework to infer factors of epidemic success based on the joint analysis of epidemiological, clinical and pathogen genetic data. We derive isolate-specific, genetic distance-based estimates of epidemic success, and we represent success-related time-dependent concepts, namely epidemicity and endemicity, by restricting analysis to specific time scales. The method is applied to analyze a surveillance-based cohort of 1,641 tuberculosis patients with minisatellite-based isolate genotypes. Known predictors of isolate endemicity (older age, native status) and epidemicity (younger age, sputum smear positivity) were identified with high confidence (P < 0.001). Long-term epidemic success also correlated with the ability of Euro-American and Beijing MTBC lineages to cause active pulmonary infection, independent of patient age and country of origin. Our results demonstrate how important insights into the transmission dynamics of tuberculosis can be gained from active surveillance data. PMID:28349973

  3. Using Genotyping and Geospatial Scanning to Estimate Recent Mycobacterium tuberculosis Transmission, United States

    PubMed Central

    Ghosh, Smita; Oeltmann, John E.; Kammerer, J. Steven; Cowan, Lauren S.; Navin, Thomas R.

    2012-01-01

    To determine the proportion of reported tuberculosis (TB) cases due to recent transmission in the United States, we conducted a cross-sectional study to examine culture-positive TB cases with complete genotype results (spoligotyping and 12-locus mycobacterial interspersed repetitive unit–variable-number tandem repeat typing) reported during January 2005–December 2009. Recently transmitted cases were defined as cases with matching results reported within statistically significant geospatial zones (identified by a spatial span statistic within a sliding 3-year window). Approximately 1 in 4 TB cases reported in the United States may be attributed to recent transmission. Groups at greatest risk for recent transmission appear to be men, persons born in the United States, members of a minority race or ethnic group, persons who abuse substances, and the homeless. Understanding transmission dynamics and establishing strategies for rapidly detecting recent transmission among these populations are essential for TB elimination in the United States. PMID:22377473

  4. Estimates for local and movement-based transmission of bovine tuberculosis in British cattle.

    PubMed

    Green, Darren M; Kiss, Istvan Z; Mitchell, Andrew P; Kao, Rowland R

    2008-05-07

    Both badgers and livestock movements have been implicated in contributing to the ongoing epidemic of bovine tuberculosis (BTB) in British cattle. However, the relative contributions of these and other causes are not well quantified. We used cattle movement data to construct an individual (premises)-based model of BTB spread within Great Britain, accounting for spread due to recorded cattle movements and other causes. Outbreak data for 2004 were best explained by a model attributing 16% of herd infections directly to cattle movements, and a further 9% unexplained, potentially including spread from unrecorded movements. The best-fit model assumed low levels of cattle-to-cattle transmission. The remaining 75% of infection was attributed to local effects within specific high-risk areas. Annual and biennial testing is mandatory for herds deemed at high risk of infection, as is pre-movement testing from such herds. The herds identified as high risk in 2004 by our model are in broad agreement with those officially designated as such at that time. However, border areas at the edges of high-risk regions are different, suggesting possible areas that should be targeted to prevent further geographical spread of disease. With these areas expanding rapidly over the last decade, their close surveillance is important to both identify infected herds qucikly, and limit their further growth.

  5. The transmission of Mycobacterium tuberculosis in high burden settings.

    PubMed

    Yates, Tom A; Khan, Palwasha Y; Knight, Gwenan M; Taylor, Jonathon G; McHugh, Timothy D; Lipman, Marc; White, Richard G; Cohen, Ted; Cobelens, Frank G; Wood, Robin; Moore, David A J; Abubakar, Ibrahim

    2016-02-01

    Unacceptable levels of Mycobacterium tuberculosis transmission are noted in high burden settings and a renewed focus on reducing person-to-person transmission in these communities is needed. We review recent developments in the understanding of airborne transmission. We outline approaches to measure transmission in populations and trials and describe the Wells-Riley equation, which is used to estimate transmission risk in indoor spaces. Present research priorities include the identification of effective strategies for tuberculosis infection control, improved understanding of where transmission occurs and the transmissibility of drug-resistant strains, and estimates of the effect of HIV and antiretroviral therapy on transmission dynamics. When research is planned and interventions are designed to interrupt transmission, resource constraints that are common in high burden settings-including shortages of health-care workers-must be considered.

  6. Recent Transmission of Tuberculosis - United States, 2011-2014.

    PubMed

    Yuen, Courtney M; Kammerer, J Steve; Marks, Kala; Navin, Thomas R; France, Anne Marie

    2016-01-01

    Tuberculosis is an infectious disease that may result from recent transmission or from an infection acquired many years in the past; there is no diagnostic test to distinguish the two causes. Cases resulting from recent transmission are particularly concerning from a public health standpoint. To describe recent tuberculosis transmission in the United States, we used a field-validated plausible source-case method to estimate cases likely resulting from recent transmission during January 2011-September 2014. We classified cases as resulting from either limited or extensive recent transmission based on transmission cluster size. We used logistic regression to analyze patient characteristics associated with recent transmission. Of 26,586 genotyped cases, 14% were attributable to recent transmission, 39% of which were attributable to extensive recent transmission. The burden of cases attributed to recent transmission was geographically heterogeneous and poorly predicted by tuberculosis incidence. Extensive recent transmission was positively associated with American Indian/Alaska Native (adjusted prevalence ratio [aPR] = 3.6 (95% confidence interval [CI] 2.9-4.4), Native Hawaiian/Pacific Islander (aPR = 3.2, 95% CI 2.3-4.5), and black (aPR = 3.0, 95% CI 2.6-3.5) race, and homelessness (aPR = 2.3, 95% CI 2.0-2.5). Extensive recent transmission was negatively associated with foreign birth (aPR = 0.2, 95% CI 0.2-0.2). Tuberculosis control efforts should prioritize reducing transmission among higher-risk populations.

  7. Recent Transmission of Tuberculosis — United States, 2011–2014

    PubMed Central

    Yuen, Courtney M.; Kammerer, J. Steve; Marks, Kala; Navin, Thomas R.; France, Anne Marie

    2016-01-01

    Tuberculosis is an infectious disease that may result from recent transmission or from an infection acquired many years in the past; there is no diagnostic test to distinguish the two causes. Cases resulting from recent transmission are particularly concerning from a public health standpoint. To describe recent tuberculosis transmission in the United States, we used a field-validated plausible source-case method to estimate cases likely resulting from recent transmission during January 2011–September 2014. We classified cases as resulting from either limited or extensive recent transmission based on transmission cluster size. We used logistic regression to analyze patient characteristics associated with recent transmission. Of 26,586 genotyped cases, 14% were attributable to recent transmission, 39% of which were attributable to extensive recent transmission. The burden of cases attributed to recent transmission was geographically heterogeneous and poorly predicted by tuberculosis incidence. Extensive recent transmission was positively associated with American Indian/Alaska Native (adjusted prevalence ratio [aPR] = 3.6 (95% confidence interval [CI] 2.9–4.4), Native Hawaiian/Pacific Islander (aPR = 3.2, 95% CI 2.3–4.5), and black (aPR = 3.0, 95% CI 2.6–3.5) race, and homelessness (aPR = 2.3, 95% CI 2.0–2.5). Extensive recent transmission was negatively associated with foreign birth (aPR = 0.2, 95% CI 0.2–0.2). Tuberculosis control efforts should prioritize reducing transmission among higher-risk populations. PMID:27082644

  8. Transmission of Mycobacterium tuberculosis in China: A Population-Based Molecular Epidemiologic Study

    PubMed Central

    Yang, Chongguang; Shen, Xin; Peng, Ying; Lan, Rushu; Zhao, Yuling; Long, Bo; Luo, Tao; Sun, Guomei; Li, Xia; Qiao, Ke; Gui, Xiaohong; Wu, Jie; Xu, Jiying; Li, Fabin; Li, Dingyue; Liu, Feiying; Shen, Mei; Hong, Jianjun; Mei, Jian; DeRiemer, Kathryn; Gao, Qian

    2015-01-01

    Background. Understanding the transmission of Mycobacterium tuberculosis is essential for the development of efficient tuberculosis control strategies. China has the second-largest tuberculosis burden in the world. Recent transmission and infection with M. tuberculosis, particularly drug-resistant strains, may account for many new tuberculosis cases. Methods. We performed a population-based molecular epidemiologic study of pulmonary tuberculosis in China during 1 July 2009 to 30 June 2012. We defined clusters as cases with identical variable number tandem repeat genotype patterns and identified the risk factors associated with clustering, by logistic regression. Relative transmission rates were estimated by the sputum smear status and drug susceptibility status of tuberculosis patients. Results. Among 2274 culture-positive tuberculosis patients with genotyped isolates, there were 705 (31.0%) tuberculosis patients in 287 clusters. Multidrug-resistant (MDR) tuberculosis (adjusted odds ratio [aOR], 1.86; 95% confidence interval [CI], 1.25–2.63) and infection with a Beijing family strain (aOR, 1.56; 95% CI, 1.23–2.96) were associated with clustering. Eighty-four of 280 (30.0%) clusters had a putative source case that was sputum smear negative, and 30.6% of their secondary cases were attributed to transmission by sputum smear–negative patients. The relative transmission rate for sputum smear negative compared with sputum smear–positive patients was 0.89 (95% CI, .68–1.10), and was 1.51 (95% CI, 1.00–2.24) for MDR tuberculosis vs drug-susceptible tuberculosis. Conclusions. Recent transmission of M. tuberculosis, including MDR strains, contributes substantially to tuberculosis disease in China. Sputum smear–negative cases were responsible for at least 30% of the secondary cases. Interventions to reduce the transmission of M. tuberculosis should be implemented in China. PMID:25829000

  9. Transmission and Institutional Infection Control of Tuberculosis.

    PubMed

    Nardell, Edward A

    2015-08-20

    Tuberculosis (TB) transmission control in institutions is evolving with increased awareness of the rapid impact of treatment on transmission, the importance of the unsuspected, untreated case of transmission, and the advent of rapid molecular diagnostics. With active case finding based on cough surveillance and rapid drug susceptibility testing, in theory, it is possible to be reasonably sure that no patient enters a facility with undiagnosed TB or drug resistance. Droplet nuclei transmission of TB is reviewed with an emphasis on risk factors relevant to control. Among environmental controls, natural ventilation and upper-room ultraviolet germicidal ultraviolet air disinfection are the most cost-effective choices, although high-volume mechanical ventilation can also be used. Room air cleaners are generally not recommended. Maintenance is required for all engineering solutions. Finally, personal protection with fit-tested respirators is used in many situations where administrative and engineering methods cannot assure protection.

  10. A SEIR model for transmission of tuberculosis

    NASA Astrophysics Data System (ADS)

    Side, Syafruddin; Mulbar, Usman; Sidjara, Sahlan; Sanusi, Wahidah

    2017-04-01

    In this paper will be described Tuberculosis (TB) transmission using Susceptible-Exposed-Infected-Recovered (SEIR) model. SEIR model for transmission of TB were analyzed and performed simulations using data on the number of TB cases in South Sulawesi. The results showed that the levels of the basic reproduction ratio R0 using the model of SEIR is R0 ≤ 1, it means that the status of TB disease in South Sulawesi is at a stage that is not alarming, but based on simulation results using MatLab, predicted that the number of infection cases will continue to increase therefore government needs to take preventive measures to control and reduce the number of TB infections in South Sulawesi.

  11. Progression to active tuberculosis, but not transmission, varies by M. tuberculosis lineage in The Gambia

    PubMed Central

    de Jong, Bouke C.; Hill, Philip C.; Aiken, Alex; Awine, Timothy; Antonio, Martin; Adetifa, Ifedayo M.; Jackson-Sillah, Dolly J.; Fox, Annette; DeRiemer, Kathryn; Gagneux, Sebastien; Borgdorff, Martien W.; McAdam, Keith P.W.J.; Corrah, Tumani; Small, Peter M.; Adegbola, Richard A.

    2008-01-01

    Considerable variability exists in the outcome of M. tuberculosis infection. We hypothesized that M. africanum was less likely than M. tuberculosis to transmit and progress to tuberculosis disease. In a cohort study of tuberculosis patients and their household contacts in the Gambia, we categorized 1,808 HIV negative tuberculosis contacts according to exposure to M. tuberculosis or to M. africanum. A positive skin test indicated transmission and development of tuberculosis during 2 years of follow-up indicated progression to disease. Transmission was similar, but progression to disease was significantly lower in contacts exposed to M. africanum than to M. tuberculosis (1.0% vs 2.9%; Hazard Ratio (HR) 3.1, 95% CI 1.1–8.7). Within M. tuberculosis sensu stricto, contacts exposed to a Beijing family strain were most likely to progress to disease (5.6%; HR 6.7 (2.0–22) relative to M. africanum). M. africanum and M. tuberculosis transmit equally well to household contacts, but contacts exposed to M. africanum are less likely to progress to tuberculosis disease than those exposed to M. tuberculosis. The variable rate of progression by lineage suggests that TB variability matters in clinical settings and should be taken into account in studies evaluating tuberculosis vaccines and treatment regimens for latent tuberculosis infection. PMID:18702608

  12. Tuberculosis in a South African prison - a transmission modelling analysis.

    PubMed

    Johnstone-Robertson, Simon; Lawn, Stephen D; Welte, Alex; Bekker, Linda-Gail; Wood, Robin

    2011-11-01

    Prisons are recognised internationally as institutions with very high tuberculosis (TB) burdens where transmission is predominantly determined by contact between infectious and susceptible prisoners. A recent South African court case described the conditions under which prisoners awaiting trial were kept. With the use of these data, a mathematical model was developed to explore the interactions between incarceration conditions and TB control measures. Cell dimensions, cell occupancy, lock-up time, TB incidence and treatment delays were derived from court evidence and judicial reports. Using the Wells-Riley equation and probability analyses of contact between prisoners, we estimated the current TB transmission probability within prison cells, and estimated transmission probabilities of improved levels of case finding in combination with implementation of national and international minimum standards for incarceration. Levels of overcrowding (230%) in communal cells and poor TB case finding result in annual TB transmission risks of 90% per annum. Implementing current national or international cell occupancy recommendations would reduce TB transmission probabilities by 30% and 50%, respectively. Improved passive case finding, modest ventilation increase or decreased lock-up time would minimally impact on transmission if introduced individually. However, active case finding together with implementation of minimum national and international standards of incarceration could reduce transmission by 50% and 94%, respectively. Current conditions of detention for awaiting-trial prisoners are highly conducive for spread of drug-sensitive and drug-resistant TB. Combinations of simple well-established scientific control measures should be implemented urgently.

  13. Genotypic and Spatial Analysis of Mycobacterium tuberculosis Transmission in a High-Incidence Urban Setting

    PubMed Central

    Ribeiro, Fabíola Karla Correa; Pan, William; Bertolde, Adelmo; Vinhas, Solange Alves; Peres, Renata Lyrio; Riley, Lee; Palaci, Moisés; Maciel, Ethel Leonor

    2015-01-01

    Background. Genotyping Mycobacterium tuberculosis isolates allows study of dynamics of tuberculosis transmission, while geoprocessing allows spatial analysis of clinical and epidemiological data. Here, genotyping data and spatial analysis were combined to characterize tuberculosis transmission in Vitória, Brazil, to identify distinct neighborhoods and risk factors associated with recent tuberculosis transmission. Methods. From 2003 to 2007, 503 isolates were genotyped by IS6110 restriction fragment length polymorphism (RFLP) and spoligotyping. The analysis included kernel density estimation, K-function analysis, and a t test distance analysis. Mycobacterium tuberculosis isolates belonging to identical RFLP patterns (clusters) were considered to represent recent tuberculosis infection (cases). Results. Of 503 genotyped isolates, 242 (48%) were categorized into 70 distinct clusters belonging to 12 RFLP families. The proportion of recent transmission was 34.2%. Kernel density maps indicated 3 areas of intense concentration of cases. K-function analysis of the largest RFLP clusters and families showed they co-localized in space. The distance analysis confirmed these results and demonstrated that unique strain patterns (controls) randomly distributed in space. A logit model identified young age, positive smear test, and lower Index of Quality of Urban Municipality as risk factors for recent transmission. The predicted probabilities for each neighborhood were mapped and identified neighborhoods with high risk for recent transmission. Conclusions. Spatial and genotypic clustering of M. tuberculosis isolates revealed ongoing active transmission of tuberculosis caused by a small subset of strains in specific neighborhoods of the city. Such information provides an opportunity to target tuberculosis transmission control, such as through rigorous and more focused contact investigation programs. PMID:25948063

  14. Genotypic and Spatial Analysis of Mycobacterium tuberculosis Transmission in a High-Incidence Urban Setting.

    PubMed

    Ribeiro, Fabíola Karla Correa; Pan, William; Bertolde, Adelmo; Vinhas, Solange Alves; Peres, Renata Lyrio; Riley, Lee; Palaci, Moisés; Maciel, Ethel Leonor

    2015-09-01

    Genotyping Mycobacterium tuberculosis isolates allows study of dynamics of tuberculosis transmission, while geoprocessing allows spatial analysis of clinical and epidemiological data. Here, genotyping data and spatial analysis were combined to characterize tuberculosis transmission in Vitória, Brazil, to identify distinct neighborhoods and risk factors associated with recent tuberculosis transmission. From 2003 to 2007, 503 isolates were genotyped by IS6110 restriction fragment length polymorphism (RFLP) and spoligotyping. The analysis included kernel density estimation, K-function analysis, and a t test distance analysis. Mycobacterium tuberculosis isolates belonging to identical RFLP patterns (clusters) were considered to represent recent tuberculosis infection (cases). Of 503 genotyped isolates, 242 (48%) were categorized into 70 distinct clusters belonging to 12 RFLP families. The proportion of recent transmission was 34.2%. Kernel density maps indicated 3 areas of intense concentration of cases. K-function analysis of the largest RFLP clusters and families showed they co-localized in space. The distance analysis confirmed these results and demonstrated that unique strain patterns (controls) randomly distributed in space. A logit model identified young age, positive smear test, and lower Index of Quality of Urban Municipality as risk factors for recent transmission. The predicted probabilities for each neighborhood were mapped and identified neighborhoods with high risk for recent transmission. Spatial and genotypic clustering of M. tuberculosis isolates revealed ongoing active transmission of tuberculosis caused by a small subset of strains in specific neighborhoods of the city. Such information provides an opportunity to target tuberculosis transmission control, such as through rigorous and more focused contact investigation programs. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights

  15. Reducing occupational transmission of tuberculosis to health care workers.

    PubMed

    Collins, C M

    1993-10-01

    Tuberculosis infection is an occupational risk for nurses and others working in health care settings. The National Institute of Occupational Safety and Health (NIOSH) and the Centers for Disease Control (CDC) have issued guidelines for preventing transmission of tuberculosis to health care workers. Nurses should be familiar with these guidelines, current recommendations for protection and post-exposure management, and the implications of the resurgence of tuberculosis as an occupational health hazard.

  16. Transforming the Fight Against Tuberculosis: Targeting Catalysts of Transmission

    PubMed Central

    Dowdy, David W.; Azman, Andrew S.; Kendall, Emily A.; Mathema, Barun

    2014-01-01

    The global tuberculosis control community has committed itself to ambitious 10-year targets. To meet these targets, biomedical advances alone will be insufficient; a more targeted public health tuberculosis strategy is also needed. We highlight the role of “tuberculosis transmission catalysts,” defined as variabilities in human behavior, bacillary properties, and host physiology that fuel the propagation of active tuberculosis at the local level. These catalysts can be categorized as factors that increase contact rates, infectiousness, or host susceptibility. Different catalysts predominate in different epidemiological and sociopolitical settings, and public health approaches are likely to succeed only if they are tailored to target the major catalysts driving transmission in the corresponding community. We argue that global tuberculosis policy should move from a country-level focus to a strategy that prioritizes collection of data on key transmission catalysts at the local level followed by deployment of “catalyst-targeted” interventions, supported by strengthened health systems. PMID:24982034

  17. The Effect of HIV-Related Immunosuppression on the Risk of Tuberculosis Transmission to Household Contacts

    PubMed Central

    Huang, Chuan-Chin; Tchetgen, Eric Tchetgen; Becerra, Mercedes C.; Cohen, Ted; Hughes, Katherine C.; Zhang, Zibiao; Calderon, Roger; Yataco, Rosa; Contreras, Carmen; Galea, Jerome; Lecca, Leonid; Murray, Megan

    2014-01-01

    Background. Coinfection with human immunodeficiency virus (HIV) may modify the risk of transmitting tuberculosis. Some previous investigations suggest that patients coinfected with HIV and tuberculosis are less likely to transmit infection, whereas others do not support this conclusion. Here, we estimated the relative risk of tuberculosis transmission from coinfected patients compared to HIV-negative patients with tuberculosis. Methods. Between September 2009 and August 2012, we identified and enrolled 4841 household contacts of 1608 patients with drug-sensitive tuberculosis in Lima, Peru. We assessed the HIV status and CD4 counts of index patients, as well as other risk factors for infection specific to the index patient, the household, and the exposed individuals. Contacts underwent tuberculin skin testing to determine tuberculosis infection status. Results. After adjusting for covariates, we found that household contacts of HIV-infected tuberculosis patients with a CD4 count ≤250 cells/µL were less likely to be infected with tuberculosis (risk ratio = 0.49 [95% confidence interval, .24–.96]) than the contacts of HIV-negative tuberculosis patients. No children younger than 15 years who were exposed to HIV-positive patients with a CD4 count ≤250 cells/µL were infected with tuberculosis, compared to 22% of those exposed to non-HIV-infected patients. There was no significant difference in the risk of infection between contacts of HIV-infected index patients with CD4 counts >250 cells/µL and contacts of index patients who were not HIV-infected. Conclusions. We found a reduced risk of tuberculosis infection among the household contacts of patients with active tuberculosis who had advanced HIV-related immunosuppression, suggesting reduced transmission from these index patients. PMID:24368620

  18. Extensions to Bayesian generalized linear mixed effects models for household tuberculosis transmission.

    PubMed

    McIntosh, Avery I; Doros, Gheorghe; Jones-López, Edward C; Gaeddert, Mary; Jenkins, Helen E; Marques-Rodrigues, Patricia; Ellner, Jerrold J; Dietze, Reynaldo; White, Laura F

    2017-07-20

    Household contact studies, a mainstay of tuberculosis transmission research, often assume that tuberculosis-infected household contacts of an index case were infected within the household. However, strain genotyping has provided evidence against this assumption. Understanding the household versus community infection dynamic is essential for designing interventions. The misattribution of infection sources can also bias household transmission predictor estimates. We present a household-community transmission model that estimates the probability of community infection, that is, the probability that a household contact of an index case was actually infected from a source outside the home and simultaneously estimates transmission predictors. We show through simulation that our method accurately predicts the probability of community infection in several scenarios and that not accounting for community-acquired infection in household contact studies can bias risk factor estimates. Applying the model to data from Vitória, Brazil, produced household risk factor estimates similar to two other standard methods for age and sex. However, our model gave different estimates for sleeping proximity to index case and disease severity score. These results show that estimating both the probability of community infection and household transmission predictors is feasible and that standard tuberculosis transmission models likely underestimate the risk for two important transmission predictors. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  19. Preventing Transmission of Mycobacterium tuberculosis in Health Care Settings.

    PubMed

    Punjabi, Chitra D; Perloff, Sarah R; Zuckerman, Jerry M

    2016-12-01

    Patients with tuberculosis (TB) pose a risk to other patients and health care workers, and outbreaks in health care settings occur when appropriate infection control measures are not used. In this article, we discuss strategies to prevent transmission of Mycobacterium tuberculosis within health care settings. All health care facilities should have an operational TB infection control plan that emphasizes the use of a hierarchy of controls (administrative, environmental, and personal respiratory protection). We also discuss resources available to clinicians who work in the prevention and investigation of nosocomial transmission of M tuberculosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. The impact of new tuberculosis diagnostics on transmission: why context matters

    PubMed Central

    Dowdy, David; Dye, Christopher; Murray, Megan; Cohen, Ted

    2012-01-01

    Abstract Objective To estimate the impact of new tuberculosis diagnostics on tuberculosis transmission given the complex contextual factors that can lead to patient loss before diagnosis or treatment. Methods An epidemic model of tuberculosis specifying discrete steps along the tuberculosis diagnostic pathway was constructed. The model was calibrated to the epidemiology of tuberculosis and human immunodeficiency virus (HIV) infection in the United Republic of Tanzania and was used to assess the impact of a new diagnostic tool with 70% sensitivity for smear-negative pulmonary tuberculosis. The influence of contextual factors on the projected epidemic impact of the new diagnostic tool over the decade following introduction was explored. Findings With the use of smear microscopy, the incidence of tuberculosis will decline by an average of 3.94% per year. If the new tool is added, incidence will decline by an annual 4.25%. This represents an absolute change of 0.31 percentage points (95% confidence interval: 0.04–0.42). However, the annual decline in transmission with use of the new tool is less when existing strategies for the diagnosis of smear-negative cases have high sensitivity and when symptomatic individuals delay in seeking care. Other influential contextual factors include access to tuberculosis care, patient loss before diagnosis, initial patient default after diagnosis and treatment success rate. Conclusion When implementing and scaling up the use of a new diagnostic tool, the operational context in which diagnosis and treatment take place needs to be considered. PMID:23109741

  1. Transmission dynamics and elimination potential of zoonotic tuberculosis in morocco

    PubMed Central

    Justus Bless, Philipp; Crump, Lisa; Lohmann, Petra; Laager, Mirjam; Chitnis, Nakul; Zinsstag, Jakob

    2017-01-01

    Bovine tuberculosis (BTB) is an endemic zoonosis in Morocco caused by Mycobacterium bovis, which infects many domestic animals and is transmitted to humans through consumption of raw milk or from contact with infected animals. The prevalence of BTB in Moroccan cattle is estimated at 18%, and 33% at the individual and the herd level respectively, but the human M. bovis burden needs further clarification. The current control strategy based on test and slaughter should be improved through local context adaptation taking into account a suitable compensation in order to reduce BTB prevalence in Morocco and decrease the disease burden in humans and animals. We established a simple compartmental deterministic mathematical model for BTB transmission in cattle and humans to provide a general understanding of BTB, in particular regarding transmission to humans. Differential equations were used to model the different pathways between the compartments for cattle and humans. Scenarios of test and slaughter were simulated to determine the effects of varying the proportion of tested animals (p) on the time to elimination of BTB (individual animal prevalence of less than one in a thousand) in cattle and humans. The time to freedom from disease ranged from 75 years for p = 20% to 12 years for p = 100%. For p > 60% the time to elimination was less than 20 years. The cumulated cost was largely stable: for p values higher than 40%, cost ranged from 1.47 to 1.60 billion euros with a time frame of 12 to 32 years to reach freedom from disease. The model simulations also suggest that using a 2mm cut off instead of a 4mm cut off in the Single Intradermal Comparative Cervical Tuberculin skin test (SICCT) would result in cheaper and quicker elimination programs. This analysis informs Moroccan bovine tuberculosis control policy regarding time frame, range of cost and levels of intervention. However, further research is needed to clarify the national human-bovine tuberculosis ratio in Morocco

  2. Transmission dynamics and elimination potential of zoonotic tuberculosis in morocco.

    PubMed

    Abakar, Mahamat Fayiz; Yahyaoui Azami, Hind; Justus Bless, Philipp; Crump, Lisa; Lohmann, Petra; Laager, Mirjam; Chitnis, Nakul; Zinsstag, Jakob

    2017-02-01

    Bovine tuberculosis (BTB) is an endemic zoonosis in Morocco caused by Mycobacterium bovis, which infects many domestic animals and is transmitted to humans through consumption of raw milk or from contact with infected animals. The prevalence of BTB in Moroccan cattle is estimated at 18%, and 33% at the individual and the herd level respectively, but the human M. bovis burden needs further clarification. The current control strategy based on test and slaughter should be improved through local context adaptation taking into account a suitable compensation in order to reduce BTB prevalence in Morocco and decrease the disease burden in humans and animals. We established a simple compartmental deterministic mathematical model for BTB transmission in cattle and humans to provide a general understanding of BTB, in particular regarding transmission to humans. Differential equations were used to model the different pathways between the compartments for cattle and humans. Scenarios of test and slaughter were simulated to determine the effects of varying the proportion of tested animals (p) on the time to elimination of BTB (individual animal prevalence of less than one in a thousand) in cattle and humans. The time to freedom from disease ranged from 75 years for p = 20% to 12 years for p = 100%. For p > 60% the time to elimination was less than 20 years. The cumulated cost was largely stable: for p values higher than 40%, cost ranged from 1.47 to 1.60 billion euros with a time frame of 12 to 32 years to reach freedom from disease. The model simulations also suggest that using a 2mm cut off instead of a 4mm cut off in the Single Intradermal Comparative Cervical Tuberculin skin test (SICCT) would result in cheaper and quicker elimination programs. This analysis informs Moroccan bovine tuberculosis control policy regarding time frame, range of cost and levels of intervention. However, further research is needed to clarify the national human-bovine tuberculosis ratio in Morocco.

  3. [Transmission of tuberculosis in the prisons of Madrid].

    PubMed

    Fernández-Martín, J I; Fernández de la Hoz, K; Catalán, S; Alonso Sanz, M; Chavese, F

    2000-09-09

    Prisons are recognized as high-risk settings for tuberculosis transmission. The purpose of this study was to describe the characteristics of prisoners with tuberculosis and to determine the extent of transmission of tuberculosis in the prison population of Madrid. Patients with positive culture for Mycobacterium tuberculosis between 1997 and 1998 from the prison system of Madrid were included. The medical records for these patients were reviewed, and they were also interviewed. Patients were included in clusters when their isolates contained 1) six or more IS6110 bands in an identical pattern or 2) five or fewer IS6110 bands that matched identically and had an identical spoligotyping pattern. Culture-proven tuberculosis was diagnosed in 97 prisoners (case rate: 693 per 100.000 per year). Isolates from 73 (75%) patients were available for fingerprinting. The mean age of these patients was 33 yr (SD: 6,9), 92% were male, and 14% were immigrants. Seventy-one percent (71%) of patients were HIV-positive, 32% were active intravenous drug users and 70% nonintravenous drug users in the last two years. Primary drug resistance to isoniazid was 1,8%. Forty-one percent of prisoners (41%) were grouped in 9 clusters. Epidemiological links were found in 37% of clustered patients. Risk factors for clustering were not detected. The results suggest recent transmission of tuberculosis in the prisons of Madrid. It is essential that correctional facilities comply fully with the recomendations for prevention and control of tuberculosis.

  4. Transmission of Extensively Drug-Resistant Tuberculosis in South Africa.

    PubMed

    Shah, N Sarita; Auld, Sara C; Brust, James C M; Mathema, Barun; Ismail, Nazir; Moodley, Pravi; Mlisana, Koleka; Allana, Salim; Campbell, Angela; Mthiyane, Thuli; Morris, Natashia; Mpangase, Primrose; van der Meulen, Hermina; Omar, Shaheed V; Brown, Tyler S; Narechania, Apurva; Shaskina, Elena; Kapwata, Thandi; Kreiswirth, Barry; Gandhi, Neel R

    2017-01-19

    Drug-resistant tuberculosis threatens recent gains in the treatment of tuberculosis and human immunodeficiency virus (HIV) infection worldwide. A widespread epidemic of extensively drug-resistant (XDR) tuberculosis is occurring in South Africa, where cases have increased substantially since 2002. The factors driving this rapid increase have not been fully elucidated, but such knowledge is needed to guide public health interventions. We conducted a prospective study involving 404 participants in KwaZulu-Natal Province, South Africa, with a diagnosis of XDR tuberculosis between 2011 and 2014. Interviews and medical-record reviews were used to elicit information on the participants' history of tuberculosis and HIV infection, hospitalizations, and social networks. Mycobacterium tuberculosis isolates underwent insertion sequence (IS)6110 restriction-fragment-length polymorphism analysis, targeted gene sequencing, and whole-genome sequencing. We used clinical and genotypic case definitions to calculate the proportion of cases of XDR tuberculosis that were due to inadequate treatment of multidrug-resistant (MDR) tuberculosis (i.e., acquired resistance) versus those that were due to transmission (i.e., transmitted resistance). We used social-network analysis to identify community and hospital locations of transmission. Of the 404 participants, 311 (77%) had HIV infection; the median CD4+ count was 340 cells per cubic millimeter (interquartile range, 117 to 431). A total of 280 participants (69%) had never received treatment for MDR tuberculosis. Genotypic analysis in 386 participants revealed that 323 (84%) belonged to 1 of 31 clusters. Clusters ranged from 2 to 14 participants, except for 1 large cluster of 212 participants (55%) with a LAM4/KZN strain. Person-to-person or hospital-based epidemiologic links were identified in 123 of 404 participants (30%). The majority of cases of XDR tuberculosis in KwaZulu-Natal, South Africa, an area with a high tuberculosis burden

  5. Transmission of Extensively Drug-Resistant Tuberculosis in South Africa

    PubMed Central

    Shah, N. Sarita; Auld, Sara C.; Brust, James C.M.; Mathema, Barun; Ismail, Nazir; Moodley, Pravi; Mlisana, Koleka; Allana, Salim; Campbell, Angela; Mthiyane, Thuli; Morris, Natashia; Mpangase, Primrose; van der Meulen, Hermina; Omar, Shaheed V.; Brown, Tyler S.; Narechania, Apurva; Shaskina, Elena; Kapwata, Thandi; Kreiswirth, Barry; Gandhi, Neel R.

    2017-01-01

    BACKGROUND Drug-resistant tuberculosis threatens recent gains in the treatment of tuberculosis and human immunodeficiency virus (HIV) infection worldwide. A widespread epidemic of extensively drug-resistant (XDR) tuberculosis is occurring in South Africa, where cases have increased substantially since 2002. The factors driving this rapid increase have not been fully elucidated, but such knowledge is needed to guide public health interventions. METHODS We conducted a prospective study involving 404 participants in KwaZulu-Natal Province, South Africa, with a diagnosis of XDR tuberculosis between 2011 and 2014. Interviews and medical-record reviews were used to elicit information on the participants’ history of tuberculosis and HIV infection, hospitalizations, and social networks. Mycobacterium tuberculosis isolates underwent insertion sequence (IS)6110 restriction-fragment– length polymorphism analysis, targeted gene sequencing, and whole-genome sequencing. We used clinical and genotypic case definitions to calculate the proportion of cases of XDR tuberculosis that were due to inadequate treatment of multidrug-resistant (MDR) tuberculosis (i.e., acquired resistance) versus those that were due to transmission (i.e., transmitted resistance). We used social-network analysis to identify community and hospital locations of transmission. RESULTS Of the 404 participants, 311 (77%) had HIV infection; the median CD4+ count was 340 cells per cubic millimeter (interquartile range, 117 to 431). A total of 280 participants (69%) had never received treatment for MDR tuberculosis. Genotypic analysis in 386 participants revealed that 323 (84%) belonged to 1 of 31 clusters. Clusters ranged from 2 to 14 participants, except for 1 large cluster of 212 participants (55%) with a LAM4/KZN strain. Person-to-person or hospital-based epidemiologic links were identified in 123 of 404 participants (30%). CONCLUSIONS The majority of cases of XDR tuberculosis in KwaZulu-Natal, South Africa

  6. Interventions to reduce tuberculosis mortality and transmission in low- and middle-income countries.

    PubMed Central

    Borgdorff, Martien W.; Floyd, Katherine; Broekmans, Jaap F.

    2002-01-01

    Tuberculosis is among the top ten causes of global mortality and affects low-income countries in particular. This paper examines, through a literature review, the impact of tuberculosis control measures on tuberculosis mortality and transmission, and constraints to scaling-up. It also provides estimates of the effectiveness of various interventions using a model proposed by Styblo. It concludes that treatment of smear-positive tuberculosis using the WHO directly observed treatment, short-course (DOTS) strategy has by far the highest impact. While BCG immunization reduces childhood tuberculosis mortality, its impact on tuberculosis transmission is probably minimal. Under specific conditions, an additional impact on mortality and transmission can be expected through treatment of smear-negative cases, intensification of case-finding for smear-positive tuberculosis, and preventive therapy among individuals with dual tuberculosis-HIV infection. Of these interventions, DOTS is the most cost-effective at around US$ 5-40 per disability-adjusted life year (DALY) gained. The cost for BCG immunization is likely to be under US$ 50 per DALY gained. Treatment of smear-negative patients has a cost per DALY gained of up to US$ 100 in low-income countries, and up to US$ 400 in middle-income settings. Other interventions, such as preventive therapy for HIV-positive individuals, appear to be less cost-effective. The major constraint to scaling up DOTS is lack of political commitment, resulting in shortages of funding and human resources for tuberculosis control. However, in recent years there have been encouraging signs of increasing political commitment. Other constraints are related to involvement of the private sector, health sector reform, management capacity of tuberculosis programmes, treatment delivery, and drug supply. Global tuberculosis control could benefit strongly from technical innovation, including the development of a vaccine giving good protection against smear

  7. Measuring ventilation and modelling M. tuberculosis transmission in indoor congregate settings, rural KwaZulu-Natal

    PubMed Central

    Yates, T. A.; Mthethwa, M.; Tanser, F.; Abubakar, I.; Altamirano, H.

    2016-01-01

    SUMMARY SETTING: Molecular epidemiology suggests that most Mycobacterium tuberculosis transmission in high-burden settings occurs outside the home. OBJECTIVE: To estimate the risk of M. tuberculosis transmission inside public buildings in a high TB burden community in KwaZulu-Natal, South Africa. DESIGN: Carbon dioxide (CO2) sensors were placed inside eight public buildings. Measurements were used with observations of occupancy to estimate infection risk using an adaptation of the Wells-Riley equation. Ventilation modelling using CONTAM was used to examine the impact of low-cost retrofits on transmission in a health clinic. RESULTS: Measurements indicate that infection risk in the church, classroom and clinic waiting room would be high with typical ventilation, occupancy levels and visit durations. For example, we estimated that health care workers in a clinic waiting room had a 16.9–24.5% annual risk of M. tuberculosis infection. Modelling results indicate that the simple addition of two new windows allowing for cross-ventilation, at a cost of US$330, would reduce the annual risk to health care workers by 57%. CONCLUSIONS: Results indicate that public buildings in this community have a range of ventilation and occupancy characteristics that may influence transmission risks. Simple retrofits may result in dramatic reductions in M. tuberculosis transmission, and intervention studies should therefore be considered. PMID:27510239

  8. Elephant-to-Human Transmission of Tuberculosis, 2009

    PubMed Central

    Warkentin, Jon V.; Dunn, John R.; Schaffner, William; Jones, Timothy F.

    2011-01-01

    In 2009, the Tennessee Department of Health received reports of 5 tuberculin skin test (TST) conversions among employees of an elephant refuge and isolation of Mycobacterium tuberculosis from a resident elephant. To determine the extent of the outbreak and identify risk factors for TST conversion, we conducted a cohort study and onsite assessment. Risk for conversion was increased for elephant caregivers and administrative employees working in the barn housing the M. tuberculosis–infected elephant or in offices connected to the barn (risk ratio 20.3, 95% confidence interval 2.8–146.7). Indirect exposure to aerosolized M. tuberculosis and delayed or inadequate infection control practices likely contributed to transmission. The following factors are needed to reduce risk for M. tuberculosis transmission in the captive elephant industry: increased knowledge about M. tuberculosis infection in elephants, improved infection control practices, and specific occupational health programs. PMID:21392425

  9. Tuberculosis part 4: Control of Mycobacterium tuberculosis transmission in dental care facilities.

    PubMed

    Feller, L; Wood, N H; Chikte, U M E; Khammissa, R A G; Meyerov, R; Lemmer, J

    2009-10-01

    The risk of transmission of Mycobacterium tuberculosis (Mtb) in oral healthcare facilities is probably low, but the consequences if it occurs, are grave. The greatest risk of exposure to Mtb transmission is associated with treating dental patients from communities with a high prevalence of tuberculosis (TB) and HIV disease because these patients may have active TB but be unaware of their status. The risk of Mtb transmission in the dental surgery is heightened by dental treatment with ultrasonic and air operated high speed instruments that generate aerosols. This article offers recommendations for the necessary components of an effective Mtb infection control programme.

  10. Interpreting measures of tuberculosis transmission: a case study on the Portuguese population

    PubMed Central

    2014-01-01

    Background Tuberculosis remains a high burden for Human society despite considerable investments in its control. Unique features in the history of infection and transmission dynamics of tuberculosis pose serious limitations on the direct interpretation of surveillance data and call for models that incorporate latent processes and simulate specific interventions. Methods A transmission model was adjusted to the dataset of active tuberculosis cases reported in Portugal between 2002 and 2009. We estimated key transmission parameters from the data (i.e. time to diagnosis, treatment length, default proportion, proportion of pulmonary TB cases). Using the adjusted model to the Portuguese case, we estimated the total burden of tuberculosis in Portugal. We further performed sensitivity analysis to heterogeneities in susceptibility to infection and exposure intensity. Results We calculated a mean time to diagnose of 2.81 months and treatment length of 8.80 months in Portugal. The proportion defaulting treatment was calculated as 0.04 and the proportion of pulmonary cases as 0.75. Using these values, we estimated a TB burden of 1.6 million infected persons, corresponding to more than 15% of the Portuguese population. We further described the sensitivity of these estimates to heterogeneity. Conclusions We showed that the model reproduces well the observed dynamics of the Portuguese data, thus demonstrating its adequacy for devising control strategies for TB and predicting the effects of interventions. PMID:24941996

  11. [Tuberculosis transmission in the triple border region: Brazil, Paraguay, and Argentina].

    PubMed

    Braga, José Ueleres; Herrero, Maria Belén; Cuellar, Célia Martinez de

    2011-07-01

    Tuberculosis is a public health problem in South America, but numerous control strategies have proven ineffective in settings with intense transmission. This study aimed to determine whether the triple border region between Brazil, Argentina, and Paraguay is an area of high tuberculosis transmission. An ecological study was conducted with incidence data and population estimates for the three countries. Mean incidence rates were calculated for 2001 to 2007. Spatial analysis techniques identified high-incidence areas in the region using maps with Bayesian smoothing of rates and spatial averages. During the target period, Foz do Iguaçu, Brazil, had the highest incidence, followed by Ciudad del Este in Paraguay, and Puerto Iguazú in Argentina. The analysis showed a spatial cluster of municipalities with high tuberculosis risk in the triple border region. Tuberculosis in the tri-border area shows increasing or stable incidence rates and municipalities with incidence rates above the State average. The area has high tuberculosis incidence and therefore heavy transmission of the disease.

  12. Transmission of Tuberculosis in a South African Community With a High Prevalence of HIV Infection

    PubMed Central

    Middelkoop, Keren; Mathema, Barun; Myer, Landon; Shashkina, Elena; Whitelaw, Andrew; Kaplan, Gilla; Kreiswirth, Barry; Wood, Robin; Bekker, Linda-Gail

    2015-01-01

    Background. In settings of high tuberculosis transmission, little is known of the interaction between human immunodeficiency virus (HIV) positive and HIV-negative tuberculosis disease and of the impact of antiretroviral treatment (ART) programs on tuberculosis transmission dynamics. Methods. Mycobacterium tuberculosis isolates were collected from patients with tuberculosis who resided in a South African township with a high burden of tuberculosis and HIV infection. Demographic and clinical data were extracted from clinic records. Isolates underwent IS6110-based restriction fragment length polymorphism analysis. Patients with unique (nonclustered) M. tuberculosis genotypes and cluster index cases (ie, the first tuberculosis case in a cluster) were defined as having tuberculosis due to reactivation of latent M. tuberculosis infection. Secondary cases in clusters were defined as having tuberculosis due to recent M. tuberculosis infection. Results. Overall, 311 M. tuberculosis genotypes were identified among 718 isolates from 710 patients; 224 (31%) isolates were unique strains, and 478 (67%) occurred in 87 clusters. Cluster index cases were significantly more likely than other tuberculosis cases to be HIV negative. HIV-positive patients were more likely to be secondary cases (P = .001), including patients receiving ART (P = .004). Only 8% of cases of adult-adult transmission of tuberculosis occurred on shared residential plots. Conclusions. Recent infection accounted for the majority of tuberculosis cases, particularly among HIV-positive patients, including patients receiving ART. HIV-negative patients may be disproportionally responsible for ongoing transmission. PMID:25053739

  13. Distribution and transmission of Mycobacterium tuberculosis complex lineages among children in peri-urban Kampala, Uganda.

    PubMed

    Wampande, Eddie M; Mupere, Ezekiel; Jaganath, Devan; Nsereko, Mary; Mayanja, Harriet K; Eisenach, Kathleen; Boom, W Henry; Gagneux, Sebastien; Joloba, Moses L

    2015-09-30

    To gain insight into the transmission of tuberculosis (TB) in peri-urban Kampala-Uganda, we performed a household contact study using children as a surrogate for recent transmission of Mycobacterium tuberculosis (MTB). Using this approach, we sought to understand M. tuberculosis complex (MTBC) lineage diversity, distribution and how these relate to TB transmission to exposed children. MTBC isolates from children aged ≤ 15 years, collected from 2002 to 2010 in a household-contact study, were analyzed using a LightCycler RT-PCR SNP genotyping assay (LRPS). The resultant genotypic data was used to determine associations between MTBC lineage and the children's clinical and epidemiological characteristics. Of the 761 children surveyed, 9% (69/761) had culture-positive TB an estimate in the range of global childhood TB; of these 71% (49/69) were infected with an MTBC strain of the "Uganda family", 17% (12/69) infected with MTBC lineage 4 strains other than MTBC Uganda family and 12% (8/69) infected with MTBC lineage 3, thereby disproportionately causing TB in the study area. Overall the data showed no correlation between the MTBC lineages studied and transmission (OR = 0.304; P-value = 0.251; CI: 95%; 0.039-2.326) using children a proxy for TB transmission. Our findings indicate that MTBC Uganda family strains are the main cause of TB in children in peri-urban Kampala. Furthermore, MTBC lineages did not differ in their transmissibility to children.

  14. The burden of transmitted multi-drug resistance among epidemics of tuberculosis: A transmission model

    PubMed Central

    Kendall, Emily A.; Fofana, Mariam O.; Dowdy, David W.

    2015-01-01

    Background Multidrug-resistant tuberculosis (MDR-TB) can be acquired through de novo mutation during TB treatment or through transmission from other individuals with active MDR-TB. Understanding the balance between these two mechanisms is essential when allocating resources for MDR-TB. Methods We constructed a dynamic transmission model of an MDR-TB epidemic, allowing for both treatment-related acquisition and person-to-person transmission of resistance. We used national TB notification data to inform Bayesian estimates of the fraction of each country’s 2013 MDR-TB incidence that resulted from MDR transmission rather than treatment-related MDR acquisition. Findings Global estimates of 3·5% MDR-TB prevalence among new TB notifications and 20·5% among retreatment notifications translate into an estimate that resistance transmission rather than acquisition accounts for a median 96% (95% UR: 68–100%) of all incident MDR-TB, and 61% (16–95%) of incident MDR-TB in previously-treated individuals. The estimated percentage of MDR-TB resulting from transmission varied substantially with different countries’ notification data; for example, we estimated this percentage at 48% (30–75%) of MDR-TB in Bangladesh, versus 99% (91–100%) in Uzbekistan. Estimates were most sensitive to estimates of the transmissibility of MDR strains, the probability of acquiring MDR during tuberculosis treatment, and the responsiveness of MDR TB to first-line treatment. Interpretation Notifications of MDR prevalence from most high-burden settings are most consistent with the vast majority of incident MDR-TB resulting from transmission rather than new treatment-related acquisition of resistance. Merely improving the treatment of drug-susceptible TB is unlikely to greatly reduce future MDR-TB incidence. Improved diagnosis and treatment of MDR-TB – including new tests and drug regimens – should be highly prioritized. PMID:26597127

  15. Modeling the Role of Public Transportation in Sustaining Tuberculosis Transmission in South Africa

    PubMed Central

    Andrews, Jason R.; Morrow, Carl; Wood, Robin

    2013-01-01

    Current tuberculosis notification rates in South Africa are among the highest ever recorded. Although the human immunodeficiency virus epidemic has been a critical factor, the density of respiratory contacts in high-risk environments may be an important and underappreciated driver. Using a modified Wells-Riley model for airborne disease transmission, we estimated the risk of tuberculosis transmission on 3 modes of public transit (minibus taxis, buses, and trains) in Cape Town, South Africa, using exhaled carbon dioxide as a natural tracer gas to evaluate air exchange. Carbon dioxide measurements were performed between October and December of 2011. Environmental risk, reflected in the rebreathed fraction of air, was highest in minibus taxis and lowest in trains; however, the average number of passengers sharing an indoor space was highest in trains and lowest in minibus taxis. Among daily commuters, the annual risk of tuberculosis infection was projected to be 3.5%–5.0% and was highest among minibus taxi commuters. Assuming a duration of infectiousness of 1 year, the basic reproductive number attributable to transportation was more than 1 in all 3 modes of transportation. Given its poor ventilation and high respiratory contact rates, public transportation may play a critical role in sustaining tuberculosis transmission in South African cities. PMID:23423215

  16. Modeling the role of public transportation in sustaining tuberculosis transmission in South Africa.

    PubMed

    Andrews, Jason R; Morrow, Carl; Wood, Robin

    2013-03-15

    Current tuberculosis notification rates in South Africa are among the highest ever recorded. Although the human immunodeficiency virus epidemic has been a critical factor, the density of respiratory contacts in high-risk environments may be an important and underappreciated driver. Using a modified Wells-Riley model for airborne disease transmission, we estimated the risk of tuberculosis transmission on 3 modes of public transit (minibus taxis, buses, and trains) in Cape Town, South Africa, using exhaled carbon dioxide as a natural tracer gas to evaluate air exchange. Carbon dioxide measurements were performed between October and December of 2011. Environmental risk, reflected in the rebreathed fraction of air, was highest in minibus taxis and lowest in trains; however, the average number of passengers sharing an indoor space was highest in trains and lowest in minibus taxis. Among daily commuters, the annual risk of tuberculosis infection was projected to be 3.5%-5.0% and was highest among minibus taxi commuters. Assuming a duration of infectiousness of 1 year, the basic reproductive number attributable to transportation was more than 1 in all 3 modes of transportation. Given its poor ventilation and high respiratory contact rates, public transportation may play a critical role in sustaining tuberculosis transmission in South African cities.

  17. Improving the estimation of the tuberculosis burden in India

    PubMed Central

    Cowling, Krycia; Dandona, Rakhi

    2014-01-01

    Abstract Although India is considered to be the country with the greatest tuberculosis burden, estimates of the disease’s incidence, prevalence and mortality in India rely on sparse data with substantial uncertainty. The relevant available data are less reliable than those from countries that have recently improved systems for case reporting or recently invested in national surveys of tuberculosis prevalence. We explored ways to improve the estimation of the tuberculosis burden in India. We focused on case notification data – among the most reliable data available – and ways to investigate the associated level of underreporting, as well as the need for a national tuberculosis prevalence survey. We discuss several recent developments – i.e. changes in national policies relating to tuberculosis, World Health Organization guidelines for the investigation of the disease, and a rapid diagnostic test – that should improve data collection for the estimation of the tuberculosis burden in India and elsewhere. We recommend the implementation of an inventory study in India to assess the underreporting of tuberculosis cases, as well as a national survey of tuberculosis prevalence. A national assessment of drug resistance in Indian strains of Mycobacterium tuberculosis should also be considered. The results of such studies will be vital for the accurate monitoring of tuberculosis control efforts in India and globally. PMID:25378743

  18. Improving the estimation of the tuberculosis burden in India.

    PubMed

    Cowling, Krycia; Dandona, Rakhi; Dandona, Lalit

    2014-11-01

    Although India is considered to be the country with the greatest tuberculosis burden, estimates of the disease's incidence, prevalence and mortality in India rely on sparse data with substantial uncertainty. The relevant available data are less reliable than those from countries that have recently improved systems for case reporting or recently invested in national surveys of tuberculosis prevalence. We explored ways to improve the estimation of the tuberculosis burden in India. We focused on case notification data - among the most reliable data available - and ways to investigate the associated level of underreporting, as well as the need for a national tuberculosis prevalence survey. We discuss several recent developments - i.e. changes in national policies relating to tuberculosis, World Health Organization guidelines for the investigation of the disease, and a rapid diagnostic test - that should improve data collection for the estimation of the tuberculosis burden in India and elsewhere. We recommend the implementation of an inventory study in India to assess the underreporting of tuberculosis cases, as well as a national survey of tuberculosis prevalence. A national assessment of drug resistance in Indian strains of Mycobacterium tuberculosis should also be considered. The results of such studies will be vital for the accurate monitoring of tuberculosis control efforts in India and globally.

  19. Tuberculosis in Cape Town: an age-structured transmission model

    PubMed Central

    Blaser, Nello; Zahnd, Cindy; Hermans, Sabine; Salazar-Vizcaya, Luisa; Estill, Janne; Morrow, Carl; Egger, Matthias; Keiser, Olivia; Wood, Robin

    2015-01-01

    Background Tuberculosis (TB) is the leading cause of death in South Africa. The burden of disease varies by age, with peaks in TB notification rates in the HIV-negative population at ages 0-5, 20-24 and 45-49 years. There is little variation between age groups in the rates in the HIV-positive population. The drivers of this age pattern remain unknown. Methods We developed an age-structured simulation model of Mycobacterium tuberculosis (Mtb) transmission in Cape Town, South Africa. We considered five states of TB progression: susceptible, infected (latent TB), active TB, treated TB and treatment default. Latently infected individuals could be re-infected; a previous Mtb infection slowed progression to active disease. We further considered three states of HIV progression: HIV negative, HIV positive, on antiretroviral therapy. To parameterize the model, we analysed treatment outcomes from the Cape Town electronic TB register, social mixing patterns from a Cape Town community and literature estimates for other parameters. To investigate the main drivers behind the age patterns, we conducted sensitivity analyses on all parameters related to the age structure. Results The model replicated the age patterns in HIV-negative TB notification rates of Cape Town in 2009. Simulated TB notification rate in HIV-negative patients was 1,000/100,000 person-years (pyrs) in children aged < 5 years and decreased to 51/100,000 in children 5-15 years. The peak in early adulthood occurred at 25-29 years (463/100,000 pyrs). After a subsequent decline, simulated TB notification rates gradually increased from the age of 30 years. Sensitivity analyses showed that the dip after the early adult peak was due to the protective effect of latent TB and that retreatment TB was mainly responsible for the rise in TB notification rates from the age of 30 years. Conclusion The protective effect of a first latent infection on subsequent infections and the faster progression in previously treated patients

  20. Tuberculosis in Cape Town: An age-structured transmission model.

    PubMed

    Blaser, Nello; Zahnd, Cindy; Hermans, Sabine; Salazar-Vizcaya, Luisa; Estill, Janne; Morrow, Carl; Egger, Matthias; Keiser, Olivia; Wood, Robin

    2016-03-01

    Tuberculosis (TB) is the leading cause of death in South Africa. The burden of disease varies by age, with peaks in TB notification rates in the HIV-negative population at ages 0-5, 20-24, and 45-49 years. There is little variation between age groups in the rates in the HIV-positive population. The drivers of this age pattern remain unknown. We developed an age-structured simulation model of Mycobacterium tuberculosis (Mtb) transmission in Cape Town, South Africa. We considered five states of TB progression: susceptible, infected (latent TB), active TB, treated TB, and treatment default. Latently infected individuals could be re-infected; a previous Mtb infection slowed progression to active disease. We further considered three states of HIV progression: HIV negative, HIV positive, on antiretroviral therapy. To parameterize the model, we analysed treatment outcomes from the Cape Town electronic TB register, social mixing patterns from a Cape Town community and used literature estimates for other parameters. To investigate the main drivers behind the age patterns, we conducted sensitivity analyses on all parameters related to the age structure. The model replicated the age patterns in HIV-negative TB notification rates of Cape Town in 2009. Simulated TB notification rate in HIV-negative patients was 1000/100,000 person-years (pyrs) in children aged <5 years and decreased to 51/100,000 in children 5-15 years. The peak in early adulthood occurred at 25-29 years (463/100,000 pyrs). After a subsequent decline, simulated TB notification rates gradually increased from the age of 30 years. Sensitivity analyses showed that the dip after the early adult peak was due to the protective effect of latent TB and that retreatment TB was mainly responsible for the rise in TB notification rates from the age of 30 years. The protective effect of a first latent infection on subsequent infections and the faster progression in previously treated patients are the key determinants of the

  1. Transmission of Multidrug-Resistant and Drug-Susceptible Tuberculosis within Households: A Prospective Cohort Study.

    PubMed

    Grandjean, Louis; Gilman, Robert H; Martin, Laura; Soto, Esther; Castro, Beatriz; Lopez, Sonia; Coronel, Jorge; Castillo, Edith; Alarcon, Valentina; Lopez, Virginia; San Miguel, Angela; Quispe, Neyda; Asencios, Luis; Dye, Christopher; Moore, David A J

    2015-06-01

    The "fitness" of an infectious pathogen is defined as the ability of the pathogen to survive, reproduce, be transmitted, and cause disease. The fitness of multidrug-resistant tuberculosis (MDRTB) relative to drug-susceptible tuberculosis is cited as one of the most important determinants of MDRTB spread and epidemic size. To estimate the relative fitness of drug-resistant tuberculosis cases, we compared the incidence of tuberculosis disease among the household contacts of MDRTB index patients to that among the contacts of drug-susceptible index patients. This 3-y (2010-2013) prospective cohort household follow-up study in South Lima and Callao, Peru, measured the incidence of tuberculosis disease among 1,055 household contacts of 213 MDRTB index cases and 2,362 household contacts of 487 drug-susceptible index cases. A total of 35/1,055 (3.3%) household contacts of 213 MDRTB index cases developed tuberculosis disease, while 114/2,362 (4.8%) household contacts of 487 drug-susceptible index patients developed tuberculosis disease. The total follow-up time for drug-susceptible tuberculosis contacts was 2,620 person-years, while the total follow-up time for MDRTB contacts was 1,425 person-years. Using multivariate Cox regression to adjust for confounding variables including contact HIV status, contact age, socio-economic status, and index case sputum smear grade, the hazard ratio for tuberculosis disease among MDRTB household contacts was found to be half that for drug-susceptible contacts (hazard ratio 0.56, 95% CI 0.34-0.90, p = 0.017). The inference of transmission in this study was limited by the lack of genotyping data for household contacts. Capturing incident disease only among household contacts may also limit the extrapolation of these findings to the community setting. The low relative fitness of MDRTB estimated by this study improves the chances of controlling drug-resistant tuberculosis. However, fitter multidrug-resistant strains that emerge over time may

  2. Transmission of Multidrug-Resistant and Drug-Susceptible Tuberculosis within Households: A Prospective Cohort Study

    PubMed Central

    Grandjean, Louis; Gilman, Robert H.; Martin, Laura; Soto, Esther; Castro, Beatriz; Lopez, Sonia; Coronel, Jorge; Castillo, Edith; Alarcon, Valentina; Lopez, Virginia; San Miguel, Angela; Quispe, Neyda; Asencios, Luis; Dye, Christopher; Moore, David A. J.

    2015-01-01

    Background The “fitness” of an infectious pathogen is defined as the ability of the pathogen to survive, reproduce, be transmitted, and cause disease. The fitness of multidrug-resistant tuberculosis (MDRTB) relative to drug-susceptible tuberculosis is cited as one of the most important determinants of MDRTB spread and epidemic size. To estimate the relative fitness of drug-resistant tuberculosis cases, we compared the incidence of tuberculosis disease among the household contacts of MDRTB index patients to that among the contacts of drug-susceptible index patients. Methods and Findings This 3-y (2010–2013) prospective cohort household follow-up study in South Lima and Callao, Peru, measured the incidence of tuberculosis disease among 1,055 household contacts of 213 MDRTB index cases and 2,362 household contacts of 487 drug-susceptible index cases. A total of 35/1,055 (3.3%) household contacts of 213 MDRTB index cases developed tuberculosis disease, while 114/2,362 (4.8%) household contacts of 487 drug-susceptible index patients developed tuberculosis disease. The total follow-up time for drug-susceptible tuberculosis contacts was 2,620 person-years, while the total follow-up time for MDRTB contacts was 1,425 person-years. Using multivariate Cox regression to adjust for confounding variables including contact HIV status, contact age, socio-economic status, and index case sputum smear grade, the hazard ratio for tuberculosis disease among MDRTB household contacts was found to be half that for drug-susceptible contacts (hazard ratio 0.56, 95% CI 0.34–0.90, p = 0.017). The inference of transmission in this study was limited by the lack of genotyping data for household contacts. Capturing incident disease only among household contacts may also limit the extrapolation of these findings to the community setting. Conclusions The low relative fitness of MDRTB estimated by this study improves the chances of controlling drug-resistant tuberculosis. However, fitter

  3. Phylogenetic assignment of Mycobacterium tuberculosis Beijing clinical isolates in Japan by maximum a posteriori estimation.

    PubMed

    Seto, Junji; Wada, Takayuki; Iwamoto, Tomotada; Tamaru, Aki; Maeda, Shinji; Yamamoto, Kaori; Hase, Atsushi; Murakami, Koichi; Maeda, Eriko; Oishi, Akira; Migita, Yuji; Yamamoto, Taro; Ahiko, Tadayuki

    2015-10-01

    Intra-species phylogeny of Mycobacterium tuberculosis has been regarded as a clue to estimate its potential risk to develop drug-resistance and various epidemiological tendencies. Genotypic characterization of variable number of tandem repeats (VNTR), a standard tool to ascertain transmission routes, has been improving as a public health effort, but determining phylogenetic information from those efforts alone is difficult. We present a platform based on maximum a posteriori (MAP) estimation to estimate phylogenetic information for M. tuberculosis clinical isolates from individual profiles of VNTR types. This study used 1245 M. tuberculosis clinical isolates obtained throughout Japan for construction of an MAP estimation formula. Two MAP estimation formulae, classification of Beijing family and other lineages, and classification of five Beijing sublineages (ST11/26, STK, ST3, and ST25/19 belonging to the ancient Beijing subfamily and modern Beijing subfamily), were created based on 24 loci VNTR (24Beijing-VNTR) profiles and phylogenetic information of the isolates. Recursive estimation based on the formulae showed high concordance with their authentic phylogeny by multi-locus sequence typing (MLST) of the isolates. The formulae might further support phylogenetic estimation of the Beijing lineage M. tuberculosis from the VNTR genotype with various geographic backgrounds. These results suggest that MAP estimation can function as a reliable probabilistic process to append phylogenetic information to VNTR genotypes of M. tuberculosis independently, which might improve the usage of genotyping data for control, understanding, prevention, and treatment of TB.

  4. Evidence of transmission of tuberculosis by DNA fingerprinting.

    PubMed Central

    Godfrey-Faussett, P.; Mortimer, P. R.; Jenkins, P. A.; Stoker, N. G.

    1992-01-01

    OBJECTIVE--To determine whether a subject who had died of tuberculous meningitis had been infected by a neighbour. DESIGN--Retrospective comparison of isolates of Mycobacterium tuberculosis from the two cases and from 10 controls by DNA fingerprinting. SETTING--Public Health Service Reference Laboratory for Mycobacteria and bacterial molecular genetics unit of the London School of Hygiene and Tropical Medicine. SUBJECTS--Deceased and neighbour; 10 controls from the same city, from whom isolates had been collected over three months before the subject's death. MAIN OUTCOME MEASURES--Identity and similarity values (SAB) between fingerprint patterns from different isolates obtained by hybridisation of restriction fragments produced by PvuII with a probe from the insertion element IS6110/986, present in multiple copies throughout the genome of M tuberculosis. RESULTS--Isolates from the two cases under investigation had identical fingerprints whereas those from the controls were all distinct. Two clusters of isolates with a similarity coefficient > 0.25 were identified: in one, four out of five patients were born in the midlands (the birth place of the fifth was not known) and in the other all three patients were born in the Indian subcontinent. CONCLUSIONS--The data are consistent with, but do not prove, transmission of tuberculosis from the neighbour to the deceased. Geographical separation of the pools of infection may have led to the evolution of distinct clusters of fingerprint patterns. DNA fingerprinting of M tuberculosis is a powerful new tool for study of the epidemiology and pathogenesis of tuberculosis. Images FIG 1 PMID:1392824

  5. Malaria transmission rates estimated from serological data.

    PubMed Central

    Burattini, M. N.; Massad, E.; Coutinho, F. A.

    1993-01-01

    A mathematical model was used to estimate malaria transmission rates based on serological data. The model is minimally stochastic and assumes an age-dependent force of infection for malaria. The transmission rates estimated were applied to a simple compartmental model in order to mimic the malaria transmission. The model has shown a good retrieving capacity for serological and parasite prevalence data. PMID:8270011

  6. First case of Mycobacterium tuberculosis transmission by heart transplantation from donor to recipient.

    PubMed

    Weile, Jan; Eickmeyer, Holm; Dreier, Jens; Liebke, Michael; Fuchs, Uwe; Wittke, Johann-Wolfgang; Richter, Elvira; Gummert, Jan; Knabbe, Cornelius; Schulz, Uwe

    2013-12-01

    We report the first documented case of a Mycobacterium tuberculosis transmission by an orthotopic heart transplantation from the donor to the recipient. Mycobacterium tuberculosis positive blood culture showed systemic prevalence of the Mycobacteria, however, prophylactic therapy was able to prevent a clinical manifestation of tuberculosis in the recipient.

  7. Mycobacterium tuberculosis transmission in a country with low tuberculosis incidence: role of immigration and HIV infection.

    PubMed

    Fenner, Lukas; Gagneux, Sebastien; Helbling, Peter; Battegay, Manuel; Rieder, Hans L; Pfyffer, Gaby E; Zwahlen, Marcel; Furrer, Hansjakob; Siegrist, Hans H; Fehr, Jan; Dolina, Marisa; Calmy, Alexandra; Stucki, David; Jaton, Katia; Janssens, Jean-Paul; Stalder, Jesica Mazza; Bodmer, Thomas; Ninet, Beatrice; Böttger, Erik C; Egger, Matthias

    2012-02-01

    Immigrants from high-burden countries and HIV-coinfected individuals are risk groups for tuberculosis (TB) in countries with low TB incidence. Therefore, we studied their role in transmission of Mycobacterium tuberculosis in Switzerland. We included all TB patients from the Swiss HIV Cohort and a sample of patients from the national TB registry. We identified molecular clusters by spoligotyping and mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) analysis and used weighted logistic regression adjusted for age and sex to identify risk factors for clustering, taking sampling proportions into account. In total, we analyzed 520 TB cases diagnosed between 2000 and 2008; 401 were foreign born, and 113 were HIV coinfected. The Euro-American M. tuberculosis lineage dominated throughout the study period (378 strains; 72.7%), with no evidence for another lineage, such as the Beijing genotype, emerging. We identified 35 molecular clusters with 90 patients, indicating recent transmission; 31 clusters involved foreign-born patients, and 15 involved HIV-infected patients. Birth origin was not associated with clustering (adjusted odds ratio [aOR], 1.58; 95% confidence interval [CI], 0.73 to 3.43; P = 0.25, comparing Swiss-born with foreign-born patients), but clustering was reduced in HIV-infected patients (aOR, 0.49; 95% CI, 0.26 to 0.93; P = 0.030). Cavitary disease, male sex, and younger age were all associated with molecular clustering. In conclusion, most TB patients in Switzerland were foreign born, but transmission of M. tuberculosis was not more common among immigrants and was reduced in HIV-infected patients followed up in the national HIV cohort study. Continued access to health services and clinical follow-up will be essential to control TB in this population.

  8. Mathematical Model Of Tuberculosis Transmission With Reccurent Infection And Vaccination

    NASA Astrophysics Data System (ADS)

    Nainggolan, J.; Supian, Sudradjat; Supriatna, A. K.; Anggriani, N.

    2013-04-01

    This paper presents a model of tuberculosis transmission with vaccination by explicitely considering the total number of recovered individuals, either from natural recovery or due to vaccination. In this paper the endemic and nonendemic fixed points, basic reproduction number, and vaccination reproduction number are given. Some results regarding the stability of the fixed points and the relation to the basic reproduction numbers are analysed. At the end of this study, the numerical computation presented and it shows that vaccination is capable to reduce the number of laten and infectious populations.

  9. Identifying multidrug resistant tuberculosis transmission hotspots using routinely collected data12

    PubMed Central

    Manjourides, Justin; Lin, Hsien-Ho; Shin, Sonya; Jeffery, Caroline; Contreras, Carmen; Cruz, Janeth Santa; Jave, Oswaldo; Yagui, Martin; Asencios, Luis; Pagano, Marcello; Cohen, Ted

    2012-01-01

    SUMMARY In most countries with large drug resistant tuberculosis epidemics, only those cases that are at highest risk of having MDRTB receive a drug sensitivity test (DST) at the time of diagnosis. Because of this prioritized testing, identification of MDRTB transmission hotspots in communities where TB cases do not receive DST is challenging, as any observed aggregation of MDRTB may reflect systematic differences in how testing is distributed in communities. We introduce a new disease mapping method, which estimates this missing information through probability–weighted locations, to identify geographic areas of increased risk of MDRTB transmission. We apply this method to routinely collected data from two districts in Lima, Peru over three consecutive years. This method identifies an area in the eastern part of Lima where previously untreated cases have increased risk of MDRTB. This may indicate an area of increased transmission of drug resistant disease, a finding that may otherwise have been missed by routine analysis of programmatic data. The risk of MDR among retreatment cases is also highest in these probable transmission hotspots, though a high level of MDR among retreatment cases is present throughout the study area. Identifying potential multidrug resistant tuberculosis (MDRTB) transmission hotspots may allow for targeted investigation and deployment of resources. PMID:22401962

  10. Confirming Mycobacterium tuberculosis transmission from a cadaver to an embalmer using molecular epidemiology.

    PubMed

    Anderson, Janelle A; Meissner, Jeanne Sullivan; Ahuja, Shama Desai; Shashkina, Elena; O'Flaherty, Tholief; Proops, Douglas C

    2015-05-01

    Genotyping results and epidemiologic investigation were used to confirm tuberculosis transmission from a cadaver to an embalmer. This investigation highlights the utility of genotyping in identifying unsuspected epidemiologic links and unusual transmission settings. In addition, the investigation provides additional evidence for the occupational risk of tuberculosis among funeral service workers and indicates a need for education about tuberculosis risk and the importance of adhering to appropriate infection control measures among funeral service workers.

  11. Estimation of tuberculosis risk on a commercial airliner.

    PubMed

    Ko, Gwangpyo; Thompson, Kimberly M; Nardell, Edward A

    2004-04-01

    This article estimates the risk of tuberculosis (TB) transmission on a typical commercial airliner using a simple one box model (OBM) and a sequential box model (SBM). We used input data derived from an actual TB exposure on an airliner, and we assumed a hypothetical scenario that a highly infectious TB source case (i.e., 108 infectious quanta per hour) travels as a passenger on an 8.7-hour flight. We estimate an average risk of TB transmission on the order of 1 chance in 1,000 for all passengers using the OBM. Applying the more realistic SBM, we show that the risk and incidence decrease sharply in a stepwise fashion in cabins downstream from the cabin containing the source case assuming some potential for airflow from more contaminated to less contaminated cabins. We further characterized spatial variability in the risk within the cabin by modeling a previously reported TB outbreak in an airplane to demonstrate that the TB cases occur most likely within close proximity of the source TB patient.

  12. Tuberculosis in a South African prison – a transmission modelling analysis

    PubMed Central

    Johnstone-Robertson, Simon; Lawn, Stephen D; Welte, Alex; Bekker, Linda-Gail; Wood, Robin

    2015-01-01

    Background Prisons are recognised internationally as institutions with very high tuberculosis (TB) burdens where transmission is predominantly determined by contact between infectious and susceptible prisoners. A recent South African court case described the conditions under which prisoners awaiting trial were kept. With the use of these data, a mathematical model was developed to explore the interactions between incarceration conditions and TB control measures. Methods Cell dimensions, cell occupancy, lock-up time, TB incidence and treatment delays were derived from court evidence and judicial reports. Using the Wells-Riley equation and probability analyses of contact between prisoners, we estimated the current TB transmission probability within prison cells, and estimated transmission probabilities of improved levels of case finding in combination with implementation of national and international minimum standards for incarceration. Results Levels of overcrowding (230%) in communal cells and poor TB case finding result in annual TB transmission risks of 90% per annum. Implementing current national or international cell occupancy recommendations would reduce TB transmission probabilities by 30% and 50%, respectively. Improved passive case finding, modest ventilation increase or decreased lock-up time would minimally impact on transmission if introduced individually. However, active case finding together with implementation of minimum national and international standards of incarceration could reduce transmission by 50% and 94%, respectively. Conclusions Current conditions of detention for awaiting-trial prisoners are highly conducive for spread of drug-sensitive and drug-resistant TB. Combinations of simple well-established scientific control measures should be implemented urgently. PMID:22272961

  13. Incidence and transmission patterns of tuberculosis among indigenous populations in Brazil

    PubMed Central

    Cunha, Eunice Atsuko; Ferrazoli, Lucilaine; Riley, Lee W; Basta, Paulo Cesar; Honer, Michael Robert; Maia, Rosalia; da Costa, Izaias Pereira

    2013-01-01

    Approximately 10% of the Brazilian indigenous population lives in the state of Mato Grosso do Sul (MS), where a large number of new cases of tuberculosis (TB) are reported. This study was conducted to assess TB occurrence, transmission and the utility of TB diagnosis based on the Ogawa-Kudoh (O-K) culture method in this remote population. The incidence of TB was estimated by a retrospective review of the surveillance data maintained by the Notifiable Diseases Surveillance System for the study region. The TB transmission pattern among indigenous people was assessed by genotyping Mycobacterium tuberculosis isolates using the IS 6110 restriction fragment length polymorphism (RFLP) technique. Of the 3,093 cases identified from 1999-2001, 610 (~20%) were indigenous patients (average incidence: 377/100,000/year). The use of the O-K culture method increased the number of diagnosed cases by 34.1%. Of the genotyped isolates from 52 indigenous patients, 33 (63.5%) belonged to cluster RFLP patterns, indicating recently transmitted TB. These results demonstrate high, on-going TB transmission rates among the indigenous people of MS and indicate that new efforts are needed to disrupt these current transmissions. PMID:24270999

  14. Transmission of Drug-Resistant Tuberculosis in Texas and Mexico

    PubMed Central

    Quitugua, Teresa N.; Seaworth, Barbara J.; Weis, Stephen E.; Taylor, Jeffery P.; Gillette, J. Seb; Rosas, Ishmael I.; Jost, Jr., Kenneth C.; Magee, D. Mitchel; Cox, Rebecca A.

    2002-01-01

    To examine the transmission of drug-resistant (DR) tuberculosis between Texas and Mexico, Mycobacterium tuberculosis isolates resistant to one or more of the first-line antimycobacterial drugs were obtained from 606 patients who resided in Texas and 313 patients who resided in Mexico, primarily within the state of Tamaulipas. The isolates were genotyped by IS6110-based restriction fragment length polymorphism (RFLP) analysis and spoligotyping. Of the 919 isolates genotyped, 413 (45%) grouped into 105 clusters containing 2 or more isolates with identical genotypes. In addition to having identical genotypes, identical drug resistance patterns were identified in 250 isolates in 78 clusters (DR clusters). Twenty DR clusters, containing isolates from 32% of the total number of patients infected with DR strains, were geographically distributed across Mexico and Texas. Within this population of 919 patients infected with DR isolates, the probability of being in a DR cluster was the same for residents of Mexico and Texas. In Texas, the significant independent predictors of clustering within DR clusters as opposed to genotype clusters were found to be race, age, country of birth, human immunodeficiency virus (HIV) infection status, and resistance to more than one drug. Specifically, isolates from African Americans, individuals under age 65, individuals born in the United States, and HIV-positive individuals were each more likely to be associated with a DR cluster. By contrast, no significant independent predictors of clustering in a DR cluster were identified in Mexico. Although some DR M. tuberculosis strains are geographically restricted, this study suggests that a number of strains are transmitted between Mexico and the United States. PMID:12149319

  15. Identifying Hotspots of Multidrug-Resistant Tuberculosis Transmission Using Spatial and Molecular Genetic Data

    PubMed Central

    Zelner, Jonathan L.; Murray, Megan B.; Becerra, Mercedes C.; Galea, Jerome; Lecca, Leonid; Calderon, Roger; Yataco, Rosa; Contreras, Carmen; Zhang, Zibiao; Manjourides, Justin; Grenfell, Bryan T.; Cohen, Ted

    2016-01-01

    Background. We aimed to identify and determine the etiology of “hotspots” of concentrated multidrug-resistant tuberculosis (MDR-tuberculosis) risk in Lima, Peru. Methods. From 2009 to 2012, we conducted a prospective cohort study among households of tuberculosis cases from 106 health center (HC) areas in Lima, Peru. All notified tuberculosis cases and their household contacts were followed for 1 year. Symptomatic individuals were screened by microscopy and culture; positive cultures were tested for drug susceptibility (DST) and genotyped by 24-loci mycobacterial interspersed repetitive units-variable-number tandem repeats (MIRU-VNTR). Results. 3286 individuals with culture-confirmed disease, DST, and 24-loci MIRU-VNTR were included in our analysis. Our analysis reveals: (1) heterogeneity in annual per-capita incidence of tuberculosis and MDR-tuberculosis by HC, with a rate of MDR-tuberculosis 89 times greater (95% confidence interval [CI], 54,185) in the most-affected versus the least-affected HC; (2) high risk for MDR-tuberculosis in a region spanning several HCs (odds ratio = 3.19, 95% CI, 2.33, 4.36); and (3) spatial aggregation of MDR-tuberculosis genotypes, suggesting localized transmission. Conclusions. These findings reveal that localized transmission is an important driver of the epidemic of MDR-tuberculosis in Lima. Efforts to interrupt transmission may be most effective if targeted to this area of the city. PMID:26175455

  16. The transmission of tuberculosis in schools involving children 3 to 11 years of age.

    PubMed

    Roberts, Jonathan R; Mason, Brendan W; Paranjothy, Shantini; Palmer, Stephen R

    2012-01-01

    Little is known about the risk of tuberculosis transmission from children. We reviewed the published literature on the transmission of tuberculosis during outbreaks involving children 3 to 11 years of age and report that transmission rates among close contacts in school outbreaks are on average higher (weighted average 69.8% vs. 39.3%) if the index case is a child than an adult.

  17. Application of DNA markers to estimate genetic diversity of Mycobacterium tuberculosis strains.

    PubMed

    Korzekwa, Karol; Polok, Kornelia; Zieliński, Roman

    2006-01-01

    The obligatory human pathogen, Mycobacterium tuberculosis, is the most important etiological factor of tuberculosis. Unfortunately, there is little information about genetic diversity of this pathogen. The main aim of this research was the estimation of genetic diversity of M. tuberculosis on the basis of various categories of DNA markers. The genome of 32 strains were scanned by DNA markers such RAPD, IS6110 and catalase-peroxidase katG gene. All 162 identified loci were polymorphic. The genetic diversity coefficient (HT) of M. tuberculosis was 0.32 for RAPD and 0.27 for IS 6110. There were 14 alleles in katG gene. All strains were characterised by the individual molecular pattern. Genetic similarity varied from 0.13 to 0.94 (RAPD markers) and from 0 to 1 for (IS6110). M. tuberculosis strains did not represent a clonal structure, single source of transmission and epidemiological relationships as well. The applied DNA markers proved to be highly efficient for analysis of genetic structure of M. tuberculosis.

  18. Seasonality Impact on the Transmission Dynamics of Tuberculosis.

    PubMed

    Yang, Yali; Guo, Chenping; Liu, Luju; Zhang, Tianhua; Liu, Weiping

    2016-01-01

    The statistical data of monthly pulmonary tuberculosis (TB) incidence cases from January 2004 to December 2012 show the seasonality fluctuations in Shaanxi of China. A seasonality TB epidemic model with periodic varying contact rate, reactivation rate, and disease-induced death rate is proposed to explore the impact of seasonality on the transmission dynamics of TB. Simulations show that the basic reproduction number of time-averaged autonomous systems may underestimate or overestimate infection risks in some cases, which may be up to the value of period. The basic reproduction number of the seasonality model is appropriately given, which determines the extinction and uniform persistence of TB disease. If it is less than one, then the disease-free equilibrium is globally asymptotically stable; if it is greater than one, the system at least has a positive periodic solution and the disease will persist. Moreover, numerical simulations demonstrate these theorem results.

  19. "Phthisiophobia": the difficult recognition of transmission of tuberculosis to health care workers.

    PubMed

    Riva, M A; Ploia, Paola Roberta; Rocca, S; Cesana, G

    2013-01-01

    Even if the contagious nature of tuberculosis was universally accepted during the nineteenth century, its transmission to health care workers (HCWs) was initially denied by the scientific community. Working among TB patients was not considered dangerous for healthy adults, so the potential risks for HCWs were branded as unwarranted "phthisiophobia" (fear of contracting tuberculosis). This study aims at analyzing the problem of tuberculosis transmission among health care workers from an historical perspective, particularly highlighting the contribution made by the Italian Occupational Medicine community. Scientific literature and historical sources on different theories regarding tuberculosis transmission were investigated, specially focusing on the period at the turn of the 19th and 20th centuries. At the beginning of the twentieth century, Luigi Devoto (1864-1936), an Italian pioneer in the field of Occupational Medicine, was one of the first scientists to conduct research on the transmission of tuberculosis among nurses. Since the 1920s several studies, conducted mainly on medical and nursing students, confirmed the risk for HCWs. However an international consensus on this issue was only achieved during the 1950s, when the institution of mandatory chest radiographs on admission for all patients significantly decreased the cases of tuberculosis among HCWs. Devoto was one of the first scholars who postulated the transmission of tuberculosis to HCWs. He also theorized that hospital personnel with active disease could also be a source of contagion to patients. Nowadays, "third party risk" and latent tuberculosis infection pose a new challenge for occupational physicians in hospitals.

  20. Modelling transmission of bovine tuberculosis in red deer and wild boar in Normandy, France.

    PubMed

    Zanella, G; Bar-Hen, A; Boschiroli, M-L; Hars, J; Moutou, F; Garin-Bastuji, B; Durand, B

    2012-09-01

    In early 2001, Mycobacterium bovis infection was confirmed in red deer (RD) (Cervus elaphus) shot in Normandy region, France. An epidemiological survey conducted during the following hunting season in two connected forests confirmed the occurrence of the disease in both free-ranging RD and wild boar (WB) (Sus scrofa). This was the first detected bovine tuberculosis outbreak in wildlife in France. We present a simple deterministic age-structured model of the within- and between-species M. bovis transmission in RD and WB populations that distinguishes direct transmission (horizontal and pseudo-vertical) and indirect transmission through contaminated offal left behind by hunters. Results issued from the epidemiological surveys conducted in Normandy forests were used to estimate transmission parameters. Because data for RD and WB populations were not available, population sizes at demographic equilibrium were estimated and used to run the model. We qualitatively tested different control measure scenarios with our model, considering different mortality rates and offal harvesting, to determine which ones affect the success of infection control. The most realistic control scenario would combine the total depopulation of RD and good compliance with offal harvesting, because the model suggests that infected offal left by hunters represents the main transmission source of M. bovis in the field. © 2012 Blackwell Verlag GmbH.

  1. The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons.

    PubMed

    Urrego, Juliana; Ko, Albert I; da Silva Santos Carbone, Andrea; Paião, Dayse Sanchez Guimarães; Sgarbi, Renata Viebrantz Enne; Yeckel, Catherine W; Andrews, Jason R; Croda, Julio

    2015-10-01

    Prisoners have among the highest incidence of tuberculosis (TB) globally. However, the contribution of the prison environment on transmission is not well understood and structural characteristics have received little attention as effective epidemiological interventions in TB control. We evaluated architectural characteristics and estimated ventilation rates in 141 cells in three prisons in central west Brazil using steady-state exhaled carbon dioxide (CO2) levels. We used a modified Wells-Riley equation to estimate the probability of infection for inmates sharing a cell with an infectious case and projected the impact of interventions, including early diagnosis and improved ventilation. Overall, prison cells were densely populated (mean 2.1 m(2) per occupant) and poorly ventilated, with only three cells meeting World Health Organization (WHO) standards for per-person ventilation (60 L/s) applied in infection control settings. In the absence of interventions, projected mean risk of infection was 78.0% during a 6-month period. Decreasing time-to-diagnosis by 25% reduced transmission risk by 8.3%. Improving ventilation to WHO standards decreased transmission by 38.2%, whereas optimizing cross-ventilation reduced transmission by 64.4%. Prison environments promote high infection risk over short-time intervals. In this context, enhanced diagnostics have a limited impact on reducing transmission. Improving natural ventilation may be required to effectively control TB in prisons.

  2. The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons

    PubMed Central

    Urrego, Juliana; Ko, Albert I.; da Silva Santos Carbone, Andrea; Paião, Dayse Sanchez Guimarães; Sgarbi, Renata Viebrantz Enne; Yeckel, Catherine W.; Andrews, Jason R.; Croda, Julio

    2015-01-01

    Prisoners have among the highest incidence of tuberculosis (TB) globally. However, the contribution of the prison environment on transmission is not well understood and structural characteristics have received little attention as effective epidemiological interventions in TB control. We evaluated architectural characteristics and estimated ventilation rates in 141 cells in three prisons in central west Brazil using steady-state exhaled carbon dioxide (CO2) levels. We used a modified Wells–Riley equation to estimate the probability of infection for inmates sharing a cell with an infectious case and projected the impact of interventions, including early diagnosis and improved ventilation. Overall, prison cells were densely populated (mean 2.1 m2 per occupant) and poorly ventilated, with only three cells meeting World Health Organization (WHO) standards for per-person ventilation (60 L/s) applied in infection control settings. In the absence of interventions, projected mean risk of infection was 78.0% during a 6-month period. Decreasing time-to-diagnosis by 25% reduced transmission risk by 8.3%. Improving ventilation to WHO standards decreased transmission by 38.2%, whereas optimizing cross-ventilation reduced transmission by 64.4%. Prison environments promote high infection risk over short-time intervals. In this context, enhanced diagnostics have a limited impact on reducing transmission. Improving natural ventilation may be required to effectively control TB in prisons. PMID:26195459

  3. Tuberculosis in domestic livestock: pathogenesis, transmission, and vaccination

    USDA-ARS?s Scientific Manuscript database

    The Mycobacterium tuberculosis complex includes agents such as M. tuberculosis and M. bovis, the cause of tuberculosis in most animals and a zoonotic pathogen. Mycobacterium bovis has one of the broadest host ranges of any pathogen, infecting most mammals, including humans. Models are used to study ...

  4. Neighborhood socioeconomic position and tuberculosis transmission: a retrospective cohort study

    PubMed Central

    2014-01-01

    Background Current understanding of tuberculosis (TB) genotype clustering in the US is based on individual risk factors. This study sought to identify whether area-based socioeconomic status (SES) was associated with genotypic clustering among culture-confirmed TB cases. Methods A retrospective cohort analysis was performed on data collected on persons with incident TB in King County, Washington, 2004–2008. Multilevel models were used to identify the relationship between area-level SES at the block group level and clustering utilizing a socioeconomic position index (SEP). Results Of 519 patients with a known genotyping result and block group, 212 (41%) of isolates clustered genotypically. Analyses suggested an association between lower area-based SES and increased recent TB transmission, particularly among US-born populations. Models in which community characteristics were measured at the block group level demonstrated that lower area-based SEP was positively associated with genotypic clustering after controlling for individual covariates. However, the trend in higher clustering odds with lower SEP index quartile diminished when additional block-group covariates. Conclusions Results stress the need for TB control interventions that take area-based measures into account, with particular focus on poor neighborhoods. Interventions based on area-based characteristics, such as improving case finding strategies, utilizing location-based screening and addressing social inequalities, could reduce recent rates of transmission. PMID:24767197

  5. Tuberculosis transmission in Northwest of Iran: using MIRU-VNTR, ETR-VNTR and IS6110-RFLP methods.

    PubMed

    Asgharzadeh, Mohammad; Kafil, Hossein Samadi; Roudsary, Ali Amoghi; Hanifi, Gholam Reza

    2011-01-01

    Tuberculosis is the main cause for adults' death from a single infectious agent killing about 2 million people every year. Identifying the source of transmission infection is necessary to decrease tuberculosis. In this study we used IS6110-RFLP, MIRU-VNTR and ETR-VNTR methods to determine transmission dynamic of tuberculosis in Northwest of Iran from March 2004 to March 2005. 156 culture positive isolates (51 from Orumieh and 105 from Tabriz) were collected. IS6110-RFLP was done by standardized method and MIRU-VNTR was done by 12 primers specific for 12 MIRU-VNTR loci by polymerase chain reaction and ETR was carried out by primers specific for ETR-A, ETR-B and ETR-C as well. Genetic relationship analyses were performed by MVSP software and MIRU-VNTRplus website. The results revealed that the copy number of IS6110 in isolates ranged from 0 to 17. One hundred and seven unique patterns and 16 shared patterns by 2-10 isolates were determined by IS6110-RFLP, and 116 distinct patterns were identified by MIRU-VNTR including 21 clustered patterns and 95 unique patterns. Having combined MIRU-VNTR and ETR-VNTR data, we increased the discriminatory power of typing method, thus 25 clusters were identified. Loci 10, 26, 40 in MIRU and ETR-A were highly discriminatory. Distribution of lineages in our study according to tentative data in MIRU-VNTRplus database was multi-matches 9.09%, Bovis 9.74%, S 8.44%, New-1 0.65%, Uganda I 0.65%, Haarlem 0.65%, Cameroon 0.65% and X 0.65%. The minimum estimate for tuberculosis proportion due to transmission was 20.1% with IS6110-RFLP and was 18.8% with MIRU and ETR. In conclusion, tuberculosis sanitation status in northwest of Iran due to minimum estimate of tuberculosis transmission was satisfactory, and the reactivation of tuberculosis was responsible for more than 80% of new tuberculosis. According to the results and drawbacks of IS6110-RFLP method we strongly recommend MIRU-VNTRplus ETR-VNTR as an easy, reliable, reproducible and highly

  6. Role of casual contacts in the recent transmission of tuberculosis in settings with high disease burden

    PubMed Central

    Wang, Weibing; Mathema, Barun; Hu, Yi; Zhao, Qi; Weili, Jiang; Xu, Biao

    2014-01-01

    Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide. It is expected that combining multiple molecular methods will further help in focusing contact investigations. We performed a population-based molecular epidemiologic study in 6 sites in China between 1 June 2009 and 31 December 2010. A genotyping method combining 7-loci MIRU-VNTR and IS6110-based RFLP was employed to determine predictors of recent transmission. A second interview was performed with the clustered patients to identify potential epidemiological links. The molecular clustering analysis revealed that 187 isolates (15.3%) were clustered by sharing identical VNTR-IS6110 combined patterns, with an estimated recent transmission index being 8.9%. None of these patients reported having contacts with other members within the same cluster. Nineteen of 121 reported having a history of contact to a TB case within 2 years before the current TB diagnosis. Additionally, geographic correlation was established for 19 cases in 9 clusters, while only one possible epidemiological link was established in secondary interview. The results underscore the role of casual contact or reactivation of latent TB as a driving factor maintaining the current endemicity in rural China with high disease burdens of tuberculosis. PMID:24941878

  7. Evaluation of tuberculosis transmission in a community by 1 year of systematic typing of Mycobacterium tuberculosis clinical isolates.

    PubMed Central

    Torrea, G; Offredo, C; Simonet, M; Gicquel, B; Berche, P; Pierre-Audigier, C

    1996-01-01

    Interhuman transmission of Mycobacterium tuberculosis was investigated by using molecular typing, including restriction fragment length polymorphism with probes IS6110, DR (direct repeat) and PGRS (polymorphic GC-rich sequence) and a PCR method using the inverted repeat sequences of IS6110 as primers. From 105 patients hospitalized for tuberculosis during a 1-year survey in three hospitals in Paris, France, 111 isolates were collected and analyzed. Eighty-eight patients were infected with genetically different isolates, demonstrating the clonal heterogeneity of M. tuberculosis in these patients originating from various geographical areas. Fourteen patients were infected by strains clustered with identical fingerprints. An epidemiological relatedness was demonstrated for isolates from only seven of these patients. Thus, the typing of isolates from all tuberculous patients in hospitals during 1 year allows the detection of transmission in the general community. This would improve the case findings, thereby further improving the detection of outbreaks. PMID:8727873

  8. Two-strain Tuberculosis Transmission Model under Three Control Strategies

    NASA Astrophysics Data System (ADS)

    Rayhan, S. N.; Bakhtiar, T.; Jaharuddin

    2017-03-01

    In 1997, Castillo-Chavez and Feng developed a two-strain tuberculosis (TB) model, which is typical TB and resistant TB. Castillo-Chavez and Feng’s model was then subsequently developed by Jung et al. (2002) by adding two control variables. In this work, Jung et al.’s model was modified by introducing a new control variable so that there are three controls, namely chemoprophylaxis and two treatment strategies, with the application of three different scenarios related to the objective functional form and control application. Pontryagin maximum principle was applied to derive the differential equations system as a condition that must be satisfied by the optimal control variables. Furthermore, the fourth-order Runge-Kutta method was exploited to determine the numerical solution of the optimal control problem. In this numerical solution, it is shown that the controls treated on TB transmission model provide a good effect because latent and infected individuals are decreasing, and the number of individuals that is treated effectively is increasing.

  9. [Adolescent tuberculosis; a challenge and opportunity to prevent community transmission].

    PubMed

    Margarit, Adriana; Simó, Sílvia; Rozas, Librada; Deyà-Martínez, Àngela; Barrabeig, Irene; Gené, Amadéu; Fortuny, Clàudia; Noguera-Julian, Antoni

    2017-03-01

    Adolescents may present with adult-type pulmonary tuberculosis (TB), including cavity disease in upper lobes and smear-positive sputum, which involves a significant transmission risk for social and family contacts. A retrospective (2007-2012) observational study of a case series of TB was conducted in children and adolescents (<18 years) in a paediatric referral centre in Barcelona. Patients aged≤12 and>12 years at diagnosis are compared. The series consisted of 124 patients (56.5% males, median age: 4.0 years). In half of the cases, the patient was of immigrant origina and TB was diagnosed after clinical-radiological suspicion, intra-thoracic disease being the most common (91.9%). Cultures yielded positive results in one third of cases (37.9%) and isolates were sensitive to oral first-line anti-TB agents in 100%. Median (interquartile range) duration of treatment was 6 (6-9) months, directly observed therapy was needed in 10 patients, and there was a satisfactory outcome after treatment in 98.4%. Among adolescents, TB was more prevalent in females (63.2%) and immigrant patients (68.4%), comorbidity at diagnosis and lung cavity forms were more common, and the source case was identified only in 21.1% of the patients. Adult-type pulmonary TB is common among adolescents, may be associated with underlying medical conditions, and is often diagnosed late, posing a significant transmission risk to the community. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Molecular epidemiology of tuberculosis transmission: Contextualizing the evidence through social network theory.

    PubMed

    Hollm-Delgado, Maria-Graciela

    2009-09-01

    Despite a long-standing recognition that factors such as age, gender, and socioeconomic status play a fundamental role in tuberculosis transmission and susceptibility, few molecular epidemiological studies have fully elucidated the etiological mechanisms by which each of these social factors may influence transmission of the disease. In this paper, we propose that in order to achieve this goal, molecular epidemiology must move towards a more holistic approach for disease transmission, thus enabling social theory to be integrated into molecular epidemiological studies on tuberculosis. We then present a social network model to illustrate how molecular and social epidemiology can be combined to study disease transmission patterns, and provide preliminary molecular epidemiological evidence to support the role of social networks in tuberculosis transmission.

  11. Tuberculosis cross-species transmission in Tanzania: towards a One-Health concept.

    PubMed

    Mbugi, Erasto V; Katale, Bugwesa Z; Kendall, Sharon; Good, Liam; Kibiki, Gibson S; Keyyu, Julius D; Godfrey-Faussett, Peter; Van Helden, Paul; Matee, Mecky I

    2012-07-20

    For centuries, tuberculosis, which is a chronic infection caused by the bacillus Mycobacterium tuberculosis has remained a global health problem. The global burden of tuberculosis has increased, particularly in the Southern African region, mainly due to HIV, and inadequate health systems which has in turn given rise to emergent drug resistant tuberculosis (TB) strains. Bovine tuberculosis (BTB) has also emerged as a significant disease with the tendency for inter-species spread. The extent of interspecies BTB transmission both in urban and rural communities has not been adequately assessed. The phenomenon is of particular importance in rural communities where people share habitats with livestock and wildlife (particularly in areas near national parks and game reserves). Aerosol and oral intake are the major routes of transmission from diseased to healthy individuals, with health care workers often contracting infection nosocomially. Although TB control has increasingly been achieved in high-income countries, the disease, like other poverty-related infections, has continued to be a disaster in countries with low income economies. Transmission of infections occurs not only amongst humans but also between animals and humans (and occasionally vice versa) necessitating assessment of the extent of transmission at their interface. This review explores tuberculosis as a disease of humans which can cross-transmit between humans, livestock and wildlife. The review also addresses issues underlying the use of molecular biology, genetic sequencing and bioinformatics as t tools to understand the extent of inter-species cross-transmission of TB in a 'One Health' context.

  12. Transmission of multidrug-resistant tuberculosis in the USA: a cross-sectional study.

    PubMed

    Moonan, Patrick K; Teeter, Larry D; Salcedo, Katya; Ghosh, Smita; Ahuja, Shama D; Flood, Jennifer; Graviss, Edward A

    2013-09-01

    Multidrug-resistant (MDR) tuberculosis is a potential threat to tuberculosis elimination, but the extent of MDR tuberculosis disease in the USA that is attributable to transmission within the country is unknown. We assessed transmission of MDR tuberculosis and potential contributing factors in the USA. In a cross-sectional study, clinical, demographic, epidemiological, and Mycobacterium tuberculosis genotype data were obtained during routine surveillance of all verified cases of MDR tuberculosis reported from eight states in the USA (California from Jan 1, 2007, to Dec 31, 2009; Texas from Jan 1, 2007, to March 31, 2009; and the states of Colorado, Maryland, Massachusetts, New York, Tennessee, and Washington from Jan 1, 2007 to Dec 31, 2008). In-depth interviews and health-record abstraction were done for all who consented to ascertain potential interpersonal connections. 168 cases of MDR tuberculosis were reported in the eight states during our study period. 92 individuals (55%) consented to in-depth interview. 20 (22%) of these individuals developed MDR tuberculosis as a result of transmission in the USA; a source case was identified for eight of them (9%). 20 individuals (22%) had imported active tuberculosis (ie, culture-confirmed disease within 3 months of entry into the USA). 38 (41%) were deemed to have reactivation of disease, of whom 14 (15%) had a known previous episode of tuberculosis outside the USA. Five individuals (5%) had documented treatment of a previous episode in the USA, and so were deemed to have relapsed. For nine cases (10%), insufficient evidence was available to definitively classify reason for presentation. About a fifth of cases of MDR tuberculosis in the USA can be linked to transmission within the country. Many individuals acquire MDR tuberculosis before entry into the USA. MDR tuberculosis needs to be diagnosed rapidly to reduce potential infectious periods, and clinicians should consider latent tuberculosis infection treatment

  13. Transmission of multidrug-resistant tuberculosis in the USA: a cross-sectional study

    PubMed Central

    Moonan, Patrick K; Teeter, Larry D; Salcedo, Katya; Ghosh, Smita; Ahuja, Shama D; Flood, Jennifer; Graviss, Edward A

    2015-01-01

    Summary Background Multidrug-resistant (MDR) tuberculosis is a potential threat to tuberculosis elimination, but the extent of MDR tuberculosis disease in the USA that is attributable to transmission within the country is unknown. We assessed transmission of MDR tuberculosis and potential contributing factors in the USA. Methods In a cross-sectional study, clinical, demographic, epidemiological, and Mycobacterium tuberculosis genotype data were obtained during routine surveillance of all verified cases of MDR tuberculosis reported from eight states in the USA (California from Jan 1, 2007, to Dec 31, 2009; Texas from Jan 1, 2007, to March 31, 2009; and the states of Colorado, Maryland, Massachusetts, New York, Tennessee, and Washington from Jan 1, 2007 to Dec 31, 2008). In-depth interviews and health-record abstraction were done for all who consented to ascertain potential interpersonal connections. Findings 168 cases of MDR tuberculosis were reported in the eight states during our study period. 92 individuals (55%) consented to in-depth interview. 20 (22%) of these individuals developed MDR tuberculosis as a result of transmission in the USA; a source case was identified for eight of them (9%). 20 individuals (22%) had imported active tuberculosis (ie, culture-confirmed disease within 3 months of entry into the USA). 38 (41%) were deemed to have reactivation of disease, of whom 14 (15%) had a known previous episode of tuberculosis outside the USA. Five individuals (5%) had documented treatment of a previous episode in the USA, and so were deemed to have relapsed. For nine cases (10%), insufficient evidence was available to definitively classify reason for presentation. Interpretation About a fifth of cases of MDR tuberculosis in the USA can be linked to transmission within the country. Many individuals acquire MDR tuberculosis before entry into the USA. MDR tuberculosis needs to be diagnosed rapidly to reduce potential infectious periods, and clinicians should

  14. Identifying Hotspots of Multidrug-Resistant Tuberculosis Transmission Using Spatial and Molecular Genetic Data.

    PubMed

    Zelner, Jonathan L; Murray, Megan B; Becerra, Mercedes C; Galea, Jerome; Lecca, Leonid; Calderon, Roger; Yataco, Rosa; Contreras, Carmen; Zhang, Zibiao; Manjourides, Justin; Grenfell, Bryan T; Cohen, Ted

    2016-01-15

    We aimed to identify and determine the etiology of "hotspots" of concentrated multidrug-resistant tuberculosis (MDR-tuberculosis) risk in Lima, Peru. From 2009 to 2012, we conducted a prospective cohort study among households of tuberculosis cases from 106 health center (HC) areas in Lima, Peru. All notified tuberculosis cases and their household contacts were followed for 1 year. Symptomatic individuals were screened by microscopy and culture; positive cultures were tested for drug susceptibility (DST) and genotyped by 24-loci mycobacterial interspersed repetitive units-variable-number tandem repeats (MIRU-VNTR). 3286 individuals with culture-confirmed disease, DST, and 24-loci MIRU-VNTR were included in our analysis. Our analysis reveals: (1) heterogeneity in annual per-capita incidence of tuberculosis and MDR-tuberculosis by HC, with a rate of MDR-tuberculosis 89 times greater (95% confidence interval [CI], 54,185) in the most-affected versus the least-affected HC; (2) high risk for MDR-tuberculosis in a region spanning several HCs (odds ratio = 3.19, 95% CI, 2.33, 4.36); and (3) spatial aggregation of MDR-tuberculosis genotypes, suggesting localized transmission. These findings reveal that localized transmission is an important driver of the epidemic of MDR-tuberculosis in Lima. Efforts to interrupt transmission may be most effective if targeted to this area of the city. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  15. Prisons as Reservoir for Community Transmission of Tuberculosis, Brazil

    PubMed Central

    Sacchi, Flávia P.C.; Praça, Renata M.; Tatara, Mariana B.; Simonsen, Vera; Ferrazoli, Lucilaine; Croda, Mariana G.; Suffys, Philip N.; Ko, Albert I.; Andrews, Jason R.

    2015-01-01

    We conducted a population-based study of tuberculosis (TB) cases in Dourados, Brazil, to assess the relationship between incarceration and TB in the general population. Incarceration was associated with TB in an urban population; 54% of Mycobacterium tuberculosis strains were related to strains from persons in prisons. TB control in prisons is critical for reducing disease prevalence. PMID:25642998

  16. Prisons as reservoir for community transmission of tuberculosis, Brazil.

    PubMed

    Sacchi, Flávia P C; Praça, Renata M; Tatara, Mariana B; Simonsen, Vera; Ferrazoli, Lucilaine; Croda, Mariana G; Suffys, Philip N; Ko, Albert I; Andrews, Jason R; Croda, Julio

    2015-03-01

    We conducted a population-based study of tuberculosis (TB) cases in Dourados, Brazil, to assess the relationship between incarceration and TB in the general population. Incarceration was associated with TB in an urban population; 54% of Mycobacterium tuberculosis strains were related to strains from persons in prisons. TB control in prisons is critical for reducing disease prevalence.

  17. Heterogeneity in tuberculosis transmission and the role of geographic hotspots in propagating epidemics

    PubMed Central

    Dowdy, David W.; Golub, Jonathan E.; Chaisson, Richard E.; Saraceni, Valeria

    2012-01-01

    The importance of high-incidence “hotspots” to population-level tuberculosis (TB) incidence remains poorly understood. TB incidence varies widely across countries, but within smaller geographic areas (e.g., cities), TB transmission may be more homogeneous than other infectious diseases. We constructed a steady-state compartmental model of TB in Rio de Janeiro, replicating nine epidemiological variables (e.g., TB incidence) within 1% of their observed values. We estimated the proportion of TB transmission originating from a high-incidence hotspot (6.0% of the city’s population, 16.5% of TB incidence) and the relative impact of TB control measures targeting the hotspot vs. the general community. If each case of active TB in the hotspot caused 0.5 secondary transmissions in the general community for each within-hotspot transmission, the 6.0% of people living in the hotspot accounted for 35.3% of city-wide TB transmission. Reducing the TB transmission rate (i.e., number of secondary infections per infectious case) in the hotspot to that in the general community reduced city-wide TB incidence by 9.8% in year 5, and 29.7% in year 50—an effect similar to halving time to diagnosis for the remaining 94% of the community. The importance of the hotspot to city-wide TB control depended strongly on the extent of TB transmission from the hotspot to the general community. High-incidence hotspots may play an important role in propagating TB epidemics. Achieving TB control targets in a hotspot containing 6% of a city’s population can have similar impact on city-wide TB incidence as achieving the same targets throughout the remaining community. PMID:22645356

  18. Heterogeneity in tuberculosis transmission and the role of geographic hotspots in propagating epidemics.

    PubMed

    Dowdy, David W; Golub, Jonathan E; Chaisson, Richard E; Saraceni, Valeria

    2012-06-12

    The importance of high-incidence "hotspots" to population-level tuberculosis (TB) incidence remains poorly understood. TB incidence varies widely across countries, but within smaller geographic areas (e.g., cities), TB transmission may be more homogeneous than other infectious diseases. We constructed a steady-state compartmental model of TB in Rio de Janeiro, replicating nine epidemiological variables (e.g., TB incidence) within 1% of their observed values. We estimated the proportion of TB transmission originating from a high-incidence hotspot (6.0% of the city's population, 16.5% of TB incidence) and the relative impact of TB control measures targeting the hotspot vs. the general community. If each case of active TB in the hotspot caused 0.5 secondary transmissions in the general community for each within-hotspot transmission, the 6.0% of people living in the hotspot accounted for 35.3% of city-wide TB transmission. Reducing the TB transmission rate (i.e., number of secondary infections per infectious case) in the hotspot to that in the general community reduced city-wide TB incidence by 9.8% in year 5, and 29.7% in year 50-an effect similar to halving time to diagnosis for the remaining 94% of the community. The importance of the hotspot to city-wide TB control depended strongly on the extent of TB transmission from the hotspot to the general community. High-incidence hotspots may play an important role in propagating TB epidemics. Achieving TB control targets in a hotspot containing 6% of a city's population can have similar impact on city-wide TB incidence as achieving the same targets throughout the remaining community.

  19. Effect of Active Case Finding on Prevalence and Transmission of Pulmonary Tuberculosis in Dhaka Central Jail, Bangladesh

    PubMed Central

    Banu, Sayera; Rahman, Md. Toufiq; Uddin, Mohammad Khaja Mafij; Khatun, Razia; Khan, Md. Siddiqur Rahman; Rahman, Md. Mojibur; Uddin, Syed Iftekhar; Ahmed, Tahmeed; Heffelfinger, James D.

    2015-01-01

    Background Understanding tuberculosis (TB) transmission dynamics is essential for establishing effective TB control strategies in settings where the burden and risk of transmission are high. The objectives of this study were to evaluate the effect of active screening on controlling TB transmission and also to characterize Mycobacterium tuberculosis strains for investigating transmission dynamics in a correctional setting. Methods The study was carried out in Dhaka Central Jail (DCJ), from October 2005 to February 2010. An active case finding strategy for pulmonary TB was established both at the entry point to the prison and inside the prison. Three sputum specimens were collected from all pulmonary TB suspects and subjected to smear microscopy, culture, and drug susceptibility testing as well as genotyping which included deletion analysis, spoligotyping and analysis of mycobacterial interspersed repetitive units (MIRU). Results A total of 60,585 inmates were screened during the study period. We found 466 inmates with pulmonary TB of whom 357 (77%) had positive smear microscopy results and 109 (23%) had negative smear microscopy results but had positive results on culture. The number of pulmonary TB cases declined significantly, from 49 cases during the first quarter to 8 cases in the final quarter of the study period (p=0.001). Deletion analysis identified all isolates as M. tuberculosis and further identified 229 (70%) strains as ‘modern’ and 100 (30%) strains as ‘ancestral’. Analysis of MIRU showed that 347 strains (85%) exhibited unique patterns, whereas 61 strains (15%) clustered into 22 groups. The largest cluster comprised eight strains of the Beijing M. tuberculosis type. The rate of recent transmission was estimated to be 9.6%. Conclusions Implementation of active screening for TB was associated with a decline in TB cases in DCJ. Implementation of active screening in prison settings might substantially reduce the national burden of TB in Bangladesh

  20. [Tuberculosis surveys in Guerrero and new estimates of the magnitude of tuberculosis infection in Mexico].

    PubMed

    Cárdenas-Ayala, V M; Bernal-Pérez, J; Cabrera-Coello, L; Stetler, H C; Pineda-Salgado, J; Guerrero-Reyes, P

    1989-01-01

    Tuberculosis infection surveys are carried out by tuberculin skin test (Mantoux) which is a simple, cheap, valid and reliable procedure for the estimation of prevalence and incidence rates. In 1987 a survey was undertaken in children of 6-7 years old who attended the elementary school and who were not vaccinated (BCG) in the region of Iguala, México. Out of 6,095 children of such age group, just 531 were not vaccinated, thus the prevalence figure was 2.5% (CL05 = 0.1%, 5.3%). On the basis of the findings by Izaguirre et al, 26 years ago, who reported that about 10% of the children of this age group were infected, it can be estimated that the annual risk of infection is about three newly infected each year per 1,000 population. It is necessary to provide better estimates of the whole tuberculosis incidence rate.

  1. Mathematical model for transmission of tuberculosis in badger population with vaccination

    NASA Astrophysics Data System (ADS)

    Tasmi, Aldila, D.; Soewono, E.; Nuraini, N.

    2016-04-01

    Badger was first time identified as a carrier of Bovine tuberculosis disease in England since 30 years ago. Bovine tuberculosis can be transmitted to another species through the faces, saliva, and breath. The control of tuberculosis in the badger is necessary to reduce the spread of the disease to other species. Many actions have been taken by the government to tackle the disease such as culling badgers with cyanide gas, but this way destroys the natural balance and disrupts the badger population. An alternative way to eliminate tuberculosis within badger population is by vaccination. Here in this paper a model for transmission of badger tuberculosis with vaccination is discussed. The existence of the endemic equilibrium, the stability and the basic reproduction ratio are shown analytically. Numerical simulations show that with proper vaccination level, the basic reproduction ratio could be reduced significantly. Sensitivity analysis for variation of parameters are shown numerically.

  2. Prevalence of self-reported tuberculosis, knowledge about tuberculosis transmission and its determinants among adults in India: results from a nation-wide cross-sectional household survey.

    PubMed

    Sreeramareddy, Chandrashekhar T; Harsha Kumar, H N; Arokiasamy, John T

    2013-01-17

    Knowledge about symptoms and transmission of tuberculosis determines health seeking behavior and helps in prevention of tuberculosis transmission in the community. Such data is useful for policy makers to formulate information, education and communication strategies for tuberculosis control. A secondary data analysis of India demographic and health survey, 2005/6 was carried out. Questions about self-reported tuberculosis, transmission and curability of tuberculosis were analysed. Correct knowledge (without misconceptions) about tuberculosis transmission was used as a dependant variable and the explanatory variables tested were: demographic data, education, wealth quintiles, frequency of exposure to media and the curability of tuberculosis. Determinants of correct knowledge without misconceptions were tested by univariate and multivariate analyses using national weighting factor to adjust for complex sampling design. A total of 109,070 households (response rate of 93.5%) and 198,718 participants (response rate of 91.6%) completed the survey. The samples of men and women interviewed were 74,360 and 124,358 respectively. Prevalence rate of self-reported tuberculosis was 445 per 100,000 usual household residents and 4.60 per 1,000 participants. The number of respondents who had "heard of an illness called tuberculosis" was 177,423 (89.3%). Of these 47,487 (26.8%) participants did not know and 55.5% knew about the correct mode of tuberculosis transmission i.e. "Through the air when coughing or sneezing". The common misconceptions about transmission were "Through food" (32.4%), "Sharing utensils" (18.2%), and "Touching a person with tuberculosis" (12.3%). Only 52,617 (29.7%) participants had correct knowledge without misconceptions. Being male (aOR 1.17, 95% CIs 1.14, 1.21), being a Hindu (aOR 1.20, 95% CIs 1.14, 1.26) or Muslim (aOR 1.26, 95% CIs 1.18, 1.34), listening to radio (aOR 1.08, 95% CIs 1.04, 1.13) and "Tuberculosis can be cured" (aOR 1.47, 95% CIs 1.41, 1

  3. Predominance of modern Mycobacterium tuberculosis strains and active transmission of Beijing sublineage in Jayapura, Indonesia Papua.

    PubMed

    Chaidir, Lidya; Sengstake, Sarah; de Beer, Jessica; Oktavian, Antonius; Krismawati, Hana; Muhapril, Erfin; Kusumadewi, Inri; Annisa, Jessi; Anthony, Richard; van Soolingen, Dick; Achmad, Tri Hanggono; Marzuki, Sangkot; Alisjahbana, Bachti; van Crevel, Reinout

    2016-04-01

    Mycobacterium tuberculosis genotype distribution is different between West and Central Indonesia, but there are no data on the most Eastern part, Papua. We aimed to identify the predominant genotypes of M. tuberculosis responsible for tuberculosis in coastal Papua, their transmission, and the association with patient characteristics. A total of 199 M. tuberculosis isolates were collected. Spoligotyping was applied to describe the population structure of M. tuberculosis, lineage identification was performed using a combination of lineage-specific markers, and genotypic clusters were identified using a combination of 24-locus-MIRU-VNTR and spoligotyping. A high degree of genetic diversity was observed among isolates based on their spoligopatterns. Strains from modern lineage 4 made up almost half of strains (46.9%), being more abundant than the ancient lineage 1 (33.7%), and modern lineage 2 (19.4%). Thirty-five percent of strains belonged to genotypic clusters, especially strains in the Beijing genotype. Previous TB treatment and mutations associated with drug resistance were more common in patients infected with strains of the Beijing genotype. Papua shows a different distribution of M. tuberculosis genotypes compared to other parts of Indonesia. Clustering and drug resistance of modern strains recently introduced to Papua may contribute to the high tuberculosis burden in this region. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Unsuspected and extensive transmission of a drug-susceptible Mycobacterium tuberculosis strain

    PubMed Central

    López-Calleja, Ana Isabel; Gavín, Patricia; Lezcano, Ma Antonia; Vitoria, Ma Asunción; Iglesias, Ma José; Guimbao, Joaquín; Lázaro, Ma Ángeles; Rastogi, Nalin; Revillo, Ma José; Martín, Carlos; Samper, Sofia

    2009-01-01

    Background A large and unsuspected tuberculosis outbreak involving 18.7% of the total of the tuberculosis cases studied, was detected in a population-based molecular epidemiological study performed in Zaragoza (Spain) from 2001 to 2004. Methods The Mycobacterium tuberculosis drug-susceptible strain, named MTZ strain, was genetically characterized by IS6110-RFLP, Spoligotyping and by MIRU-VNTR typing and the genetic patterns obtained were compared with those included in international databases. The characteristics of the affected patients, in an attempt to understand why the MTZ strain was so highly transmitted among the population were also analyzed. Results The genetic profile of the MTZ strain was rare and not widely distributed in our area or elsewhere. The patients affected did not show any notable risk factor for TB. Conclusion The M. tuberculosis strain MTZ, might have particular transmissibility or virulence properties, and we believe that greater focus should be placed on stopping its widespread dissemination. PMID:19144198

  5. Transmission and Progression to Disease of Mycobacterium tuberculosis Phylogenetic Lineages in The Netherlands

    PubMed Central

    Verhagen, Lilly M.; Borgdorff, Martien W.; van Soolingen, Dick

    2015-01-01

    The aim of this study was to determine if mycobacterial lineages affect infection risk, clustering, and disease progression among Mycobacterium tuberculosis cases in The Netherlands. Multivariate negative binomial regression models adjusted for patient-related factors and stratified by patient ethnicity were used to determine the association between phylogenetic lineages and infectivity (mean number of positive contacts around each patient) and clustering (as defined by number of secondary cases within 2 years after diagnosis of an index case sharing the same fingerprint) indices. An estimate of progression to disease by each risk factor was calculated as a bootstrapped risk ratio of the clustering index by the infectivity index. Compared to the Euro-American reference, Mycobacterium africanum showed significantly lower infectivity and clustering indices in the foreign-born population, while Mycobacterium bovis showed significantly lower infectivity and clustering indices in the native population. Significantly lower infectivity was also observed for the East African Indian lineage in the foreign-born population. Smear positivity was a significant risk factor for increased infectivity and increased clustering. Estimates of progression to disease were significantly associated with age, sputum-smear status, and behavioral risk factors, such as alcohol and intravenous drug abuse, but not with phylogenetic lineages. In conclusion, we found evidence of a bacteriological factor influencing indicators of a strain's transmissibility, namely, a decreased ability to infect and a lower clustering index in ancient phylogenetic lineages compared to their modern counterparts. Confirmation of these findings via follow-up studies using tuberculin skin test conversion data should have important implications on M. tuberculosis control efforts. PMID:26224845

  6. Transmission and Progression to Disease of Mycobacterium tuberculosis Phylogenetic Lineages in The Netherlands.

    PubMed

    Nebenzahl-Guimaraes, Hanna; Verhagen, Lilly M; Borgdorff, Martien W; van Soolingen, Dick

    2015-10-01

    The aim of this study was to determine if mycobacterial lineages affect infection risk, clustering, and disease progression among Mycobacterium tuberculosis cases in The Netherlands. Multivariate negative binomial regression models adjusted for patient-related factors and stratified by patient ethnicity were used to determine the association between phylogenetic lineages and infectivity (mean number of positive contacts around each patient) and clustering (as defined by number of secondary cases within 2 years after diagnosis of an index case sharing the same fingerprint) indices. An estimate of progression to disease by each risk factor was calculated as a bootstrapped risk ratio of the clustering index by the infectivity index. Compared to the Euro-American reference, Mycobacterium africanum showed significantly lower infectivity and clustering indices in the foreign-born population, while Mycobacterium bovis showed significantly lower infectivity and clustering indices in the native population. Significantly lower infectivity was also observed for the East African Indian lineage in the foreign-born population. Smear positivity was a significant risk factor for increased infectivity and increased clustering. Estimates of progression to disease were significantly associated with age, sputum-smear status, and behavioral risk factors, such as alcohol and intravenous drug abuse, but not with phylogenetic lineages. In conclusion, we found evidence of a bacteriological factor influencing indicators of a strain's transmissibility, namely, a decreased ability to infect and a lower clustering index in ancient phylogenetic lineages compared to their modern counterparts. Confirmation of these findings via follow-up studies using tuberculin skin test conversion data should have important implications on M. tuberculosis control efforts.

  7. Mycobacterium tuberculosis complex transmission is not associated with recent immigration (≤5 years) in Florida.

    PubMed

    Séraphin, Marie Nancy; Lauzardo, Michael

    2015-12-01

    As tuberculosis (TB) incidence decreases in the US, foreign-born persons continue to account for a larger proportion of the burden. In these cross-sectional analyses of 1149 culture-confirmed TB cases genotyped using spoligotyping and 24-locus MIRU, we show that over a quarter of cases among the foreign-born population in Florida resulted from recent transmission of the Mycobacterium tuberculosis complex. In addition, over a third of these cases occurred among persons who had immigrated 5 years or less prior to their diagnosis. Although recent immigration was not a significant predictor of TB transmission, younger age, birthplace in the Americas, homelessness, drug use and TB lineage are risk factors for TB transmission among the foreign-born population in Florida. These data provide actionable insights into TB transmission among the foreign-born population in Florida. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Estimating tuberculosis incidence from primary survey data: a mathematical modeling approach

    PubMed Central

    Chadha, V. K.; Laxminarayan, R.; Arinaminpathy, N.

    2017-01-01

    SUMMARY BACKGROUND: There is an urgent need for improved estimations of the burden of tuberculosis (TB). OBJECTIVE: To develop a new quantitative method based on mathematical modelling, and to demonstrate its application to TB in India. DESIGN: We developed a simple model of TB transmission dynamics to estimate the annual incidence of TB disease from the annual risk of tuberculous infection and prevalence of smear-positive TB. We first compared model estimates for annual infections per smear-positive TB case using previous empirical estimates from China, Korea and the Philippines. We then applied the model to estimate TB incidence in India, stratified by urban and rural settings. RESULTS: Study model estimates show agreement with previous empirical estimates. Applied to India, the model suggests an annual incidence of smear-positive TB of 89.8 per 100 000 population (95%CI 56.8–156.3). Results show differences in urban and rural TB: while an urban TB case infects more individuals per year, a rural TB case remains infectious for appreciably longer, suggesting the need for interventions tailored to these different settings. CONCLUSIONS: Simple models of TB transmission, in conjunction with necessary data, can offer approaches to burden estimation that complement those currently being used. PMID:28284250

  9. Prevalence of self-reported tuberculosis, knowledge about tuberculosis transmission and its determinants among adults in India: results from a nation-wide cross-sectional household survey

    PubMed Central

    2013-01-01

    Background Knowledge about symptoms and transmission of tuberculosis determines health seeking behavior and helps in prevention of tuberculosis transmission in the community. Such data is useful for policy makers to formulate information, education and communication strategies for tuberculosis control. Methods A secondary data analysis of India demographic and health survey, 2005/6 was carried out. Questions about self-reported tuberculosis, transmission and curability of tuberculosis were analysed. Correct knowledge (without misconceptions) about tuberculosis transmission was used as a dependant variable and the explanatory variables tested were: demographic data, education, wealth quintiles, frequency of exposure to media and the curability of tuberculosis. Determinants of correct knowledge without misconceptions were tested by univariate and multivariate analyses using national weighting factor to adjust for complex sampling design. Results A total of 109,070 households (response rate of 93.5%) and 198,718 participants (response rate of 91.6%) completed the survey. The samples of men and women interviewed were 74,360 and 124,358 respectively. Prevalence rate of self-reported tuberculosis was 445 per 100,000 usual household residents and 4.60 per 1,000 participants. The number of respondents who had “heard of an illness called tuberculosis” was 177,423 (89.3%). Of these 47,487 (26.8%) participants did not know and 55.5% knew about the correct mode of tuberculosis transmission i.e. “Through the air when coughing or sneezing”. The common misconceptions about transmission were “Through food” (32.4%), “Sharing utensils” (18.2%), and “Touching a person with tuberculosis” (12.3%). Only 52,617 (29.7%) participants had correct knowledge without misconceptions. Being male (aOR 1.17, 95% CIs 1.14, 1.21), being a Hindu (aOR 1.20, 95% CIs 1.14, 1.26) or Muslim (aOR 1.26, 95% CIs 1.18, 1.34), listening to radio (aOR 1.08, 95% CIs 1.04, 1.13) and “Tuberculosis

  10. Virulence, immunopathology and transmissibility of selected strains of Mycobacterium tuberculosis in a murine model

    PubMed Central

    Marquina-Castillo, Brenda; García-García, Lourdes; Ponce-de-León, Alfredo; Jimenez-Corona, Maria-Eugenia; Bobadilla-del Valle, Miriam; Cano-Arellano, Bulmaro; Canizales-Quintero, Sergio; Martinez-Gamboa, Areli; Kato-Maeda, Midori; Robertson, Brian; Young, Douglas; Small, Peter; Schoolnik, Gary; Sifuentes-Osornio, Jose; Hernandez-Pando, Rogelio

    2009-01-01

    After encounter with Mycobacterium tuberculosis, a series of non-uniform immune responses are triggered that define the course of the infection. Eight M. tuberculosis strains were selected from a prospective population-based study of pulmonary tuberculosis patients (1995–2003) based on relevant clinical/epidemiological patterns and tested in a well-characterized BALB/c mouse model of progressive pulmonary tuberculosis. In addition, a new mouse model of transmissibility consisting of prolonged cohousing (up to 60 days) of infected and naïve animals was tested. Four phenotypes were defined based on strain virulence (mouse survival, lung bacillary load and tissue damage), immunology response (cytokine expression determined by real-time polymerase chain reaction) and transmissibility (lung bacillary loads and cutaneous delayed-type hypersensitivity in naïve animals).We identified four clearly defined strain phenotypes: (1) hypervirulent strain with non-protective immune response and highly transmissible; (2) virulent strain, associated with high expression of proinflammatory cytokines (tumour necrosis factor and interferon) and very low anti-inflammatory cytokine expression (interleukins 4 and 10), which induced accelerated death by immunopathology; (3) strain inducing efficient protective immunity with lower virulence, and (4) strain demonstrating strong and early macrophage activation (innate immunity) with delayed participation of acquired immunity (interferon expression). We were able to correlate virulent and transmissible phenotypes in the mouse model and markers of community transmission such as tuberculin reactivity among contacts, rapid progression to disease and cluster status. However, we were not able to find correlation with the other two phenotypes. Our new transmission model supported the hypothesis that among these strains increased virulence was linked to increased transmission. PMID:19191912

  11. Transmission of Tuberculosis in Resource-Limited Settings

    PubMed Central

    Kompala, Tejaswi; Shenoi, Sheela V.; Friedland, Gerald

    2013-01-01

    Unrecognized transmission is a major contributor to ongoing TB epidemics in high-burden, resource-constrained settings. Limitations in diagnosis, treatment, and infection control in health-care and community settings allow for continued transmission of drug-sensitive and drug-resistant TB, particularly in regions of high HIV prevalence. Health-care facilities are common sites of TB transmission. Improved implementation of infection control practices appropriate for the local setting and in combination, has been associated with reduced transmission. Community settings account for the majority of TB transmission and deserve increased focus. Strengthening and intensifying existing high-yield strategies, including household contact tracing, can reduce onward TB transmission. Recent studies documenting high transmission risk community sites and strategies for community-based intensive case finding hold promise for feasible, effective transmission reduction. Infection control in community settings has been neglected and requires urgent attention. Developing and implementing improved strategies for decreasing transmission to children, within prisons and of drug-resistant TB are needed. PMID:23824469

  12. Transmission of Mycobacterium tuberculosis between Farmers and Cattle in Central Ethiopia

    PubMed Central

    Ameni, Gobena; Tadesse, Konjit; Hailu, Elena; Deresse, Yohannes; Medhin, Girmay; Aseffa, Abraham; Hewinson, Glyn; Vordermeier, Martin; Berg, Stefan

    2013-01-01

    Background Transmission of Mycobacterium tuberculosis (M. tuberculosis) complex could be possible between farmers and their cattle in Ethiopia. Methodology/Principal Findings A study was conducted in mixed type multi-purposes cattle raising region of Ethiopia on 287 households (146 households with case of pulmonary tuberculosis (TB) and 141 free of TB) and 287 herds consisting of 2,033 cattle belonging to these households to evaluate transmission of TB between cattle and farmers. Interview, bacteriological examinations and molecular typing were used for human subjects while comparative intradermal tuberculin (CIDT) test, post mortem and bacteriological examinations, and molecular typing were used for animal studies. Herd prevalence of CIDT reactors was 9.4% and was higher (p<0.01) in herds owned by households with TB than in herds owned by TB free households. Animal prevalence was 1.8% and also higher (p<0.01) in cattle owned by households with TB case than in those owned by TB free households. All mycobacteria (141) isolated from farmers were M. tuberculosis, while only five of the 16 isolates from cattle were members of the M. tuberculosis complex (MTC) while the remaining 11 were members of non-tuberculosis mycobacteria (NTM). Further speciation of the five MTC isolates showed that three of the isolates were M. bovis (strain SB1176), while the remaining two were M. tuberculosis strains (SIT149 and SIT53). Pathology scoring method described by “Vordermeier et al. (2002)” was applied and the average severity of pathology in two cattle infected with M. bovis, in 11 infected with NTM and two infected with M. tuberculosis were 5.5, 2.1 and 0.5, respectively. Conclusions/Significance The results showed that transmission of TB from farmers to cattle by the airborne route sensitizes the cows but rarely leads to TB. Similarly, low transmission of M. bovis between farmers and their cattle was found, suggesting requirement of ingestion of contaminated milk from cows

  13. A VSEIR model for transmission of tuberculosis (TB) disease in North Sumatera, Indonesia

    NASA Astrophysics Data System (ADS)

    Rangkuti, Yulita M.; Sinaga, Marlina S.; Marpaung, F.; Side, Syafruddin

    2014-12-01

    In this work, Vaccination (V), Susceptible (S) Infected (I), and Recovered (R) (VSIR) model for transmission of Tuberculosis in North Sumatera is modified. An exposed class is adopted to VSIR model so called VSEIR to determine the probability of people who infectious before infected. This model is written in ordinary differential equation (ODEs) in five classes. Determination the equilibrium point and stability analysis of the model is discussed to determine the dynamic behaviour of systems. A simulation is also discussed to see the suitable model to North Sumatera data. The simulation of VSEIR model indicates Tuberculosis has not endemic in North Sumatera.

  14. Mycobacterium tuberculosis Transmission among Elderly Persons, Yamagata Prefecture, Japan, 2009–2015

    PubMed Central

    Wada, Takayuki; Suzuki, Yu; Ikeda, Tatsuya; Mizuta, Katsumi; Yamamoto, Taro; Ahiko, Tadayuki

    2017-01-01

    In many countries with low to moderate tuberculosis (TB) incidence, cases have shifted to elderly persons. It is unclear, however, whether these cases are associated with recent Mycobacterium tuberculosis transmissionor represent reactivation of past disease. During 2009–2015, we performed a population-based TB investigation in Yamagata Prefecture, Japan, using in-depth contact tracing and 24-loci variable-number tandem-repeat typing optimized for Beijing family M. tuberculosis strains. We analyzed 494 strains, of which 387 (78.3%) were derived from elderly patients. Recent transmission with an epidemiologic link was confirmed in 22 clusters (70 cases). In 17 (77.3%) clusters, the source patient was elderly; 11 (64.7%) of the 17 clusters occurred in a hospital or nursing home. In this setting, the increase in TB cases was associated with M. tuberculosis transmissions from elderly persons. Prevention of transmission in places where elderly persons gather will be an effective strategy for decreasing TB incidence among predominantly elderly populations. PMID:28221133

  15. Mathematical analysis of tuberculosis transmission model with delay

    NASA Astrophysics Data System (ADS)

    Lapaan, R. D.; Collera, J. A.; Addawe, J. M.

    2016-11-01

    In this paper, a delayed Tuberculosis infection model is formulated and investigated. We showed the existence of disease free equilibrium and endemic equilibrium points. We used La Salle-Lyapunov Invariance Principle to show that if the reproductive number R0 < 1, the disease-free equilibrium of the model is globally asymptotically stable. Numerical simulations are then performed to illustrate the existence of the disease free equilibrium and the endemic equilibrium point for a given value of R0. Thus, when R0 < 1, the disease dies out in the population.

  16. Chest Radiographic Patterns and the Transmission of Tuberculosis: Implications for Automated Systems

    PubMed Central

    Lau, Angela; Barrie, James; Winter, Christopher; Elamy, Abdel-Halim; Tyrrell, Gregory; Long, Richard

    2016-01-01

    Background Computer-aided detection to identify and diagnose pulmonary tuberculosis is being explored. While both cavitation on chest radiograph and smear-positivity on microscopy are independent risk factors for the infectiousness of pulmonary tuberculosis it is unknown which radiographic pattern, were it detectable, would provide the greatest public health benefit; i.e. reduced transmission. Herein we provide that evidence. Objectives 1) to determine whether pulmonary tuberculosis in a high income, low incidence country is more likely to present with “typical” adult-type pulmonary tuberculosis radiographic features and 2) to determine whether those with “typical” radiographic features are more likely than those without such features to transmit the organism and/or cause secondary cases. Methods Over a three-year period beginning January 1, 2006 consecutive adults with smear-positive pulmonary tuberculosis in the Province of Alberta, Canada, were identified and their pre-treatment radiographs scored by three independent readers as “typical” (having an upper lung zone predominant infiltrate, with or without cavitation but no discernable adenopathy) or “atypical” (all others). Each patient’s pre-treatment bacillary burden was carefully documented and, during a 30-month transmission window, each patient’s transmission events were recorded. Mycobacteriology, radiology and transmission were compared in those with “typical” versus “atypical” radiographs. Findings A total of 97 smear-positive pulmonary tuberculosis cases were identified, 69 (71.1%) with and 28 (28.9%) without “typical” chest radiographs. “Typical” cases were more likely to have high bacillary burdens and cavitation (Odds Ratios and 95% Confidence Intervals: 2.75 [1.04–7.31] and 9.10 [2.51–32.94], respectively). Typical cases were also responsible for most transmission events—78% of tuberculin skin test conversions (p<0.002) and 95% of secondary cases in reported

  17. Recent transmission of drug-resistant Mycobacterium tuberculosis in a prison population in southern Brazil.

    PubMed

    Reis, Ana Julia; David, Simone Maria Martini de; Nunes, Luciana de Souza; Valim, Andreia Rosane de Moura; Possuelo, Lia Gonçalves

    2016-01-01

    We conducted a cross-sectional, retrospective study, characterized by classical and molecular epidemiology, involving M. tuberculosis isolates from a regional prison in southern Brazil. Between January of 2011 and August of 2014, 379 prisoners underwent sputum smear microscopy and culture; 53 (13.9%) were diagnosed with active tuberculosis. Of those, 8 (22.9%) presented with isoniazid-resistant tuberculosis. Strain genotyping was carried out by 15-locus mycobacterial interspersed repetitive unit-variable-number tandem-repeat analysis; 68.6% of the patients were distributed into five clusters, and 87.5% of the resistant cases were in the same cluster. The frequency of drug-resistant tuberculosis cases and the rate of recent transmission were high. Our data suggest the need to implement an effective tuberculosis control program within the prison system. RESUMO Estudo transversal, retrospectivo, com isolados de M. tuberculosis de pacientes de um presídio regional no sul do Brasil, caracterizado através de epidemiologia clássica e molecular. Entre janeiro de 2011 e agosto de 2014, 379 detentos foram submetidos a baciloscopia e cultura, sendo 53 (13,9%) diagnosticados com tuberculose ativa. Desses, 8 (22,9%) apresentavam tuberculose resistente a isoniazida. A genotipagem das cepas foi realizada por 15-locus mycobacterial interspersed repetitive units-variable number of tandem repeat analysis; 68,6% dos pacientes estavam distribuídos em cinco clusters, e 87,5% dos casos resistentes estavam em um mesmo cluster. Verificou-se uma frequência elevada de casos de resistência e alta taxa de transmissão recente. Estes dados sugerem a necessidade da implantação de um programa efetivo de controle da tuberculose no sistema prisional.

  18. Accuracy of prospective space-time surveillance in detecting tuberculosis transmission.

    PubMed

    Verma, Aman; Schwartzman, Kevin; Behr, Marcel A; Zwerling, Alice; Allard, Robert; Rochefort, Christian M; Buckeridge, David L

    2014-04-01

    To improve detection of tuberculosis transmission, public health can supplement contact tracing with space-time surveillance. However, investigation of space-time clusters not due to transmission (false alarms), may lead to costly, unnecessary interventions. We measured the accuracy of prospective space-time surveillance in detecting tuberculosis transmission, assessing the number of clusters containing transmission and the false alarm rate. We simulated monthly prospective applications of a scan statistic using the home addresses and diagnosis dates of all 1566 culture-positive TB cases reported in Montreal during 1996-2007. We verified transmission within the space-time clusters by analyzing the TB genotype. Over 11.5 years, at 1.3 false alarms per month, we detected 89 transmission chains; at 0.05 false alarms per month we detected 5 transmission chains. We found evidence that prospective space-time surveillance for TB leads to a high false alarm rate, limiting its practical utility in settings with TB epidemiology similar to Montreal. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. The number of privately treated tuberculosis cases in India: an estimation from drug sales data.

    PubMed

    Arinaminpathy, Nimalan; Batra, Deepak; Khaparde, Sunil; Vualnam, Thongsuanmung; Maheshwari, Nilesh; Sharma, Lokesh; Nair, Sreenivas A; Dewan, Puneet

    2016-11-01

    Understanding the amount of tuberculosis managed by the private sector in India is crucial to understanding the true burden of the disease in the country, and thus globally. In the absence of quality surveillance data on privately treated patients, commercial drug sales data offer an empirical foundation for disease burden estimation. We used a large, nationally representative commercial dataset on sales of 189 anti-tuberculosis products available in India to calculate the amount of anti-tuberculosis treatment in the private sector in 2013-14. We corrected estimates using validation studies that audited prescriptions against tuberculosis diagnosis, and estimated uncertainty using Monte Carlo simulation. To address implications for numbers of patients with tuberculosis, we explored varying assumptions for average duration of tuberculosis treatment and accuracy of private diagnosis. There were 17·793 million patient-months (95% credible interval 16·709 million to 19·841 million) of anti-tuberculosis treatment in the private sector in 2014, twice as many as the public sector. If 40-60% of private-sector tuberculosis diagnoses are correct, and if private-sector tuberculosis treatment lasts on average 2-6 months, this implies that 1·19-5·34 million tuberculosis cases were treated in the private sector in 2014 alone. The midpoint of these ranges yields an estimate of 2·2 million cases, two to three times higher than currently assumed. India's private sector is treating an enormous number of patients for tuberculosis, appreciably higher than has been previously recognised. Accordingly, there is a re-doubled need to address this burden and to strengthen surveillance. Tuberculosis burden estimates in India and worldwide require revision. Bill & Melinda Gates Foundation. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

  20. The Detection of Airborne Transmission of Tuberculosis from HIV-Infected Patients, Using an In Vivo Air Sampling Model

    PubMed Central

    Escombe, A. Roderick; Oeser, Clarissa; Gilman, Robert H.; Navincopa, Marcos; Ticona, Eduardo; Martínez, Carlos; Caviedes, Luz; Sheen, Patricia; Gonzalez, Armando; Noakes, Catherine; Moore, David A. J.; Friedland, Jon S.; Evans, Carlton A.

    2010-01-01

    Background Nosocomial transmission of tuberculosis remains an important public health problem. We created an in vivo air sampling model to study airborne transmission of tuberculosis from patients coinfected with human immunodeficiency virus (HIV) and to evaluate environmental control measures. Methods An animal facility was built above a mechanically ventilated HIV-tuberculosis ward in Lima, Peru. A mean of 92 guinea pigs were continuously exposed to all ward exhaust air for 16 months. Animals had tuberculin skin tests performed at monthly intervals, and those with positive reactions were removed for autopsy and culture for tuberculosis. Results Over 505 consecutive days, there were 118 ward admissions by 97 patients with pulmonary tuberculosis, with a median duration of hospitalization of 11 days. All patients were infected with HIV and constituted a heterogeneous group with both new and existing diagnoses of tuberculosis. There was a wide variation in monthly rates of guinea pigs developing positive tuberculin test results (0%–53%). Of 292 animals exposed to ward air, 159 developed positive tuberculin skin test results, of which 129 had laboratory confirmation of tuberculosis. The HIV-positive patients with pulmonary tuberculosis produced a mean of 8.2 infectious quanta per hour, compared with 1.25 for HIV-negative patients with tuberculosis in similar studies from the 1950s. The mean monthly patient infectiousness varied greatly, from production of 0–44 infectious quanta per hour, as did the theoretical risk for a health care worker to acquire tuberculosis by breathing ward air. Conclusions HIV-positive patients with tuberculosis varied greatly in their infectiousness, and some were highly infectious. Use of environmental control strategies for nosocomial tuberculosis is therefore a priority, especially in areas with a high prevalence of both tuberculosis and HIV infection. PMID:17443474

  1. Genetic diversity, transmission dynamics and drug resistance of Mycobacterium tuberculosis in Angola.

    PubMed

    Perdigão, João; Clemente, Sofia; Ramos, Jorge; Masakidi, Pedro; Machado, Diana; Silva, Carla; Couto, Isabel; Viveiros, Miguel; Taveira, Nuno; Portugal, Isabel

    2017-02-23

    Tuberculosis (TB) poses a serious public health problem in Angola. No surveillance data on drug resistance is available and nothing is known regarding the genetic diversity and population structure of circulating Mycobacterium tuberculosis strains. Here, we have genotyped and evaluated drug susceptibility of 89 Mycobacterium tuberculosis clinical isolates from Luanda. Thirty-three different spoligotype profiles corresponding to 24 different Shared International Types (SIT) and 9 orphan profiles were detected. SIT 20 (LAM1) was the most prevalent (n = 16, 18.2%) followed by SIT 42 (LAM9; n = 15, 17.1%). Overall, the M. tuberculosis population structure in this sample was dominated by LAM (64.8%) and T (33.0%) strains. Twenty-four-loci MIRU-VNTR analysis revealed that a total of 13 isolates were grouped in 5 distinct clusters. Drug susceptibility data showed that 22 (24.7%) of the 89 clinical isolates were resistant to one or more antibacillary drugs of which 4 (4.5%) were multidrug resistant. In conclusion, this study demonstrates a high predominance of LAM strains circulating in the Luanda setting and the presence of recent transmission events. The rate and the emergence dynamics of drug resistant TB found in this sample are significant and highlight the need of further studies specifically focused on MDR-TB transmission.

  2. Genetic diversity, transmission dynamics and drug resistance of Mycobacterium tuberculosis in Angola

    PubMed Central

    Perdigão, João; Clemente, Sofia; Ramos, Jorge; Masakidi, Pedro; Machado, Diana; Silva, Carla; Couto, Isabel; Viveiros, Miguel; Taveira, Nuno; Portugal, Isabel

    2017-01-01

    Tuberculosis (TB) poses a serious public health problem in Angola. No surveillance data on drug resistance is available and nothing is known regarding the genetic diversity and population structure of circulating Mycobacterium tuberculosis strains. Here, we have genotyped and evaluated drug susceptibility of 89 Mycobacterium tuberculosis clinical isolates from Luanda. Thirty-three different spoligotype profiles corresponding to 24 different Shared International Types (SIT) and 9 orphan profiles were detected. SIT 20 (LAM1) was the most prevalent (n = 16, 18.2%) followed by SIT 42 (LAM9; n = 15, 17.1%). Overall, the M. tuberculosis population structure in this sample was dominated by LAM (64.8%) and T (33.0%) strains. Twenty-four-loci MIRU-VNTR analysis revealed that a total of 13 isolates were grouped in 5 distinct clusters. Drug susceptibility data showed that 22 (24.7%) of the 89 clinical isolates were resistant to one or more antibacillary drugs of which 4 (4.5%) were multidrug resistant. In conclusion, this study demonstrates a high predominance of LAM strains circulating in the Luanda setting and the presence of recent transmission events. The rate and the emergence dynamics of drug resistant TB found in this sample are significant and highlight the need of further studies specifically focused on MDR-TB transmission. PMID:28230095

  3. Tuberculosis

    MedlinePlus

    ... Can I Help Someone Who's Being Bullied? Volunteering Tuberculosis KidsHealth > For Teens > Tuberculosis Print A A A What's in this article? ... Duration When to Call the Doctor en español Tuberculosis TB Basics Tuberculosis (also known as "TB") is ...

  4. Tuberculosis

    MedlinePlus

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Tuberculosis KidsHealth > For Teens > Tuberculosis A A A What's in this article? TB ... Duration When to Call the Doctor en español Tuberculosis TB Basics Tuberculosis (also known as "TB") is ...

  5. Transmission overhaul estimates for partial and full replacement at repair

    NASA Technical Reports Server (NTRS)

    Savage, M.; Lewicki, D. G.

    1991-01-01

    Timely transmission overhauls increase in-flight service reliability greater than the calculated design reliabilities of the individual aircraft transmission components. Although necessary for aircraft safety, transmission overhauls contribute significantly to aircraft expense. Predictions of a transmission's maintenance needs at the design stage should enable the development of more cost effective and reliable transmissions in the future. The frequency is estimated of overhaul along with the number of transmissions or components needed to support the overhaul schedule. Two methods based on the two parameter Weibull statistical distribution for component life are used to estimate the time between transmission overhauls. These methods predict transmission lives for maintenance schedules which repair the transmission with a complete system replacement or repair only failed components of the transmission. An example illustrates the methods.

  6. Use of genomics to track bovine tuberculosis transmission.

    PubMed

    Kao, R R; Price-Carter, M; Robbe-Austerman, S

    2016-04-01

    The control of any infectious disease of livestock is made more difficult by the presence of a wildlife reservoir, as the reservoir is often poorly observed and difficult to manage. This problem is particularly acute for bovine tuberculosis (bTB) because the long duration of infection and low levels of infectiousness make tracing the sources of infection difficult. For over 30 years, the process of contact tracing has been aided by the exploitation of molecular markers in the pathogen, but this has largely only been capable of characterising broad associations between large communities of similar types. However, the recent advent of mass high-throughput 'whole-genome' sequencing (WGS) has revolutionised forensic epidemiology for other diseases, and now it has the potential to do so for bTB. In this review, the authors consider the historical context of WGS use and look at what prior molecular techniques have already achieved. They outline the key approaches to interpreting WGS data and consider both the role of advanced analytical techniques that exploit the evolutionary and epidemiological properties of the system and the problems associated with quantifying the role of hidden reservoirs of disease. Finally, they consider the particular difficulties associated with developing this technology for routine diagnostics and its potential for mass use.

  7. Tuberculosis in pregnancy: an estimate of the global burden of disease.

    PubMed

    Sugarman, Jordan; Colvin, Charlotte; Moran, Allisyn C; Oxlade, Olivia

    2014-12-01

    The estimated number of maternal deaths in 2013 worldwide was 289 000, a 45% reduction from 1990. Non-obstetric causes such as infectious diseases including tuberculosis now account for 28% of maternal deaths. In 2013, 3·3 million cases of tuberculosis were estimated to occur in women globally. During pregnancy, tuberculosis is associated with poor outcomes, including increased mortality in both the neonate and the pregnant woman. The aim of our study was to estimate the burden of tuberculosis disease among pregnant women, and to describe how maternal care services could be used as a platform to improve case detection. We used publicly accessible country-level estimates of the total population, distribution of the total population by age and sex, crude birth rate, estimated prevalence of active tuberculosis, and case notification data by age and sex to estimate the number of pregnant women with active tuberculosis for 217 countries. We then used indicators of health system access and tuberculosis diagnostic test performance obtained from published literature to determine how many of these cases could ultimately be detected. We estimated that 216 500 (95% uncertainty range 192 100-247 000) active tuberculosis cases existed in pregnant women globally in 2011. The greatest burdens were in the WHO African region with 89 400 cases and the WHO South East Asian region with 67 500 cases in pregnant women. Chest radiography or Xpert RIF/MTB, delivered through maternal care services, were estimated to detect as many as 114 100 and 120 300 tuberculosis cases, respectively. Copyright © 2014 Sugarman et al. Open Access article distributed under the terms of CC BY-NC-SA. Published by .. All rights reserved.

  8. Whole Genome Sequencing Demonstrates Limited Transmission within Identified Mycobacterium tuberculosis Clusters in New South Wales, Australia

    PubMed Central

    Gurjav, Ulziijargal; Outhred, Alexander C.; Jelfs, Peter; McCallum, Nadine; Wang, Qinning; Hill-Cawthorne, Grant A.; Marais, Ben J.; Sintchenko, Vitali

    2016-01-01

    Australia has a low tuberculosis incidence rate with most cases occurring among recent immigrants. Given suboptimal cluster resolution achieved with 24-locus mycobacterium interspersed repetitive unit (MIRU-24) genotyping, the added value of whole genome sequencing was explored. MIRU-24 profiles of all Mycobacterium tuberculosis culture-confirmed tuberculosis cases diagnosed between 2009 and 2013 in New South Wales (NSW), Australia, were examined and clusters identified. The relatedness of cases within the largest MIRU-24 clusters was assessed using whole genome sequencing and phylogenetic analyses. Of 1841 culture-confirmed TB cases, 91.9% (1692/1841) had complete demographic and genotyping data. East-African Indian (474; 28.0%) and Beijing (470; 27.8%) lineage strains predominated. The overall rate of MIRU-24 clustering was 20.1% (340/1692) and was highest among Beijing lineage strains (35.7%; 168/470). One Beijing and three East-African Indian (EAI) clonal complexes were responsible for the majority of observed clusters. Whole genome sequencing of the 4 largest clusters (30 isolates) demonstrated diverse single nucleotide polymorphisms (SNPs) within identified clusters. All sequenced EAI strains and 70% of Beijing lineage strains clustered by MIRU-24 typing demonstrated distinct SNP profiles. The superior resolution provided by whole genome sequencing demonstrated limited M. tuberculosis transmission within NSW, even within identified MIRU-24 clusters. Routine whole genome sequencing could provide valuable public health guidance in low burden settings. PMID:27737005

  9. Tuberculosis

    MedlinePlus

    Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body. TB spreads through the air when a person with ...

  10. [Evaluation of tuberculosis transmission routes in an outbreak among young adults for developing an effective method for contact investigations].

    PubMed

    Toyota, Makoto

    2012-12-01

    To evaluate the various transmission routes of tuberculosis in an outbreak among young adults in order to develop an effective method for contact investigations. We reviewed the records of 21 tuberculosis patients involved in an outbreak of tuberculosis; the records were collected by conventional epidemiological studies. Mycobacterium tuberculosis isolates were genotyped using IS6110-based restriction fragment length polymorphism (RFLP). The index patient was a 26-year-old man whose 32-year-old brother was identified as the source patient of tuberculosis through a contact investigation. Investigation of their contacts led to the identification of 10 tuberculosis patients. Further, 5 more patients with only casual contact with the index or source patients developed tuberculosis 18-25 months after identification of the index patient. The RFLP analysis of strains obtained from these 5 patients as well as the index and source patients revealed an identical pattern. Further, 4 persons, among those who had epidemiological links with some of the above-mentioned 5 patients, developed tuberculosis 22-34 months after identification of the index patient. All 21 patients were relatively young. In total, 15 strains obtained from these patients were sent for the RFLP analysis, all of which showed an identical pattern. The epidemiological links were categorized into a household environment, an entertainment area, a university, a music band, and a construction site. Molecular epidemiology can provide insights into the process of tuberculosis transmission, which may otherwise go unrecognized by conventional contact investigations. Additionally, it can play an important role in identifying places of tuberculosis outbreaks and routes of transmission in a contact investigation.

  11. The risk of tuberculosis transmission to free-ranging great apes.

    PubMed

    Wolf, Tiffany M; Sreevatsan, Srinand; Travis, Dominic; Mugisha, Lawrence; Singer, Randall S

    2014-01-01

    Pathogen exchange between humans and primates has been facilitated by anthropogenic disturbances, such as changing land use patterns, habitat destruction, and poaching, which decrease population sizes and increase levels of primate-human interaction. As a result, human and domestic animal diseases have become a recognized threat to endangered primate populations. Tuberculosis is a major global human and animal health concern, especially in equatorial Africa where many of the remaining free-living great ape populations exist in proximity with exposed and/or infected human populations and their domestic animals. Increased anthropogenic pressure creates an opportunity for the anthropozoonotic spread of this disease. This review examines current evidence of the risk of tuberculosis transmission to great apes, the benefits and limitations of current detection methods, the impact of current great ape conservation and management strategies on this risk, and the need for an ecosystem health-based approach to mitigating the risks of tuberculosis transmission to great apes. © 2013 Wiley Periodicals, Inc.

  12. Problems connected with estimating the incidence of tuberculosis infection*

    PubMed Central

    Narain, Raj; Nair, S. S.; Chandrasekhar, P.; Rao, G. Ramanatha

    1966-01-01

    Many problems have to be faced in the estimation of an apparently simple but valuable index—namely, the incidence of tuberculosis infection. Very little attention seems to have been paid to these problems so far. Records from 50 villages in a district of South India, whose populations were tested with 1 TU of PPD RT 23 in Tween 80 diluent and retested after 18 months, have been examined for a reappraisal of existing methods. As a result, it has been found that some of these methods are subject to gross errors and that available figures are unreliable. For estimating the newly infected, a new approach based on the drawing of a curve for the distribution of differences in reaction size from one round of tuberculin testing to another is presented. Further, it is shown that the newly infected probably constitute a homogeneous group with an increase in mean reaction size of about 24 mm and standard deviation of 4 mm. Accordingly, 98% of the newly infected show an increase in reaction size of 16 mm or more. There are others who show similarly large increases in allergy on a retest, even in the absence of infection. The number of persons in the latter category rises with age and is likely to be greater in areas with a high prevalence of non-specific allergy. PMID:5296384

  13. Impact of HIV co-infection on the evolution and transmission of multidrug-resistant tuberculosis

    PubMed Central

    Eldholm, Vegard; Rieux, Adrien; Monteserin, Johana; Lopez, Julia Montana; Palmero, Domingo; Lopez, Beatriz; Ritacco, Viviana; Didelot, Xavier; Balloux, Francois

    2016-01-01

    The tuberculosis (TB) epidemic is fueled by a parallel Human Immunodeficiency Virus (HIV) epidemic, but it remains unclear to what extent the HIV epidemic has been a driver for drug resistance in Mycobacterium tuberculosis (Mtb). Here we assess the impact of HIV co-infection on the emergence of resistance and transmission of Mtb in the largest outbreak of multidrug-resistant TB in South America to date. By combining Bayesian evolutionary analyses and the reconstruction of transmission networks utilizing a new model optimized for TB, we find that HIV co-infection does not significantly affect the transmissibility or the mutation rate of Mtb within patients and was not associated with increased emergence of resistance within patients. Our results indicate that the HIV epidemic serves as an amplifier of TB outbreaks by providing a reservoir of susceptible hosts, but that HIV co-infection is not a direct driver for the emergence and transmission of resistant strains. DOI: http://dx.doi.org/10.7554/eLife.16644.001 PMID:27502557

  14. Assessment of Mycobacterium tuberculosis transmission in Oxfordshire, UK, 2007–12, with whole pathogen genome sequences: an observational study

    PubMed Central

    Walker, Timothy M; Lalor, Maeve K; Broda, Agnieszka; Ortega, Luisa Saldana; Morgan, Marcus; Parker, Lynne; Churchill, Sheila; Bennett, Karen; Golubchik, Tanya; Giess, Adam P; Del Ojo Elias, Carlos; Jeffery, Katie J; Bowler, Ian C J W; Laurenson, Ian F; Barrett, Anne; Drobniewski, Francis; McCarthy, Noel D; Anderson, Laura F; Abubakar, Ibrahim; Thomas, H Lucy; Monk, Philip; Smith, E Grace; Walker, A Sarah; Crook, Derrick W

    2015-01-01

    Summary Background Patients born outside the UK have contributed to a 20% rise in the UK’s tuberculosis incidence since 2000, but their effect on domestic transmission is not known. Here we use whole-genome sequencing to investigate the epidemiology of tuberculosis transmission in an unselected population over 6 years. Methods We identified all residents with Oxfordshire postcodes with a Mycobacterium tuberculosis culture or a clinical diagnosis of tuberculosis between Jan 1, 2007, and Dec 31, 2012, using local databases and checking against the national Enhanced Tuberculosis Surveillance database. We used Illumina technology to sequence all available M tuberculosis cultures from identified cases. Sequences were clustered by genetic relatedness and compared retrospectively with contact investigations. The first patient diagnosed in each cluster was defined as the index case, with links to subsequent cases assigned first by use of any epidemiological linkage, then by genetic distance, and then by timing of diagnosis. Findings Although we identified 384 patients with a diagnosis of tuberculosis, country of birth was known for 380 and we sequenced isolates from 247 of 269 cases with culture-confirmed disease. 39 cases were genomically linked within 13 clusters, implying 26 local transmission events. Only 11 of 26 possible transmissions had been previously identified through contact tracing. Of seven genomically confirmed household clusters, five contained additional genomic links to epidemiologically unidentified non-household members. 255 (67%) patients were born in a country with high tuberculosis incidence, conferring a local incidence of 109 cases per 100 000 population per year in Oxfordshire, compared with 3·5 cases per 100 000 per year for those born in low-incidence countries. However, patients born in the low-incidence countries, predominantly UK, were more likely to have pulmonary disease (adjusted odds ratio 1·8 [95% CI 1·2–2·9]; p=0·009), social

  15. Multi-state modelling reveals sex-dependent transmission, progression and severity of tuberculosis in wild badgers.

    PubMed

    Graham, J; Smith, G C; Delahay, R J; Bailey, T; McDonald, R A; Hodgson, D

    2013-07-01

    Statistical models of epidemiology in wildlife populations usually consider diseased individuals as a single class, despite knowledge that infections progress through states of severity. Bovine tuberculosis (bTB) is a serious zoonotic disease threatening the UK livestock industry, but we have limited understanding of key epidemiological processes in its wildlife reservoirs. We estimated differential survival, force of infection and progression in disease states in a population of Eurasian badgers (Meles meles), naturally infected with bTB. Our state-dependent models overturn prevailing categorizations of badger disease states, and find novel evidence for early onset of disease-induced mortality in male but not female badgers. Males also have higher risk of infection and more rapid disease progression which, coupled with state-dependent increases in mortality, could promote sex biases in the risk of transmission to cattle. Our results reveal hidden complexities in wildlife disease epidemiology, with implications for the management of TB and other zoonotic diseases.

  16. Spatial-temporal distribution of genotyped tuberculosis cases in a county with active transmission.

    PubMed

    Agarwal, Saroochi; Nguyen, Duc T; Teeter, Larry D; Graviss, Edward A

    2017-05-31

    Harris County, Texas is the third most populous county in the United States and consistently has tuberculosis rates above the national average. Understanding jurisdictional epidemiologic characteristics for the most common Mycobacterium tuberculosis genotyped clusters is needed for tuberculosis prevention programs. Our objective is to describe the demographic, laboratory, clinical, temporal and geospatial characteristics for the most common Mycobacterium tuberculosis GENType clusters in Harris County from 2009 to 2015. We analyzed data from the Centers for Disease Control and Prevention (CDC) Tuberculosis Genotyping Information Management System (TB GIMS). Chi-square analyses were used to determine associations between selected clusters and specific characteristics of interest. Geographical Information System (GIS) point density and hot spot maps were generated and analyzed with ArcGIS 10.4. In Harris County from 2009 to 2015, 1655 of 1705 (97.1%) culture positive tuberculosis cases were genotyped and assigned a GENType, and 1058 different GENTypes were identified. The analyzed genotype clusters represent 14.1% (233/1655) of all genotyped cases: G00010 (n = 118), G00014 (n = 38), G00769 (n = 33), G01521 (n = 26), and G08964 (n = 18). Male gender (p = 0.002), ethnicity (p < 0.001), homelessness (p < 0.001), excessive alcohol use (p = 0.002), and U.S.-birth (p = 0.004) were associated with the 5 GENTypes. Hot and cold spots were identified as geographic areas having high and low TB incidence. Of more than 1000 distinct GENTypes identified in Harris County, there were 5 common Mycobacterium tuberculosis GENType clusters seen from 2009 to 2015. The common genotypes were observed primarily in U.S.-born populations despite the large foreign-born population residing in Harris County. GENType was significant distributed spatially and temporally in Harris County in the analyzed time period indicating that there may be outbreaks caused by transmission.

  17. Usefulness of molecular techniques to identify ongoing tuberculosis transmission in Saudi Arabia.

    PubMed

    Al-Hajoj, Sahal A; Mohammed, Viqaruddin K; Al-Hokail, Abdullah A

    2007-02-01

    This study represents the first time that molecular tracing techniques have been used to identify patterns of tuberculosis TB infection in Saudi Arabia. The 2 strains were isolated from a socio-economically advantage family who share a number of common facilities including a car and a driver. There are several factors that may play vital roles in on-going transmission of TB in Saudi Arabia including a high number of expatriates, the Hajj pilgrimage, and the social habits of Saudi citizens. Our sibling case series is believed to be a frequent pattern of disease transmission in this country. Control measures such as health education, active case finding, and prompt and supervised medical treatment are needed. More studies using molecular techniques are recommended to find the incidence of cross infection in Saudi Arabia. In addition, molecular techniques have to be established in all reference laboratories to help the detection of ongoing active transmission, molecular epidemiology and detect sources of infection.

  18. Standard Genotyping Overestimates Transmission of Mycobacterium tuberculosis among Immigrants in a Low-Incidence Country

    PubMed Central

    Stucki, David; Ballif, Marie; Egger, Matthias; Furrer, Hansjakob; Altpeter, Ekkehardt; Battegay, Manuel; Droz, Sara; Bruderer, Thomas; Coscolla, Mireia; Borrell, Sonia; Zürcher, Kathrin; Janssens, Jean-Paul; Calmy, Alexandra; Mazza Stalder, Jesica; Jaton, Katia; Rieder, Hans L.; Pfyffer, Gaby E.; Siegrist, Hans H.; Hoffmann, Matthias; Fehr, Jan; Dolina, Marisa; Frei, Reno; Schrenzel, Jacques; Böttger, Erik C.; Gagneux, Sebastien

    2016-01-01

    Immigrants from regions with a high incidence of tuberculosis (TB) are a risk group for TB in low-incidence countries such as Switzerland. In a previous analysis of a nationwide collection of 520 Mycobacterium tuberculosis isolates from 2000 to 2008, we identified 35 clusters comprising 90 patients based on standard genotyping (24-locus mycobacterial interspersed repetitive-unit–variable-number tandem-repeat [MIRU-VNTR] typing and spoligotyping). Here, we used whole-genome sequencing (WGS) to revisit these transmission clusters. Genome-based transmission clusters were defined as isolate pairs separated by ≤12 single nucleotide polymorphisms (SNPs). WGS confirmed 17/35 (49%) MIRU-VNTR typing clusters; the other 18 clusters contained pairs separated by >12 SNPs. Most transmission clusters (3/4) of Swiss-born patients were confirmed by WGS, as opposed to 25% (4/16) of the clusters involving only foreign-born patients. The overall clustering proportion was 17% (90 patients; 95% confidence interval [CI], 14 to 21%) by standard genotyping but only 8% (43 patients; 95% CI, 6 to 11%) by WGS. The clustering proportion was 17% (67/401; 95% CI, 13 to 21%) by standard genotyping and 7% (26/401; 95% CI, 4 to 9%) by WGS among foreign-born patients and 19% (23/119; 95% CI, 13 to 28%) and 14% (17/119; 95% CI, 9 to 22%), respectively, among Swiss-born patients. Using weighted logistic regression, we found weak evidence of an association between birth origin and transmission (adjusted odds ratio of 2.2 and 95% CI of 0.9 to 5.5 comparing Swiss-born patients to others). In conclusion, standard genotyping overestimated recent TB transmission in Switzerland compared to WGS, particularly among immigrants from regions with a high TB incidence, where genetically closely related strains often predominate. We recommend the use of WGS to identify transmission clusters in settings with a low incidence of TB. PMID:27194683

  19. The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis.

    PubMed

    Dheda, Keertan; Gumbo, Tawanda; Maartens, Gary; Dooley, Kelly E; McNerney, Ruth; Murray, Megan; Furin, Jennifer; Nardell, Edward A; London, Leslie; Lessem, Erica; Theron, Grant; van Helden, Paul; Niemann, Stefan; Merker, Matthias; Dowdy, David; Van Rie, Annelies; Siu, Gilman K H; Pasipanodya, Jotam G; Rodrigues, Camilla; Clark, Taane G; Sirgel, Frik A; Esmail, Aliasgar; Lin, Hsien-Ho; Atre, Sachin R; Schaaf, H Simon; Chang, Kwok Chiu; Lange, Christoph; Nahid, Payam; Udwadia, Zarir F; Horsburgh, C Robert; Churchyard, Gavin J; Menzies, Dick; Hesseling, Anneke C; Nuermberger, Eric; McIlleron, Helen; Fennelly, Kevin P; Goemaere, Eric; Jaramillo, Ernesto; Low, Marcus; Jara, Carolina Morán; Padayatchi, Nesri; Warren, Robin M

    2017-03-15

    Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including Africa and Asia. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. XDR tuberculosis has evolved in several tuberculosis-endemic countries to drug-incurable or programmatically incurable tuberculosis (totally drug-resistant tuberculosis). This poses several challenges similar to those encountered in the pre-chemotherapy era, including the inability to cure tuberculosis, high mortality, and the need for alternative methods to prevent disease transmission. This phenomenon mirrors the worldwide increase in antimicrobial resistance and the emergence of other MDR pathogens, such as malaria, HIV, and Gram-negative bacteria. MDR and XDR tuberculosis are associated with high morbidity and substantial mortality, are a threat to health-care workers, prohibitively expensive to treat, and are therefore a serious public health problem. In this Commission, we examine several aspects of drug-resistant tuberculosis. The traditional view that acquired resistance to antituberculous drugs is driven by poor compliance and programmatic failure is now being questioned, and several lines of evidence suggest that alternative mechanisms-including pharmacokinetic variability, induction of efflux pumps that transport the drug out of cells, and suboptimal drug penetration into tuberculosis lesions-are likely crucial to the pathogenesis of drug-resistant tuberculosis. These factors have implications for the design of new interventions, drug delivery and dosing mechanisms, and public health policy. We discuss epidemiology and transmission dynamics, including new insights into the fundamental biology of transmission, and we review the utility of newer diagnostic tools, including

  20. Transmission permeability of tuberculosis involving immigrants, revealed by a multicentre analysis of clusters.

    PubMed

    Alonso Rodríguez, N; Chaves, F; Iñigo, J; Bouza, E; García de Viedma, D; Andrés, S; Cías, R; Daza, R; Domingo, D; Esteban, J; García, J; Gómez Mampaso, E; Herranz, M; Palenque, E; Ruiz Serrano, M J

    2009-05-01

    In recent years, the number of cases of tuberculosis (TB) among immigrants in Spain has increased markedly, and led to this analysis of the recent transmission patterns of TB in the immigrant population in Madrid. The countries from which the highest number of immigrant cases have been reported were Ecuador (21%), Romania (16%), Morocco (12%), Peru (11%) and Bolivia (9%). Fifty-one per cent of the cases were from South America. In a multicentre study (2004-2006), IS6110 restriction fragment length polymorphism and spoligotyping were used to genotype the Mycobacterium tuberculosis isolates from 632 immigrant cases from 47 countries. A total of 183 cases (29%) were grouped into 59 clusters, which are markers of potential transmission events. Most of the clusters (81%) included patients living in different healthcare districts, and 54% of the clusters were multinational. When a sample of 478 autochthonous cases was included, 53% of the clusters involving immigrants also included autochthonous cases. This study revealed marked transmission permeability among nationalities and between the immigrant and the autochthonous populations.

  1. Turning off the spigot: reducing drug-resistant tuberculosis transmission in resource-limited settings.

    PubMed

    Nardell, E; Dharmadhikari, A

    2010-10-01

    Ongoing transmission and re-infection, primarily in congregate settings, is a key factor fueling the global multidrug-resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) epidemic, especially in association with the human immunodeficiency virus. Even as efforts to broadly implement conventional TB transmission control measures begin, current strategies may be incompletely effective under the overcrowded conditions extant in high-burden, resource-limited settings. Longstanding evidence suggesting that TB patients on effective therapy rapidly become non-infectious and that unsuspected, untreated TB cases account for the most transmission makes a strong case for the implementation of rapid point-of-care diagnostics coupled with fully supervised effective treatment. Among the most important decisions affecting transmission, the choice of an MDR-TB treatment model that includes community-based treatment may offer important advantages over hospital or clinic-based care, not only in cost and effectiveness, but also in transmission control. In the community, too, rapid identification of infectious cases, especially drug-resistant cases, followed by effective, fully supervised treatment, is critical to stopping transmission. Among the conventional interventions available, we present a simple triage and separation strategy, point out that separation is intimately linked to the design and engineering of clinical space and call attention to the pros and cons of natural ventilation, simple mechanical ventilation systems, germicidal ultraviolet air disinfection, fit-tested respirators on health care workers and short-term use of masks on patients before treatment is initiated.

  2. Turning off the spigot: reducing drug-resistant tuberculosis transmission in resource-limited settings

    PubMed Central

    Nardell, E.; Dharmadhikari, A.

    2013-01-01

    SUMMARY Ongoing transmission and re-infection, primarily in congregate settings, is a key factor fueling the global multidrug-resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) epidemic, especially in association with the human immunodeficiency virus. Even as efforts to broadly implement conventional TB transmission control measures begin, current strategies may be incompletely effective under the overcrowded conditions extant in high-burden, resource-limited settings. Longstanding evidence suggesting that TB patients on effective therapy rapidly become non-infectious and that unsuspected, untreated TB cases account for the most transmission makes a strong case for the implementation of rapid point-of-care diagnostics coupled with fully supervised effective treatment. Among the most important decisions affecting transmission, the choice of an MDR-TB treatment model that includes community-based treatment may offer important advantages over hospital or clinic-based care, not only in cost and effectiveness, but also in transmission control. In the community, too, rapid identification of infectious cases, especially drug-resistant cases, followed by effective, fully supervised treatment, is critical to stopping transmission. Among the conventional interventions available, we present a simple triage and separation strategy, point out that separation is intimately linked to the design and engineering of clinical space and call attention to the pros and cons of natural ventilation, simple mechanical ventilation systems, germicidal ultraviolet air disinfection, fit-tested respirators on health care workers and short-term use of masks on patients before treatment is initiated. PMID:20843413

  3. Mycobacterium tuberculosis Beijing Strains Favor Transmission but Not Drug Resistance in China

    PubMed Central

    Yang, Chongguang; Luo, Tao; Sun, Guomei; Qiao, Ke; Sun, Gang; DeRiemer, Kathryn; Mei, Jian; Gao, Qian

    2012-01-01

    Background. The Mycobacterium tuberculosis Beijing strains are widespread globally. We aimed to determine whether Beijing strains in China are more likely than other strains to spread, and whether they are more likely to become drug resistant. We also sought to determine whether different Beijing sublineages have distinct phenotypic characteristics. Methods. We conducted a population-based molecular epidemiologic study in 6 provinces in China from 2009 to 2010. We analyzed data and specimens from culture-confirmed pulmonary tuberculosis patients. Each patient's isolate was genotyped using 16-loci variable number of tandem repeats and 6 single-nucleotide polymorphisms. Results. By genotyping, 75.0% (1031/1375) of the strains of M. tuberculosis were Beijing strains. Beijing strains were more likely than non-Beijing strains to be in a genotypic cluster (odds ratio, 2.40, P < .001), and were significantly associated with younger age (Ptrend < .05). There was no significant difference in the proportion of Beijing strains and non-Beijing strains that were drug resistant, even when stratified by new vs retreatment patients. We identified 6 sublineages of Beijing strains in the study population. The modern sublineage of Beijing strains were more likely than the ancient sublineages to be clustered (odds ratio, 2.27, P < .001). Conclusions. Beijing strains of M. tuberculosis were significantly associated with genotypic clustering, reflecting recent transmission, and younger age, but were not associated with drug resistance. Future studies of Beijing family strains should avoid assuming and attributing characteristics to the entire family and should assess strains of specific sublineages and/or settings. PMID:22865872

  4. Recent transmission of tuberculosis in Madrid: application of capture-recapture analysis to conventional and molecular epidemiology.

    PubMed

    Iñigo, J; Arce, A; Martín-Moreno, J M; Herruzo, R; Palenque, E; Chaves, F

    2003-10-01

    Population-based studies using a combination of molecular techniques and conventional epidemiological methods have been used to study the dynamics of tuberculosis (TB) transmission but the relative utility of each technique has not yet been established. A prospective population-based molecular and epidemiological study of patients diagnosed with TB was conducted in three urban districts of Madrid (Spain) during 1997-1999. Analysis was performed using the capture-recapture method including covariates in which conventional epidemiological data and the information on clustered cases obtained by DNA fingerprinting were regarded as independent and complementary procedures. The estimate obtained by molecular analysis alone, that 31.6% of TB cases were due to recent transmission, was revised to 44.8% (95% CI: 31.4-58.2) using the capture-recapture method. The estimated completeness of the combined databases for identification of recent transmission was 59.2%. Underestimation of the true prevalence of recent transmission was higher with conventional epidemiology than molecular analysis, particularly for patients <35 years old and those with a history of imprisonment. In this study, use of the capture-recapture technique allowed us to combine epidemiological information obtained by conventional and molecular methods to quantify the number of cases of recently transmitted TB in the community and identify specific populations at high risk of disease. This information is clearly important because such groups are a prime target for improved TB control measures. In the long term, this combination of techniques may contribute significantly to control the spread of TB.

  5. Tuberculosis in prisoners and their contacts in Chile: estimating incidence and latent infection.

    PubMed

    Aguilera, X P; González, C; Nájera-De Ferrari, M; Hirmas, M; Delgado, I; Olea, A; Lezaeta, L; Montaña, A; González, P; Hormazábal, J-C; Fernández, J; García, C; Herrera, T

    2016-01-01

    Contact investigation of tuberculosis (TB) patients in Chilean prisons. 1) To estimate TB incidence and the prevalence of latent tuberculous infection (LTBI) among prisoners and their contacts; and 2) to determine factors associated with disease transmission. Cross-sectional study conducted in 46 prisons (51% of the total prison population) to assess the prevalence of and risk factors for LTBI among contacts of prisoners newly diagnosed with pulmonary TB. We used in vitro interferon-gamma release assays to establish LTBI and a questionnaire to address risk factors. During the 1-year follow-up, we studied 418 contacts of 33 active TB cases. We found high TB incidence (123.9 per 100,000 prisoners) and high LTBI prevalence (29.4%) among contacts. LTBI rates are significantly higher in prison inmates than in non-prisoners (33.2% vs. 15.6%). Male sex, illicit drugs, malnutrition, corticosteroid use, low educational level and sharing a cell with a case increase the risk of LTBI. Multivariate analyses showed that corticosteroid use, duration of incarceration and overcrowding are the most relevant determinants for LTBI among all contacts. Our results confirm that incarceration increases the risk of tuberculous infection and TB disease, and that it was associated not only with origin from vulnerable groups, but also with the prison environment. Reinforcing TB control is essential to prevent TB transmission in prisons.

  6. Transmission of multidrug-resistant and extensively drug-resistant tuberculosis in rural Bangladesh: lessons learnt.

    PubMed

    Gumusboga, A; Aung, K J M; Rigouts, L; Van Deun, A

    2012-09-21

    We report community transmission of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) documented by fingerprinting, with secondary cases appearing over a period of 10 years. The index case failed MDR-TB treatment, with amplification to XDR-TB after refusing treatment when first diagnosed and developing pre-XDR-TB on private treatment. Some of the first MDR-TB patients were not started on appropriate treatment due to delayed diagnosis or to excessively rigid application of National TB Programme guidelines. Early presumptive MDR- and XDR-TB diagnosis and removal of barriers, such as obligatory hospitalisation, could have stopped this trend of resistance amplification and transmission.

  7. HIV Infection and Geographically Bound Transmission of Drug-Resistant Tuberculosis, Argentina

    PubMed Central

    López, Beatriz; Ambroggi, Marta; Palmero, Domingo; Salvadores, Bernardo; Gravina, Elida; Mazzeo, Eduardo; Imaz, Susana; Barrera, Lucía

    2012-01-01

    During 2003–2009, the National Tuberculosis (TB) Laboratory Network in Argentina gave 830 patients a new diagnosis of multidrug-resistant (MDR) TB and 53 a diagnosis of extensively drug- resistant (XDR) TB. HIV co-infection was involved in nearly one third of these cases. Strain genotyping showed that 7 major clusters gathered 56% of patients within restricted geographic areas. The 3 largest clusters corresponded to epidemic MDR TB strains that have been undergoing transmission for >10 years. The indigenous M strain accounted for 29% and 40% of MDR and XDR TB cases, respectively. Drug-resistant TB trends in Argentina are driven by spread of a few strains in hotspots where the rate of HIV infection is high. To curb transmission, the national TB program is focusing stringent interventions in these areas by strengthening infection control in large hospitals and prisons, expediting drug resistance detection, and streamlining information-sharing systems between HIV and TB programs. PMID:23092584

  8. An evaluation of indices for quantifying tuberculosis transmission using genotypes of pathogen isolates

    PubMed Central

    Tanaka, Mark M; Phong, Renault; Francis, Andrew R

    2006-01-01

    Background Infectious diseases are often studied by characterising the population structure of the pathogen using genetic markers. An unresolved problem is the effective quantification of the extent of transmission using genetic variation data from such pathogen isolates. Methods It is important that transmission indices reflect the growth of the infectious population as well as account for the mutation rate of the marker and the effects of sampling. That is, while responding to this growth rate, indices should be unresponsive to the sample size and the mutation rate. We use simulation methods taking into account both the mutation and sampling processes to evaluate indices designed to quantify transmission of tuberculosis. Results Previously proposed indices generally perform inadequately according to the above criteria, with the partial exception of the recently proposed Transmission-Mutation Index. Conclusion Any transmission index needs to take into account mutation of the marker and the effects of sampling. Simple indices are unlikely to capture the full complexity of the underlying processes. PMID:16756684

  9. A train passenger with pulmonary tuberculosis: evidence of limited transmission during travel.

    PubMed

    Moore, M; Valway, S E; Ihle, W; Onorato, I M

    1999-01-01

    In January 1996, smear- and culture-positive tuberculosis (TB) was diagnosed for a 22-year-old black man after he had traveled on two U.S. passenger trains (29.1 hours) and a bus (5.5 hours) over 2 days. To determine if transmission had occurred, passengers and crew were notified of the potential exposure and instructed to undergo a tuberculin skin test (TST). Of the 240 persons who completed screening, 4 (2%) had a documented TST conversion (increase in induration of > or = 10 mm between successive TSTs), 11 (5%) had a single positive TST (> or = 10 mm), and 225 (94%) had a negative TST (< 10 mm). For two persons who underwent conversion, no other risk factors for a conversion were identified other than exposure to the ill passenger during train and/or bus travel. These findings support limited transmission of Mycobacterium tuberculosis from a potentially highly infectious passenger to other persons during extended train and bus travel.

  10. Analysis of Changes in Recent Tuberculosis Transmission Patterns after a Sharp Increase in Immigration▿

    PubMed Central

    Iñigo, Jesús; García de Viedma, Darío; Arce, Araceli; Palenque, Elia; Alonso Rodríguez, Noelia; Rodríguez, Elena; Ruiz Serrano, María Jesús; Andrés, Sandra; Bouza, Emilio; Chaves, Fernando

    2007-01-01

    We conducted a population-based molecular epidemiological study of tuberculosis (TB) in Madrid, Spain (2002 to 2004), to define transmission patterns and factors associated with clustering. We particularly focused on examining how the increase in TB cases among immigrants in recent years (2.8% in 1997 to 1999 to 36.2% during the current study) was modifying transmission patterns. Mycobacterium tuberculosis isolates obtained from patients living in nine districts of Madrid (1,459,232 inhabitants) were genotyped. The TB case rate among foreign-born people was three to four times that of Spanish-born people, and the median time from arrival to the onset of treatment was 22.4 months. During the study period, 227 (36.3%) patients were grouped in 64 clusters, and 115 (50.7%) of them were in 21 clusters with mixed Spanish-born and foreign-born patients. Three of the 21 mixed clusters accounted for 21.1% of clustered patients. Twenty-two of 38 (57.9%) immigrants in mixed clusters were infected with TB strains that had already been identified in the native population in 1997 to 1999, including the three most prevalent strains. Factors identified as independent predictors of clustering were homelessness (odds ratio [OR], 2.3; 95% confidence interval [95% CI], 1.2 to 4.5; P = 0.011) and to be born in Spain (OR, 1.8; 95% CI, 1.2 to 2.6; P = 0.002). The results indicated that (i) TB transmission was higher in Spanish-born people, associated mainly with homelessness, (ii) that foreign-born people were much less likely to be clustered, suggesting a higher percentage of infection before arriving in Spain, and (iii) that an extensive transmission between Spanish- and foreign-born populations, caused mainly by autochthonous strains, was taking place in Madrid. PMID:17108076

  11. Analysis of changes in recent tuberculosis transmission patterns after a sharp increase in immigration.

    PubMed

    Iñigo, Jesús; García de Viedma, Darío; Arce, Araceli; Palenque, Elia; Alonso Rodríguez, Noelia; Rodríguez, Elena; Ruiz Serrano, María Jesús; Andrés, Sandra; Bouza, Emilio; Chaves, Fernando

    2007-01-01

    We conducted a population-based molecular epidemiological study of tuberculosis (TB) in Madrid, Spain (2002 to 2004), to define transmission patterns and factors associated with clustering. We particularly focused on examining how the increase in TB cases among immigrants in recent years (2.8% in 1997 to 1999 to 36.2% during the current study) was modifying transmission patterns. Mycobacterium tuberculosis isolates obtained from patients living in nine districts of Madrid (1,459,232 inhabitants) were genotyped. The TB case rate among foreign-born people was three to four times that of Spanish-born people, and the median time from arrival to the onset of treatment was 22.4 months. During the study period, 227 (36.3%) patients were grouped in 64 clusters, and 115 (50.7%) of them were in 21 clusters with mixed Spanish-born and foreign-born patients. Three of the 21 mixed clusters accounted for 21.1% of clustered patients. Twenty-two of 38 (57.9%) immigrants in mixed clusters were infected with TB strains that had already been identified in the native population in 1997 to 1999, including the three most prevalent strains. Factors identified as independent predictors of clustering were homelessness (odds ratio [OR], 2.3; 95% confidence interval [95% CI], 1.2 to 4.5; P = 0.011) and to be born in Spain (OR, 1.8; 95% CI, 1.2 to 2.6; P = 0.002). The results indicated that (i) TB transmission was higher in Spanish-born people, associated mainly with homelessness, (ii) that foreign-born people were much less likely to be clustered, suggesting a higher percentage of infection before arriving in Spain, and (iii) that an extensive transmission between Spanish- and foreign-born populations, caused mainly by autochthonous strains, was taking place in Madrid.

  12. Acquisition of second-line drug resistance and extensive drug resistance during recent transmission of Mycobacterium tuberculosis in rural China.

    PubMed

    Hu, Y; Mathema, B; Zhao, Q; Chen, L; Lu, W; Wang, W; Kreiswirth, B; Xu, B

    2015-12-01

    Multidrug-resistant tuberculosis (MDR-TB) is prevalent in countries with a high TB burden, like China. As little is known about the emergence and spread of second-line drug (SLD) -resistant TB, we investigate the emergence and transmission of SLD-resistant Mycobacterium tuberculosis in rural China. In a multi-centre population-based study, we described the bacterial population structure and the transmission characteristics of SLD-resistant TB using Spoligotyping in combination with genotyping based on 24-locus MIRU-VNTR (mycobacterial interspersed repetitive unit-variable-number tandem repeat) plus four highly variable loci for the Beijing family, in four rural Chinese regions with diverse geographic and socio-demographic characteristics. Transmission networks among genotypically clustered patients were constructed using social network analysis. Of 1332 M. tuberculosis patient isolates recovered, the Beijing family represented 74.8% of all isolates and an association with MDR and simultaneous resistance between first-line drugs and SLDs. The genotyping analysis revealed that 189 isolates shared MIRU-VNTR patterns in 78 clusters with clustering rate and recent transmission rate of 14.2% and 8.3%, respectively. Fifty-three SLD-resistant isolates were observed in 31 clusters, 30 of which contained the strains with different drug susceptibility profiles and genetic mutations. In conjunction with molecular data, socio-network analysis indicated a key role of Central Township in the transmission across a highly interconnected network where SLD resistance accumulation occurred during transmission. SLD-resistant M. tuberculosis has been spreading in rural China with Beijing family being the dominant strains. Primary transmission of SLD-resistant strains in the population highlights the importance of routine drug susceptibility testing and effective anti-tuberculosis regimens for drug-resistant TB.

  13. Image-based spectral transmission estimation using "sensitivity comparison".

    PubMed

    Nahavandi, Alireza Mahmoudi; Tehran, Mohammad Amani

    2017-01-20

    Although digital cameras have been used for spectral reflectance estimation, transmission measurement has rarely been considered in studies. This study presents a method named sensitivity comparison (SC) for spectral transmission estimation. The method needs neither a priori knowledge from the samples nor statistical information of a given reflectance dataset. As with spectrophotometers, the SC method needs one shot for calibration and another shot for measurement. The method exploits the sensitivity of the camera in the absence and presence of transparent colored objects for transmission estimation. 138 Kodak Wratten Gelatin filter transmissions were used for controlling the proposed method. Using modeling of the imaging system in different levels of noise, the performance of the proposed method was compared with a training-based Matrix R method. For checking the performance of the SC method in practice, 33 manmade colored transparent films were used in a conventional three-channel camera. The method generated promising results using different error metrics.

  14. Tuberculosis.

    PubMed

    Dheda, Keertan; Barry, Clifton E; Maartens, Gary

    2016-03-19

    Although the worldwide incidence of tuberculosis has been slowly decreasing, the global disease burden remains substantial (∼9 million cases and ∼1·5 million deaths in 2013), and tuberculosis incidence and drug resistance are rising in some parts of the world such as Africa. The modest gains achieved thus far are threatened by high prevalence of HIV, persisting global poverty, and emergence of highly drug-resistant forms of tuberculosis. Tuberculosis is also a major problem in health-care workers in both low-burden and high-burden settings. Although the ideal preventive agent, an effective vaccine, is still some time away, several new diagnostic technologies have emerged, and two new tuberculosis drugs have been licensed after almost 50 years of no tuberculosis drugs being registered. Efforts towards an effective vaccine have been thwarted by poor understanding of what constitutes protective immunity. Although new interventions and investment in control programmes will enable control, eradication will only be possible through substantial reductions in poverty and overcrowding, political will and stability, and containing co-drivers of tuberculosis, such as HIV, smoking, and diabetes.

  15. Who infects whom? Social networks and tuberculosis transmission in wild meerkats.

    PubMed

    Drewe, Julian A

    2010-02-22

    Transmission of infectious diseases is strongly influenced by who contacts whom. Despite the global distribution of tuberculosis (TB) in free-living wild mammal populations, little is known of the mechanisms of social transmission of Mycobacterium bovis between individuals. Here, I use a network approach to examine for correlations between five distinct types of intra- and intergroup social interaction and changes in TB status of 110 wild meerkats (Suricata suricatta) in five social groups over two years. Contrary to predictions, the most socially interactive animals were not at highest risk of acquiring infection, indicating that in addition to contact frequency, the type and direction of interactions must be considered when quantifying disease risk. Within social groups, meerkats that groomed others most were more likely to become infected than individuals who received high levels of grooming. Conversely, receiving, but not initiating, aggression was associated with M. bovis infection. Incidence of intergroup roving by male meerkats was correlated with the rovers themselves subsequently testing TB-positive, suggesting a possible route for transmission of infection between social groups. Exposure time was less important than these social interactions in influencing TB risk. This study represents a novel application of social network analysis using empirical data to elucidate the role of specific interactions in the transmission of an infectious disease in a free-living wild animal population.

  16. Who infects whom? Social networks and tuberculosis transmission in wild meerkats

    PubMed Central

    Drewe, Julian A.

    2010-01-01

    Transmission of infectious diseases is strongly influenced by who contacts whom. Despite the global distribution of tuberculosis (TB) in free-living wild mammal populations, little is known of the mechanisms of social transmission of Mycobacterium bovis between individuals. Here, I use a network approach to examine for correlations between five distinct types of intra- and intergroup social interaction and changes in TB status of 110 wild meerkats (Suricata suricatta) in five social groups over two years. Contrary to predictions, the most socially interactive animals were not at highest risk of acquiring infection, indicating that in addition to contact frequency, the type and direction of interactions must be considered when quantifying disease risk. Within social groups, meerkats that groomed others most were more likely to become infected than individuals who received high levels of grooming. Conversely, receiving, but not initiating, aggression was associated with M. bovis infection. Incidence of intergroup roving by male meerkats was correlated with the rovers themselves subsequently testing TB-positive, suggesting a possible route for transmission of infection between social groups. Exposure time was less important than these social interactions in influencing TB risk. This study represents a novel application of social network analysis using empirical data to elucidate the role of specific interactions in the transmission of an infectious disease in a free-living wild animal population. PMID:19889705

  17. Genetic Diversity and Transmission Characteristics of Beijing Family Strains of Mycobacterium tuberculosis in Peru

    PubMed Central

    Iwamoto, Tomotada; Grandjean, Louis; Arikawa, Kentaro; Nakanishi, Noriko; Caviedes, Luz; Coronel, Jorge; Sheen, Patricia; Wada, Takayuki; Taype, Carmen A.; Shaw, Marie-Anne; Moore, David A. J.; Gilman, Robert H.

    2012-01-01

    Beijing family strains of Mycobacterium tuberculosis have attracted worldwide attention because of their wide geographical distribution and global emergence. Peru, which has a historical relationship with East Asia, is considered to be a hotspot for Beijing family strains in South America. We aimed to unveil the genetic diversity and transmission characteristics of the Beijing strains in Peru. A total of 200 Beijing family strains were identified from 2140 M. tuberculosis isolates obtained in Lima, Peru, between December 2008 and January 2010. Of them, 198 strains were classified into sublineages, on the basis of 10 sets of single nucleotide polymorphisms (SNPs). They were also subjected to variable number tandem-repeat (VNTR) typing using an international standard set of 15 loci (15-MIRU-VNTR) plus 9 additional loci optimized for Beijing strains. An additional 70 Beijing family strains, isolated between 1999 and 2006 in Lima, were also analyzed in order to make a longitudinal comparison. The Beijing family was the third largest spoligotyping clade in Peru. Its population structure, by SNP typing, was characterized by a high frequency of Sequence Type 10 (ST10), which belongs to a modern subfamily of Beijing strains (178/198, 89.9%). Twelve strains belonged to the ancient subfamily (ST3 [n = 3], ST25 [n = 1], ST19 [n = 8]). Overall, the polymorphic information content for each of the 24 loci values was low. The 24 loci VNTR showed a high clustering rate (80.3%) and a high recent transmission index (RTIn−1 = 0.707). These strongly suggest the active and on-going transmission of Beijing family strains in the survey area. Notably, 1 VNTR genotype was found to account for 43.9% of the strains. Comparisons with data from East Asia suggested the genotype emerged as a uniquely endemic clone in Peru. A longitudinal comparison revealed the genotype was present in Lima by 1999. PMID:23185395

  18. Genetic diversity and transmission characteristics of Beijing family strains of Mycobacterium tuberculosis in Peru.

    PubMed

    Iwamoto, Tomotada; Grandjean, Louis; Arikawa, Kentaro; Nakanishi, Noriko; Caviedes, Luz; Coronel, Jorge; Sheen, Patricia; Wada, Takayuki; Taype, Carmen A; Shaw, Marie-Anne; Moore, David A J; Gilman, Robert H

    2012-01-01

    Beijing family strains of Mycobacterium tuberculosis have attracted worldwide attention because of their wide geographical distribution and global emergence. Peru, which has a historical relationship with East Asia, is considered to be a hotspot for Beijing family strains in South America. We aimed to unveil the genetic diversity and transmission characteristics of the Beijing strains in Peru. A total of 200 Beijing family strains were identified from 2140 M. tuberculosis isolates obtained in Lima, Peru, between December 2008 and January 2010. Of them, 198 strains were classified into sublineages, on the basis of 10 sets of single nucleotide polymorphisms (SNPs). They were also subjected to variable number tandem-repeat (VNTR) typing using an international standard set of 15 loci (15-MIRU-VNTR) plus 9 additional loci optimized for Beijing strains. An additional 70 Beijing family strains, isolated between 1999 and 2006 in Lima, were also analyzed in order to make a longitudinal comparison. The Beijing family was the third largest spoligotyping clade in Peru. Its population structure, by SNP typing, was characterized by a high frequency of Sequence Type 10 (ST10), which belongs to a modern subfamily of Beijing strains (178/198, 89.9%). Twelve strains belonged to the ancient subfamily (ST3 [n=3], ST25 [n=1], ST19 [n=8]). Overall, the polymorphic information content for each of the 24 loci values was low. The 24 loci VNTR showed a high clustering rate (80.3%) and a high recent transmission index (RTI(n-1)=0.707). These strongly suggest the active and on-going transmission of Beijing family strains in the survey area. Notably, 1 VNTR genotype was found to account for 43.9% of the strains. Comparisons with data from East Asia suggested the genotype emerged as a uniquely endemic clone in Peru. A longitudinal comparison revealed the genotype was present in Lima by 1999.

  19. A close-up on the epidemiology and transmission of multidrug-resistant tuberculosis in Poland.

    PubMed

    Jagielski, T; Brzostek, A; van Belkum, A; Dziadek, J; Augustynowicz-Kopeć, E; Zwolska, Z

    2015-01-01

    Multidrug-resistant tuberculosis (MDR-TB) poses a serious challenge to the global control of the disease. The purpose of this study was to characterize MDR-TB patients from Poland and to determine the extent of MDR-TB disease attributable to recent transmission. The study included all 46 patients diagnosed with MDR-TB in Poland in 2004 and followed up for 6 years (until 2011). For each patient, sociodemographic and clinical characteristics, treatment outcomes, and bacteriological data were collected by the review of medical and laboratory records. Mycobacterium tuberculosis isolates from all patients were characterized using spoligotyping, mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing, IS6110 restriction fragment length polymorphism (RFLP) analysis, and sequencing analysis of drug resistance-associated loci (katG, mabA-inhA, rpoβ, rpsL, and embB). The majority of patients were male (86.9%), 40-64 years of age (60.8%), with a history of TB treatment (84.8%), and producing smear-positive sputa (86.9%). Twenty-two (47.8%) patients suffered from concomitant diseases and 28 (60.8%) were alcohol abusers. Treatment outcome assessment revealed that 8 (17.4%) patients were cured or completed therapy, while 15 (32.6%) died of TB, 11 (23.9%) defaulted, 8 (17.4%) failed, and 1 (2.2%) was transferred and lost to follow-up. Upon genotyping, 10 (21.7%) isolates were allocated in four clusters. These were further subdivided by mutational profiling. Overall, in 6 (13%) patients, MDR-TB was a result of recent transmission. For 4 (8.7%) of these patients, a direct epidemiological link was established. The study shows that the transmission of MDR-TB occurs at a low rate in Poland. Of urgent need is the implementation of a policy of enforced treatment of MDR-TB patients in Poland.

  20. Estimating parameter of influenza transmission using regularized least square

    NASA Astrophysics Data System (ADS)

    Nuraini, N.; Syukriah, Y.; Indratno, S. W.

    2014-02-01

    Transmission process of influenza can be presented in a mathematical model as a non-linear differential equations system. In this model the transmission of influenza is determined by the parameter of contact rate of the infected host and susceptible host. This parameter will be estimated using a regularized least square method where the Finite Element Method and Euler Method are used for approximating the solution of the SIR differential equation. The new infected data of influenza from CDC is used to see the effectiveness of the method. The estimated parameter represents the contact rate proportion of transmission probability in a day which can influence the number of infected people by the influenza. Relation between the estimated parameter and the number of infected people by the influenza is measured by coefficient of correlation. The numerical results show positive correlation between the estimated parameters and the infected people.

  1. Construction of a mathematical model for tuberculosis transmission in highly endemic regions of the Asia-Pacific.

    PubMed

    Trauer, James M; Denholm, Justin T; McBryde, Emma S

    2014-10-07

    We present a mathematical model to simulate tuberculosis (TB) transmission in highly endemic regions of the Asia-Pacific, where epidemiology does not appear to be primarily driven by HIV-coinfection. The ten-compartment deterministic model captures many of the observed phenomena important to disease dynamics, including partial and temporary vaccine efficacy, declining risk of active disease following infection, the possibility of reinfection both during the infection latent period and after treatment, multidrug resistant TB (MDR-TB) and de novo resistance during treatment. We found that the model could not be calibrated to the estimated incidence rate without allowing for reinfection during latency, and that even in the presence of a moderate fitness cost and a lower value of R0, MDR-TB becomes the dominant strain at equilibrium. Of the modifiable programmatic parameters, the rate of detection and treatment commencement was the most important determinant of disease rates with each respective strain, while vaccination rates were less important. Improved treatment of drug-susceptible TB did not result in decreased rates of MDR-TB through prevention of de novo resistance, but rather resulted in a modest increase in MDR-TB through strain replacement. This was due to the considerably greater relative contribution of community transmission to MDR-TB incidence, by comparison to de novo amplification of resistance in previously susceptible strains.

  2. Modelling the role of multi-transmission routes in the epidemiology of bovine tuberculosis in cattle and buffalo populations.

    PubMed

    Phepa, Patrick B; Chirove, Faraimunashe; Govinder, Keshlan S

    2016-07-01

    A mathematical model that describes the transmission dynamics of bovine tuberculosis (BTB) in both buffalo and cattle populations is proposed. The model incorporates cross-infection and contaminated environment transmission routes. A full analysis of the model is undertaken. The reproduction number of the entire model is comprised of cross-infection and contaminated parameters. This underscores the importance of including both cross-infection and contaminated environment transmission routes. Crucially our simulations suggest that the disease has a more devastating effect on cattle populations than on buffalo populations when all transmission routes are involved. This has important implications for agriculture and tourism.

  3. Interpreting whole genome sequencing for investigating tuberculosis transmission: a systematic review.

    PubMed

    Hatherell, Hollie-Ann; Colijn, Caroline; Stagg, Helen R; Jackson, Charlotte; Winter, Joanne R; Abubakar, Ibrahim

    2016-03-23

    Whole genome sequencing (WGS) is becoming an important part of epidemiological investigations of infectious diseases due to greater resolution and cost reductions compared to traditional typing approaches. Many public health and clinical teams will increasingly use WGS to investigate clusters of potential pathogen transmission, making it crucial to understand the benefits and assumptions of the analytical methods for investigating the data. We aimed to understand how different approaches affect inferences of transmission dynamics and outline limitations of the methods. We comprehensively searched electronic databases for studies that presented methods used to interpret WGS data for investigating tuberculosis (TB) transmission. Two authors independently selected studies for inclusion and extracted data. Due to considerable methodological heterogeneity between studies, we present summary data with accompanying narrative synthesis rather than pooled analyses. Twenty-five studies met our inclusion criteria. Despite the range of interpretation tools, the usefulness of WGS data in understanding TB transmission often depends on the amount of genetic diversity in the setting. Where diversity is small, distinguishing re-infections from relapses may be impossible; interpretation may be aided by the use of epidemiological data, examining minor variants and deep sequencing. Conversely, when within-host diversity is large, due to genetic hitchhiking or co-infection of two dissimilar strains, it is critical to understand how it arose. Greater understanding of microevolution and mixed infection will enhance interpretation of WGS data. As sequencing studies have sampled more intensely and integrated multiple sources of information, the understanding of TB transmission and diversity has grown, but there is still much to be learnt about the origins of diversity that will affect inferences from these data. Public health teams and researchers should combine epidemiological, clinical

  4. Transmission of Mycobacterium tuberculosis from an Asian elephant (Elephas maximus) to a chimpanzee (Pan troglodytes) and humans in an Australian zoo.

    PubMed

    Stephens, N; Vogelnest, L; Lowbridge, C; Christensen, A; Marks, G B; Sintchenko, V; McAnulty, J

    2013-07-01

    Mycobacterium tuberculosis is primarily a pathogen of humans. Infections have been reported in animal species and it is emerging as a significant disease of elephants in the care of humans. With the close association between humans and animals, transmission can occur. In November 2010, a clinically healthy Asian elephant in an Australian zoo was found to be shedding M. tuberculosis; in September 2011, a sick chimpanzee at the same zoo was diagnosed with tuberculosis caused by an indistinguishable strain of M. tuberculosis. Investigations included staff and animal screening. Four staff had tuberculin skin test conversions associated with spending at least 10 hours within the elephant enclosure; none had disease. Six chimpanzees had suspected infection. A pathway of transmission between the animals could not be confirmed. Tuberculosis in an elephant can be transmissible to people in close contact and to other animals more remotely. The mechanism for transmission from elephants requires further investigation.

  5. Evaluating parasite densities and estimation of parameters in transmission systems.

    PubMed

    Heinzmann, D; Torgerson, P R

    2008-09-01

    Mathematical modelling of parasite transmission systems can provide useful information about host parasite interactions and biology and parasite population dynamics. In addition good predictive models may assist in designing control programmes to reduce the burden of human and animal disease. Model building is only the first part of the process. These models then need to be confronted with data to obtain parameter estimates and the accuracy of these estimates has to be evaluated. Estimation of parasite densities is central to this. Parasite density estimates can include the proportion of hosts infected with parasites (prevalence) or estimates of the parasite biomass within the host population (abundance or intensity estimates). Parasite density estimation is often complicated by highly aggregated distributions of parasites within the hosts. This causes additional challenges when calculating transmission parameters. Using Echinococcus spp. as a model organism, this manuscript gives a brief overview of the types of descriptors of parasite densities, how to estimate them and on the use of these estimates in a transmission model.

  6. Population decline induced by gonorrhoea and tuberculosis transmission: Micronesia during the Japanese occupation, 1919-45.

    PubMed

    Cassels, Susan; Singer, Burton H

    2010-12-01

    The islands of Yap in Micronesia survived a period of severe depopulation during the Japanese occupation from 1919 to 1945. Using data from historical documents, supplemented by ethnographic evidence, we calibrate a simulation model that accounts for this phenomenon. Our model tracks the reproduction histories of a synthetic cohort of women in Yap, including effects of infertility due to gonorrhoea as well as tuberculosis mortality, and predicts the net reproduction rate (NRR). In this particular case and throughout history, human migrations and associated social and cultural interactions have frequently been accompanied by dramatic changes in patterns of disease transmission and substantial demographic consequences. Despite the broad emphasis on mortality as a measure of demographic consequences in the historical and contemporary literature, there are important instances where life expectancy at birth, fertility rates, and total population size are important demographic consequences. We find that gonorrhoea may have significantly contributed to depopulation during the Japanese occupation of Micronesia, due to repeated infections and high risk of sterility. Results of our model suggest that gonorrhoea alone could have reduced the net reproduction rate by 82%, whereas deaths from tuberculosis may have contributed to a 17% decline.

  7. Estimating regional transmissivity of the Upper Floridan aquifer

    SciTech Connect

    Johnston, R.H. )

    1993-03-01

    The distribution of permeability in the Upper Floridan aquifer is complex due to variations in the original depositional environments and the post-depositional history. The transmissivity of the aquifer is directly related to the thickness and lithology of the overlying confining unit (Miocene clastic deposits). Where this unit has been thinned or removed by erosion, solution-cavity development and thus high transmissivity are common. At depth, transmissivity is affected by the lithology of the carbonate rocks and the occurrence of paleokarst. The transmissivity of the Upper Floridan varies by more than three orders of magnitude: from less than 1,000 feet squared per day in the thickly confined, micrite-rich limestone of the Fort Walton Beach area of panhandle Florida to more than 1,000,000 feet squared per day in the unconfined, karstic areas of central and northern Florida. The application of aquifer-test methods to determine transmissivity of the Upper Floridan aquifer is summarized as follows: (1) Conducting aquifer tests in the unconfined, karstic areas is virtually impossible because of logistical problems (removing large volumes of pumped water to prevent recycling) and because non-Darcian flow can preclude the use of standard aquifer-test methods. However, flow-net analyses using springs as the discharge control have been used successfully to estimate regional transmissivity values. (2) Multi-well aquifer tests outside of karst areas generally provide data plots that match appropriate type curves. (3) Specific capacity is not a good basis for estimating regional transmissivity values. Transmissivity maps of the Floridan should be accompanied by an evaluation of their reliability based on availability of field-test data. If transmissivity values are derived from computer models, the model sensitivity to transmissivity should be discussed.

  8. Knowledge about HIV prevention and transmission among recently diagnosed tuberculosis patients: a cross sectional study

    PubMed Central

    2013-01-01

    Background Patients with Tuberculosis (TB) are a vulnerable group for acquiring HIV infection. Therefore, countries with a concentrated HIV epidemic and high prevalence of TB should provide adequate information about HIV prevention to TB patients. Methods We conducted a cross-sectional study to evaluate the level of knowledge on HIV prevention and transmission among newly diagnosed TB patients in Lima, Peru. The survey evaluated knowledge about HIV infection and prevention and was administered before HIV counseling and blood sampling for HIV testing were performed. Results A total of 171 TB patients were enrolled; mean age was 31.1 years, 101 (59%) were male. The overall mean level of knowledge of HIV was 59%; but the specific mean level of knowledge on HIV transmission and prevention was only 33.3% and 41.5%, respectively. Age and level of education correlated with overall level of knowledge in the multivariate model (P-value: 0.02 and <0.001 respectively). Conclusions The study shows inadequate levels of knowledge about HIV transmission and prevention among newly-diagnosed TB patients in this setting, and underscores the need for implementing educational interventions in this population. PMID:24373517

  9. Within the Enemy’s Camp: contribution of the granuloma to the dissemination, persistence and transmission of Mycobacterium tuberculosis

    PubMed Central

    Shaler, Christopher R.; Horvath, Carly N.; Jeyanathan, Mangalakumari; Xing, Zhou

    2013-01-01

    Pulmonary tuberculosis, caused by Mycobacterium tuberculosis (M.tb) represents a leading global health concern, with 8.7 million newly emerging cases, and 1.4 million reported deaths annually. Despite an estimated one third of the world’s population being infected, relatively few infected individuals ever develop active clinical disease. The ability of the host to remain latently infected while preventing disease is thought to be due to the generation of a robust type 1 immune response in the lung, capable of controlling, but not clearing, M.tb. A key feature of the type 1 immune response to M.tb is the formation of immune cellular aggregates termed granuloma. The granuloma structure has long been considered a hallmark of host’s protective response toward M.tb. Historically, a correlative relationship between granuloma formation/maintenance and bacterial control has been seen in models where disrupted granuloma formation or structure was found to be fatal. Despite this established relationship much about the granuloma’s role in M.tb immunity remains unknown. Recent publications suggest that the granuloma actually aids the persistence of M.tb and that the development of a necrotic granuloma is essential to person-to-person transmission. Our group and others have recently demonstrated that enclosed within the granuloma is a population of immunologically altered antigen-presenting cells and T lymphocyte populations. Of note, the ability of these populations to produce type 1 cytokines such as interferon-gamma, and bactericidal products including nitric oxide, are significantly reduced, while remaining competent to produce high levels immunosuppressive interleukin-10. These observations indicate that although the chronic granuloma represents a highly unique environment, it is more similar to that of a tumor than an active site of bacterial control. In this review we will explore what is known about this unique environment and its contribution to the persistence

  10. The potential effects of changing HIV treatment policy on tuberculosis outcomes in South Africa: results from three tuberculosis-HIV transmission models.

    PubMed

    Pretorius, Carel; Menzies, Nicolas A; Chindelevitch, Leonid; Cohen, Ted; Cori, Anne; Eaton, Jeffrey W; Fraser, Christophe; Gopalappa, Chaitra; Hallett, Timothy B; Salomon, Joshua A; Stover, John; White, Richard G; Dodd, Peter J

    2014-01-01

    Many countries are considering expanding HIV treatment following recent findings emphasizing the effects of antiretroviral therapy (ART) on reducing HIV transmission in addition to already established survival benefits. Given the close interaction of tuberculosis (TB) and HIV epidemics, ART expansion could have important ramifications for TB burden. Previous studies suggest a wide range of possible TB impacts following ART expansion. We used three independently developed TB-HIV models to estimate the TB-related impact of expanding ART in South Africa. We considered two dimensions of ART expansion--improving coverage of pre-ART and ART services, and expanding CD4-based ART eligibility criteria (from CD4 <350 to CD4 <500 or all HIV-positive). Three independent mathematical models were calibrated to the same data pertaining to the South African HIV-TB epidemic, and used to assess standardized ART policy changes. Key TB impact indicators were projected from 2014 to 2033. Compared with current eligibility and coverage, cumulative TB incidence was projected to decline by 6-30% over the period 2014-2033 if ART eligibility were expanded to all HIV positive individuals, and by 28-37% if effective ART coverage were additionally increased to 80%. Overall, expanding ART was estimated to avert one TB case for each 10-13 additional person-years of ART. All models showed that TB incidence and mortality reductions would grow over time, but would stabilize towards the end of the projection period. ART expansion could substantially reduce TB incidence and mortality in South Africa and could provide a platform for collaborative HIV-TB programs to effectively halt HIV-associated TB.

  11. Real-Time Investigation of Tuberculosis Transmission: Developing the Respiratory Aerosol Sampling Chamber (RASC)

    PubMed Central

    Wood, Robin; Morrow, Carl; Barry, Clifton E.; Bryden, Wayne A.; Call, Charles J.; Hickey, Anthony J.; Rodes, Charles E.; Scriba, Thomas J.; Blackburn, Jonathan; Issarow, Chacha; Mulder, Nicola; Woodward, Jeremy; Moosa, Atica; Singh, Vinayak; Mizrahi, Valerie; Warner, Digby F.

    2016-01-01

    Knowledge of the airborne nature of respiratory disease transmission owes much to the pioneering experiments of Wells and Riley over half a century ago. However, the mechanical, physiological, and immunopathological processes which drive the production of infectious aerosols by a diseased host remain poorly understood. Similarly, very little is known about the specific physiological, metabolic and morphological adaptations which enable pathogens such as Mycobacterium tuberculosis (Mtb) to exit the infected host, survive exposure to the external environment during airborne carriage, and adopt a form that is able to enter the respiratory tract of a new host, avoiding innate immune and physical defenses to establish a nascent infection. As a first step towards addressing these fundamental knowledge gaps which are central to any efforts to interrupt disease transmission, we developed and characterized a small personal clean room comprising an array of sampling devices which enable isolation and representative sampling of airborne particles and organic matter from tuberculosis (TB) patients. The complete unit, termed the Respiratory Aerosol Sampling Chamber (RASC), is instrumented to provide real-time information about the particulate output of a single patient, and to capture samples via a suite of particulate impingers, impactors and filters. Applying the RASC in a clinical setting, we demonstrate that a combination of molecular and microbiological assays, as well as imaging by fluorescence and scanning electron microscopy, can be applied to investigate the identity, viability, and morphology of isolated aerosolized particles. Importantly, from a preliminary panel of active TB patients, we observed the real-time production of large numbers of airborne particles including Mtb, as confirmed by microbiological culture and polymerase chain reaction (PCR) genotyping. Moreover, direct imaging of captured samples revealed the presence of multiple rod-like Mtb organisms whose

  12. Factors associated with primary transmission of multidrug-resistant tuberculosis compared with healthy controls in Henan Province, China.

    PubMed

    Li, Wei-Bin; Zhang, Yan-Qiu; Xing, Jin; Ma, Zhen-Ya; Qu, Ya-Hong; Li, Xin-Xu

    2015-01-01

    It is estimated that there are about 74,000 primary multidrug-resistant tuberculosis (MDR-TB) patients per year according to the prevalence of MDR-TB of 5.7% among new TB patients in China. Thus, the risks of primary transmission of MDR-TB require further attention. This study aimed to identify the factors associated with primary transmission of MDR-TB in Henan province, where the number of new TB patients is ranked second highest in China. A 1:1 matched case-control study was conducted in Henan, China. Cases were primary MDR-TB patients who were individually matched with a healthy control without TB from the same neighborhood. The study was conducted from July 2013 to June 2014. Both case and control were matched by age (±5 years) and sex. Conditional logistic regression was used to compute adjusted odds ratios (AORs) with corresponding 95% confidence intervals (CIs) for risk factors associated with primary MDR-TB. For the study, 146 pairs of participants were recruited. The final multivariable logistic regression model disclosed that after adjusting for age and sex, primary MDR-TB cases were more likely to be single (AOR, 5.4; 95% CI, 1.4-20.7), earn an annual income of ≤ 12,000 yuan (RMB) (AOR, 9.9; 95% CI, 2.0-48.1), experience more life pressure/stress (AOR, 10.8; 95% CI, 2.8-41.5), not be medically insured (AOR, 50.1; 95% CI, 8.2-306.8), and suffer from diabetes, cardiovascular disease or other respiratory diseases, or cancer (AOR, 57.1; 95% CI, 8.6-424.2). In order to control primary transmission of MDR-TB in China, we recommend that improving the social support, living standards and medical security of the lower social class become a priority.

  13. An application of forward-backward difference approximation method on the optimal control problem in the transmission of tuberculosis model

    NASA Astrophysics Data System (ADS)

    Rahmah, Z.; Subartini, B.; Djauhari, E.; Anggriani, N.; Supriatna, A. K.

    2017-03-01

    Tuberculosis (TB) is a disease that is infected by the bacteria Mycobacterium tuberculosis. The World Health Organization (WHO) recommends to implement the Baccilus Calmete Guerin (BCG) vaccine in toddler aged two to three months to be protected from the infection. This research explores the numerical simulation of forward-backward difference approximation method on the model of TB transmission considering this vaccination program. The model considers five compartments of sub-populations, i.e. susceptible, vaccinated, exposed, infected, and recovered human sub-populations. We consider here the vaccination as a control variable. The results of the simulation showed that vaccination can indeed reduce the number of infected human population.

  14. Molecular epidemiology and transmission dynamics of Mycobacterium tuberculosis in Northwest Ethiopia: new phylogenetic lineages found in Northwest Ethiopia.

    PubMed

    Tessema, Belay; Beer, Joerg; Merker, Matthias; Emmrich, Frank; Sack, Ulrich; Rodloff, Arne C; Niemann, Stefan

    2013-03-11

    Although Ethiopia ranks seventh among the world's 22 high-burden tuberculosis (TB) countries, little is known about strain diversity and transmission. In this study, we present the first in-depth analysis of the population structure and transmission dynamics of Mycobacterium tuberculosis strains from Northwest Ethiopia. In the present study, 244 M. tuberculosis isolates where analysed by mycobacterial interspersed repetitive unit - variable number tandem repeat 24-loci typing and spoligotyping methods to determine phylogenetic lineages and perform cluster analysis. Clusters of strains with identical genotyping patterns were considered as an indicator for the recent transmission. Of 244 isolates, 59.0% were classified into nine previously described lineages: Dehli/CAS (38.9%), Haarlem (8.6%), Ural (3.3%), LAM (3.3%), TUR (2.0%), X-type (1.2%), S-type (0.8%), Beijing (0.4%) and Uganda II (0.4%). Interestingly, 31.6% of the strains were grouped into four new lineages and were named as Ethiopia_3 (13.1%), Ethiopia_1 (7.8%), Ethiopia_H37Rv like (7.0%) and Ethiopia_2 (3.7%) lineages. The remaining 9.4% of the isolates could not be assigned to the known or new lineages. Overall, 45.1% of the isolates were grouped in clusters, indicating a high rate of recent transmission. This study confirms a highly diverse M. tuberculosis population structure, the presence of new phylogenetic lineages and a predominance of the Dehli/CAS lineage in Northwest Ethiopia. The high rate of recent transmission indicates defects of the TB control program in Northwest Ethiopia. This emphasizes the importance of strengthening laboratory diagnosis of TB, intensified case finding and treatment of TB patients to interrupt the chain of transmission.

  15. Cost estimation of HVDC transmission system of Bangka's NPP candidates

    NASA Astrophysics Data System (ADS)

    Liun, Edwaren; Suparman

    2014-09-01

    Regarding nuclear power plant development in Bangka Island, it can be estimated that produced power will be oversupply for the Bangka Island and needs to transmit to Sumatra or Java Island. The distance between the regions or islands causing considerable loss of power in transmission by alternating current, and a wide range of technical and economical issues. The objective of this paper addresses to economics analysis of direct current transmission system to overcome those technical problem. Direct current transmission has a stable characteristic, so that the power delivery from Bangka to Sumatra or Java in a large scale efficiently and reliably can be done. HVDC system costs depend on the power capacity applied to the system and length of the transmission line in addition to other variables that may be different.

  16. Tuberculosis.

    PubMed

    Pearce, Lynne

    2017-03-10

    Essential facts Tuberculosis (TB) is an infection caused by a bacterium, mycobacterium tuberculosis. While it can affect any part of the body, only pulmonary TB is infectious. According to the charity TB Alert, there were 5,758 cases of TB in the UK in 2015 and 39% of them were in London. This represented a fall from a peak of 8,919 cases in 2011. Left untreated, TB is life-threatening, but is usually curable with antibiotics. The sooner it is diagnosed and treated, the better, both for the person's health and in preventing them from passing the infection on to others.

  17. Tuberculosis.

    PubMed

    Pearce, Lynne

    2017-02-22

    Essential facts Tuberculosis (TB) is an infection caused by a bacterium, mycobacterium tuberculosis. While it can affect any part of the body, only pulmonary TB is infectious. According to the charity TB Alert, there were 5,758 cases of TB in the UK in 2015 and 39% of them were in London. This represented a fall from a peak of 8,919 cases in 2011. Left untreated, TB is life-threatening, but is usually curable with antibiotics. The sooner it is diagnosed and treated, the better, both for the person's health and in preventing them from passing the infection on to others.

  18. Estimation of multiple transmission rates for epidemics in heterogeneous populations.

    PubMed

    Cook, Alex R; Otten, Wilfred; Marion, Glenn; Gibson, Gavin J; Gilligan, Christopher A

    2007-12-18

    One of the principal challenges in epidemiological modeling is to parameterize models with realistic estimates for transmission rates in order to analyze strategies for control and to predict disease outcomes. Using a combination of replicated experiments, Bayesian statistical inference, and stochastic modeling, we introduce and illustrate a strategy to estimate transmission parameters for the spread of infection through a two-phase mosaic, comprising favorable and unfavorable hosts. We focus on epidemics with local dispersal and formulate a spatially explicit, stochastic set of transition probabilities using a percolation paradigm for a susceptible-infected (S-I) epidemiological model. The S-I percolation model is further generalized to allow for multiple sources of infection including external inoculum and host-to-host infection. We fit the model using Bayesian inference and Markov chain Monte Carlo simulation to successive snapshots of damping-off disease spreading through replicated plant populations that differ in relative proportions of favorable and unfavorable hosts and with time-varying rates of transmission. Epidemiologically plausible parametric forms for these transmission rates are compared by using the deviance information criterion. Our results show that there are four transmission rates for a two-phase system, corresponding to each combination of infected donor and susceptible recipient. Knowing the number and magnitudes of the transmission rates allows the dominant pathways for transmission in a heterogeneous population to be identified. Finally, we show how failure to allow for multiple transmission rates can overestimate or underestimate the rate of spread of epidemics in heterogeneous environments, which could lead to marked failure or inefficiency of control strategies.

  19. A Model of Tuberculosis Transmission and Intervention Strategies in an Urban Residential Area

    PubMed Central

    Pienaar, Elsje; Fluitt, Aaron M.; Whitney, Scott E.; Freifeld, Alison G.; Viljoen, Hendrik J.

    2011-01-01

    The model herein aims to explore the dynamics of the spread of tuberculosis (TB) in an informal settlement or township. The population is divided into households of various sizes and also based on commuting status. The model dynamics distinguishes between three distinct social patterns: the exposure of commuters during travel, random diurnal interaction and familial exposure at night. Following the general SLIR models, the population is further segmented into susceptible (S), exposed/latently infected (L), active/infectious (I), and recovered (R) individuals. During the daytime, commuters travel on public transport, while non-commuters randomly interact in the community to mimic chance encounters with infectious persons. At night, each family interacts and sleeps together in the home. The risk of exposure to TB is based on the proximity, duration, and frequency of encounters with infectious persons. The model is applied to a hypothetical population to explore the effects of different intervention strategies including vaccination, wearing of masks or scarves during the commute, prophylactic treatment of latent infections and more effective case-finding and treatment. The most important findings of the model are: (1) members of larger families are responsible for more disease transmissions than those from smaller families, (2) daily commutes on public transport provide ideal conditions for transmission of the disease, (3) improved diagnosis and treatment has the greatest impact on the spread of the disease, and (4) detecting TB at the first clinic visit, when patients are still smear negative, is key. PMID:20381428

  20. Mathematical modeling of transmission co-infection tuberculosis in HIV community

    NASA Astrophysics Data System (ADS)

    Lusiana, V.; Putra, P. S.; Nuraini, N.; Soewono, E.

    2017-03-01

    TB and HIV infection have the effect of deeply on assault the immune system, since they can afford to weaken host immune respone through a mechanism that has not been fully understood. HIV co-infection is the stongest risk factor for progression of M. tuberculosis to active TB disease in HIV individuals, as well as TB has been accelerated to progression HIV infection. In this paper we create a model of transmission co-infection TB in HIV community, dynamic system with ten compartments built in here. Dynamic analysis in this paper mentioned ranging from disease free equilibrium conditions, endemic equilibrium conditions, basic reproduction ratio, stability analysis and numerical simulation. Basic reproductive ratio were obtained from spectral radius the next generation matrix of the model. Numerical simulations are built to justify the results of the analysis and to see the changes in the dynamics of the population in each compartment. The sensitivity analysis indicates that the parameters affecting the population dynamics of TB in people with HIV infection is parameters rate of progression of individuals from the exposed TB class to the active TB, treatment rate of exposed TB individuals, treatment rate of infectious (active TB) individuals and probability of transmission of TB infection from an infective to a susceptible per contact per unit time. We can conclude that growing number of infections carried by infectious TB in people with HIV infection can lead to increased spread of disease or increase in endemic conditions.

  1. Preventing the Transmission of Tuberculosis in Health Care Settings: Administrative Control

    PubMed Central

    2017-01-01

    It is well established that health care workers (HCWs) have a considerably higher risk of occupationally acquired tuberculosis (TB). To reduce the transmission of TB to HCWs and patients, TB infection control programs should be implemented in health care settings. The first and most important level of all protection and control programs is administrative control. Its goals are to prevent HCWs, other staff, and patients from being exposed to TB, and to reduce the transmission of infection by ensuring rapid diagnosis and treatment of affected individuals. Administrative control measures recommended by the United States Centers for Disease Control and Prevention and the World Health Organization include prompt identification of people with TB symptoms, isolation of infectious patients, control of the spread of the pathogen, and minimization of time spent in health care facilities. Another key component of measures undertaken is the baseline and serial screening for latent TB infection in HCWs who are at risk of exposure to TB. Although the interferon-gamma release assay has some advantages over the tuberculin skin test, the former has serious limitations, mostly due to its high conversion rate. PMID:28119743

  2. Tuberculosis.

    PubMed

    Pai, Madhukar; Behr, Marcel A; Dowdy, David; Dheda, Keertan; Divangahi, Maziar; Boehme, Catharina C; Ginsberg, Ann; Swaminathan, Soumya; Spigelman, Melvin; Getahun, Haileyesus; Menzies, Dick; Raviglione, Mario

    2016-10-27

    Tuberculosis (TB) is an airborne infectious disease caused by organisms of the Mycobacterium tuberculosis complex. Although primarily a pulmonary pathogen, M. tuberculosis can cause disease in almost any part of the body. Infection with M. tuberculosis can evolve from containment in the host, in which the bacteria are isolated within granulomas (latent TB infection), to a contagious state, in which the patient will show symptoms that can include cough, fever, night sweats and weight loss. Only active pulmonary TB is contagious. In many low-income and middle-income countries, TB continues to be a major cause of morbidity and mortality, and drug-resistant TB is a major concern in many settings. Although several new TB diagnostics have been developed, including rapid molecular tests, there is a need for simpler point-of-care tests. Treatment usually requires a prolonged course of multiple antimicrobials, stimulating efforts to develop shorter drug regimens. Although the Bacillus Calmette-Guérin (BCG) vaccine is used worldwide, mainly to prevent life-threatening TB in infants and young children, it has been ineffective in controlling the global TB epidemic. Thus, efforts are underway to develop newer vaccines with improved efficacy. New tools as well as improved programme implementation and financing are necessary to end the global TB epidemic by 2035.

  3. COUNTING THE MISSING CASES: ESTIMATING THE GLOBAL BURDEN OF MULTIDRUG-RESISTANT TUBERCULOSIS AMONG PREVALENT CASES OF TB

    PubMed Central

    Nourzad, Susan; Jenkins, Helen E.; Milstein, Meredith; Mitnick, Carole D.

    2017-01-01

    SUMMARY Background Multidrug-resistant tuberculosis (MDR-TB) burden estimates are based on incomplete, infrequently updated data among a limited pool of cases: notified or incident, pulmonary TB patients. Methods Using WHO data reported by 217 countries/territories in 2014, we calculated MDR-TB burdens among prevalent TB cases and compared these with estimates among incident and notified TB patients. We also compared treatment coverage across estimates. Findings Among prevalent TB patients globally in 2014, we estimate that 555,545 (95% credible bounds: 499,340–617,391) MDR-TB cases occurred. This is 85% more than the 300,000 estimated among notified cases, and 16% more than the 480,000 among incident cases. Only 20% of MDR-TB cases among prevalent—compared to 37% of MDR-TB among notified—TB patients had access to MDR-TB treatment. Applying prior estimates, only 10% of MDR-TB cases will have successful outcomes. Interpretation Estimates based on likely-to-be-diagnosed cases of MDR-TB overlook a significant proportion of morbidity, mortality, and transmission: that occur in undiagnosed, untreated, prevalent TB patients. Still likely underestimating the true disease burden, MDR-TB among patients with prevalent TB represents a closer approximation of disease burden than currently reported indicators. Progress toward elimination—or control—depends on policies guided by a more complete representation of the disease burden. PMID:28157458

  4. Tuberculosis.

    PubMed

    Jacobson, Karen R

    2017-02-07

    This issue provides a clinical overview of tuberculosis, focusing on screening, prevention, diagnosis, and treatment. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  5. A comparison of fertility control and lethal control of bovine tuberculosis in badgers: the impact of perturbation induced transmission.

    PubMed

    Swinton, J; Tuyttens, F; MacDonald, D; Nokes, D J; Cheeseman, C L; Clifton-Hadley, R

    1997-05-29

    In this paper we use mathematical modelling to consider the broad advantages and disadvantages of fertility control over lethal control for bovine tuberculosis in badger populations. We use a deliberately simple model, attempting to capture only the key transmission processes. The model is parametrized with reference to the long-term Woodchester Park study. Estimates of mortality rate from this study suggest no significant extra mortality risk for animals with evidence of infection as indicated by the presence of anti-Mycobacterium bovis antibodies or M. bovis isolation. We find that large reductions in prevalence are sometimes the consequence of only moderate reductions in population numbers. If we assume that the act of control does not in itself affect transmission rates, then as far as eradication is concerned, both fertility control and mortality control operate through the same epidemiological mechanism, the removal of susceptibles: if one is in principle capable of keeping a population low enough to be infection free then so is the other. It is necessary to continue either form of control at regular intervals to maintain a constant level of infection in the long term. If control were to be stopped, return to precontrol levels of badger population and infection prevalence would be expected within a few years. Fertility control is less effective in reducing population density than lethal control since it can only act, at maximum, to remove one age cohort per year. It is also less effective in reducing transmission as it can only ever remove susceptibles, while lethal control also removes infectious badgers. However, if the social disturbance caused by lethal control does in fact increase contact rates for the remaining infectious badgers, the relative efficacies of the two strategies become a great deal less clear. While we have no quantitative data on the extent to which social perturbation does act to promote transmission, model simulations show that it is

  6. A comparison of fertility control and lethal control of bovine tuberculosis in badgers: the impact of perturbation induced transmission.

    PubMed Central

    Swinton, J; Tuyttens, F; MacDonald, D; Nokes, D J; Cheeseman, C L; Clifton-Hadley, R

    1997-01-01

    In this paper we use mathematical modelling to consider the broad advantages and disadvantages of fertility control over lethal control for bovine tuberculosis in badger populations. We use a deliberately simple model, attempting to capture only the key transmission processes. The model is parametrized with reference to the long-term Woodchester Park study. Estimates of mortality rate from this study suggest no significant extra mortality risk for animals with evidence of infection as indicated by the presence of anti-Mycobacterium bovis antibodies or M. bovis isolation. We find that large reductions in prevalence are sometimes the consequence of only moderate reductions in population numbers. If we assume that the act of control does not in itself affect transmission rates, then as far as eradication is concerned, both fertility control and mortality control operate through the same epidemiological mechanism, the removal of susceptibles: if one is in principle capable of keeping a population low enough to be infection free then so is the other. It is necessary to continue either form of control at regular intervals to maintain a constant level of infection in the long term. If control were to be stopped, return to precontrol levels of badger population and infection prevalence would be expected within a few years. Fertility control is less effective in reducing population density than lethal control since it can only act, at maximum, to remove one age cohort per year. It is also less effective in reducing transmission as it can only ever remove susceptibles, while lethal control also removes infectious badgers. However, if the social disturbance caused by lethal control does in fact increase contact rates for the remaining infectious badgers, the relative efficacies of the two strategies become a great deal less clear. While we have no quantitative data on the extent to which social perturbation does act to promote transmission, model simulations show that it is

  7. Networked Estimation with an Area-Triggered Transmission Method

    PubMed Central

    Nguyen, Vinh Hao; Suh, Young Soo

    2008-01-01

    This paper is concerned with the networked estimation problem in which sensor data are transmitted over the network. In the event-driven sampling scheme known as level-crossing or send-on-delta, sensor data are transmitted to the estimator node if the difference between the current sensor value and the last transmitted one is greater than a given threshold. The event-driven sampling generally requires less transmission than the time-driven one. However, the transmission rate of the send-on-delta method becomes large when the sensor noise is large since sensor data variation becomes large due to the sensor noise. Motivated by this issue, we propose another event-driven sampling method called area-triggered in which sensor data are sent only when the integral of differences between the current sensor value and the last transmitted one is greater than a given threshold. Through theoretical analysis and simulation results, we show that in the certain cases the proposed method not only reduces data transmission rate but also improves estimation performance in comparison with the conventional event-driven method. PMID:27879742

  8. Tuberculosis and mass gatherings-opportunities for defining burden, transmission risk, and the optimal surveillance, prevention, and control measures at the annual Hajj pilgrimage.

    PubMed

    Zumla, Alimuddin; Saeed, Abdulaziz Bin; Alotaibi, Badriah; Yezli, Saber; Dar, Osman; Bieh, Kingsley; Bates, Matthew; Tayeb, Tamara; Mwaba, Peter; Shafi, Shuja; McCloskey, Brian; Petersen, Eskild; Azhar, Esam I

    2016-06-01

    Tuberculosis (TB) is now the most common infectious cause of death worldwide. In 2014, an estimated 9.6 million people developed active TB. There were an estimated three million people with active TB including 360000 with multidrug-resistant TB (MDR-TB) who were not diagnosed, and such people continue to fuel TB transmission in the community. Accurate data on the actual burden of TB and the transmission risk associated with mass gatherings are scarce and unreliable due to the small numbers studied and methodological issues. Every year, an estimated 10 million pilgrims from 184 countries travel to the Kingdom of Saudi Arabia (KSA) to perform the Hajj and Umrah pilgrimages. A large majority of pilgrims come from high TB burden and MDR-TB endemic areas and thus many may have undiagnosed active TB, sub-clinical TB, and latent TB infection. The Hajj pilgrimage provides unique opportunities for the KSA and the 184 countries from which pilgrims originate, to conduct high quality priority research studies on TB under the remit of the Global Centre for Mass Gatherings Medicine. Research opportunities are discussed, including those related to the definition of the TB burden, transmission risk, and the optimal surveillance, prevention, and control measures at the annual Hajj pilgrimage. The associated data are required to develop international recommendations and guidelines for TB management and control at mass gathering events.

  9. Transmission Electron Microscopy of XDR Mycobacterium tuberculosis Isolates Grown on High Dose of Ofloxacin

    PubMed Central

    Arjomandzadegan, Mohammad; Sadrnia, Maryam; Titov, Leonid; Surkova, Larissa; Sarmadian, Hossein; Ghasemikhah, Reza; Hosseiny, Hossein

    2017-01-01

    The aim of the study was to investigate behavior of resistant Mycobacterium tuberculosis (MTB) isolates under a high dose of ofloxacin and its morphological changes. 19 extensively drug resistant (XDR) clinical isolates of MTB were grown on Löwenstein–Jensen medium containing progressively increasing concentrations of ofloxacin (2, 4, 8, 16, 32 mg/L). Ultra-structure analyses of resistant isolates grown on ofloxacin were conducted by transmission electron microscopy (TEM). Fixation was carried out by 4% glutaraldehyde in 0.1 M sodium cacodylate buffer on 300 mesh carbon formvar copper grid. The samples were negatively stained with uranium acetate suspension. All 19 XDR MTB isolates were grown and formed colonies successfully on 2, 4, 8 mg/L, seven isolates on 16 mg/L, and four isolates on 32 mg/L ofloxacin. Morphological changes and unusual forms were detected in 8, 16 and 32 mg/L ofloxacin at 43%, 76.5% and 81% of cells, respectively. Swollen form (protoplast like), ghost-like cell, degraded forms, and in a few cases, detached cytoplasm from cell wall were clearly detected in high drug concentrations in comparison to control. Changes in morphology were increased with increasing ofloxacin concentrations (p < 0.05). Some XDR isolates could be successfully grown on high doses of ofloxacin (32 mg/L), but with changes in morphology. It was concluded that several magnitudes of the drug doses could not prevent growth of drug resistant forms. PMID:28157163

  10. An Experimental Model to Study Tuberculosis-Malaria Coinfection upon Natural Transmission of Mycobacterium tuberculosis and Plasmodium berghei

    PubMed Central

    Mueller, Ann-Kristin; Behrends, Jochen; Blank, Jannike; Schaible, Ulrich E.; Schneider, Bianca E.

    2014-01-01

    Coinfections naturally occur due to the geographic overlap of distinct types of pathogenic organisms. Concurrent infections most likely modulate the respective immune response to each single pathogen and may thereby affect pathogenesis and disease outcome. Coinfected patients may also respond differentially to anti-infective interventions. Coinfection between tuberculosis as caused by mycobacteria and the malaria parasite Plasmodium, both of which are coendemic in many parts of sub-Saharan Africa, has not been studied in detail. In order to approach the challenging but scientifically and clinically highly relevant question how malaria-tuberculosis coinfection modulate host immunity and the course of each disease, we established an experimental mouse model that allows us to dissect the elicited immune responses to both pathogens in the coinfected host. Of note, in order to most precisely mimic naturally acquired human infections, we perform experimental infections of mice with both pathogens by their natural routes of infection, i.e. aerosol and mosquito bite, respectively. PMID:24637905

  11. Institutional Tuberculosis Transmission. Controlled Trial of Upper Room Ultraviolet Air Disinfection: A Basis for New Dosing Guidelines.

    PubMed

    Mphaphlele, Matsie; Dharmadhikari, Ashwin S; Jensen, Paul A; Rudnick, Stephen N; van Reenen, Tobias H; Pagano, Marcello A; Leuschner, Wilhelm; Sears, Tim A; Milonova, Sonya P; van der Walt, Martie; Stoltz, Anton C; Weyer, Karin; Nardell, Edward A

    2015-08-15

    Transmission is driving the global tuberculosis epidemic, especially in congregate settings. Worldwide, natural ventilation is the most common means of air disinfection, but it is inherently unreliable and of limited use in cold climates. Upper room germicidal ultraviolet (UV) air disinfection with air mixing has been shown to be highly effective, but improved evidence-based dosing guidelines are needed. To test the efficacy of upper room germicidal air disinfection with air mixing to reduce tuberculosis transmission under real hospital conditions, and to define the application parameters responsible as a basis for proposed new dosing guidelines. Over an exposure period of 7 months, 90 guinea pigs breathed only untreated exhaust ward air, and another 90 guinea pigs breathed only air from the same six-bed tuberculosis ward on alternate days when upper room germicidal air disinfection was turned on throughout the ward. The tuberculin skin test conversion rates (>6 mm) of the two chambers were compared. The hazard ratio for guinea pigs in the control chamber converting their skin test to positive was 4.9 (95% confidence interval, 2.8-8.6), with an efficacy of approximately 80%. Upper room germicidal UV air disinfection with air mixing was highly effective in reducing tuberculosis transmission under hospital conditions. These data support using either a total fixture output (rather than electrical or UV lamp wattage) of 15-20 mW/m(3) total room volume, or an average whole-room UV irradiance (fluence rate) of 5-7 μW/cm(2), calculated by a lighting computer-assisted design program modified for UV use.

  12. Institutional Tuberculosis Transmission. Controlled Trial of Upper Room Ultraviolet Air Disinfection: A Basis for New Dosing Guidelines

    PubMed Central

    Mphaphlele, Matsie; Dharmadhikari, Ashwin S.; Jensen, Paul A.; Rudnick, Stephen N.; van Reenen, Tobias H.; Pagano, Marcello A.; Leuschner, Wilhelm; Sears, Tim A.; Milonova, Sonya P.; van der Walt, Martie; Stoltz, Anton C.; Weyer, Karin

    2015-01-01

    Rationale: Transmission is driving the global tuberculosis epidemic, especially in congregate settings. Worldwide, natural ventilation is the most common means of air disinfection, but it is inherently unreliable and of limited use in cold climates. Upper room germicidal ultraviolet (UV) air disinfection with air mixing has been shown to be highly effective, but improved evidence-based dosing guidelines are needed. Objectives: To test the efficacy of upper room germicidal air disinfection with air mixing to reduce tuberculosis transmission under real hospital conditions, and to define the application parameters responsible as a basis for proposed new dosing guidelines. Methods: Over an exposure period of 7 months, 90 guinea pigs breathed only untreated exhaust ward air, and another 90 guinea pigs breathed only air from the same six-bed tuberculosis ward on alternate days when upper room germicidal air disinfection was turned on throughout the ward. Measurements and Main Results: The tuberculin skin test conversion rates (>6 mm) of the two chambers were compared. The hazard ratio for guinea pigs in the control chamber converting their skin test to positive was 4.9 (95% confidence interval, 2.8–8.6), with an efficacy of approximately 80%. Conclusions: Upper room germicidal UV air disinfection with air mixing was highly effective in reducing tuberculosis transmission under hospital conditions. These data support using either a total fixture output (rather than electrical or UV lamp wattage) of 15–20 mW/m3 total room volume, or an average whole-room UV irradiance (fluence rate) of 5–7 μW/cm2, calculated by a lighting computer-assisted design program modified for UV use. PMID:25928547

  13. Evaluating Transmissivity Estimates from Well Hydrographs in Karst Aquifers

    SciTech Connect

    Powers, J.g.; Shevenell, l

    1999-07-01

    Hydrograph recessions from rainfall events have previously been analyzed for discharge at springs and streams; however, relatively little quantitative research has been conducted with regard to hydrograph analysis of recessions from monitoring wells screened in karst aquifers. In previous work a quantitative hydrography analysis technique has been proposed born which matrix transmissivity (i.e., transmissivity of intergranular porosity) and specific yields of matrix, fracture, and conduit components of the aquifer may be determined from well hydrography. The technique has yielded realistic results at three sites tested by the authors thus far (Y-12, Oak Ridge, TN; Crane, IN, and Ft. Campbell, KY). Observed field data, as well as theoretical considerations, show that karst well hydrography are valid indicators of hydraulic properties of the associated karst aquifers. Results show matrix transmissivity (T) values to be in good agreement with values calculated using more traditional parameter estimation techniques such as aquifer pumping tests and slug tests in matrix dominated wells. While the hydrograph analysis technique shows promise for obtaining reliable estimates of karst aquifer T with a simple, relatively inexpensive and passive method, the utility of the technique is limited in its application depending on site-specific hydrologic conditions, which include shallow, submerged conduit systems located in areas with sufficient rainfall for water levels to respond to precipitation events.

  14. Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmission.

    PubMed

    Escombe, A Roderick; Moore, David A J; Gilman, Robert H; Navincopa, Marcos; Ticona, Eduardo; Mitchell, Bailey; Noakes, Catherine; Martínez, Carlos; Sheen, Patricia; Ramirez, Rocio; Quino, Willi; Gonzalez, Armando; Friedland, Jon S; Evans, Carlton A

    2009-03-17

    Institutional tuberculosis (TB) transmission is an important public health problem highlighted by the HIV/AIDS pandemic and the emergence of multidrug- and extensively drug-resistant TB. Effective TB infection control measures are urgently needed. We evaluated the efficacy of upper-room ultraviolet (UV) lights and negative air ionization for preventing airborne TB transmission using a guinea pig air-sampling model to measure the TB infectiousness of ward air. For 535 consecutive days, exhaust air from an HIV-TB ward in Lima, Perú, was passed through three guinea pig air-sampling enclosures each housing approximately 150 guinea pigs, using a 2-d cycle. On UV-off days, ward air passed in parallel through a control animal enclosure and a similar enclosure containing negative ionizers. On UV-on days, UV lights and mixing fans were turned on in the ward, and a third animal enclosure alone received ward air. TB infection in guinea pigs was defined by monthly tuberculin skin tests. All guinea pigs underwent autopsy to test for TB disease, defined by characteristic autopsy changes or by the culture of Mycobacterium tuberculosis from organs. 35% (106/304) of guinea pigs in the control group developed TB infection, and this was reduced to 14% (43/303) by ionizers, and to 9.5% (29/307) by UV lights (both p < 0.0001 compared with the control group). TB disease was confirmed in 8.6% (26/304) of control group animals, and this was reduced to 4.3% (13/303) by ionizers, and to 3.6% (11/307) by UV lights (both p < 0.03 compared with the control group). Time-to-event analysis demonstrated that TB infection was prevented by ionizers (log-rank 27; p < 0.0001) and by UV lights (log-rank 46; p < 0.0001). Time-to-event analysis also demonstrated that TB disease was prevented by ionizers (log-rank 3.7; p = 0.055) and by UV lights (log-rank 5.4; p = 0.02). An alternative analysis using an airborne infection model demonstrated that ionizers prevented 60% of TB infection and 51% of TB

  15. Upper-Room Ultraviolet Light and Negative Air Ionization to Prevent Tuberculosis Transmission

    PubMed Central

    Escombe, A. Roderick; Moore, David A. J; Gilman, Robert H; Navincopa, Marcos; Ticona, Eduardo; Mitchell, Bailey; Noakes, Catherine; Martínez, Carlos; Sheen, Patricia; Ramirez, Rocio; Quino, Willi; Gonzalez, Armando; Friedland, Jon S; Evans, Carlton A

    2009-01-01

    Background Institutional tuberculosis (TB) transmission is an important public health problem highlighted by the HIV/AIDS pandemic and the emergence of multidrug- and extensively drug-resistant TB. Effective TB infection control measures are urgently needed. We evaluated the efficacy of upper-room ultraviolet (UV) lights and negative air ionization for preventing airborne TB transmission using a guinea pig air-sampling model to measure the TB infectiousness of ward air. Methods and Findings For 535 consecutive days, exhaust air from an HIV-TB ward in Lima, Perú, was passed through three guinea pig air-sampling enclosures each housing approximately 150 guinea pigs, using a 2-d cycle. On UV-off days, ward air passed in parallel through a control animal enclosure and a similar enclosure containing negative ionizers. On UV-on days, UV lights and mixing fans were turned on in the ward, and a third animal enclosure alone received ward air. TB infection in guinea pigs was defined by monthly tuberculin skin tests. All guinea pigs underwent autopsy to test for TB disease, defined by characteristic autopsy changes or by the culture of Mycobacterium tuberculosis from organs. 35% (106/304) of guinea pigs in the control group developed TB infection, and this was reduced to 14% (43/303) by ionizers, and to 9.5% (29/307) by UV lights (both p < 0.0001 compared with the control group). TB disease was confirmed in 8.6% (26/304) of control group animals, and this was reduced to 4.3% (13/303) by ionizers, and to 3.6% (11/307) by UV lights (both p < 0.03 compared with the control group). Time-to-event analysis demonstrated that TB infection was prevented by ionizers (log-rank 27; p < 0.0001) and by UV lights (log-rank 46; p < 0.0001). Time-to-event analysis also demonstrated that TB disease was prevented by ionizers (log-rank 3.7; p = 0.055) and by UV lights (log-rank 5.4; p = 0.02). An alternative analysis using an airborne infection model demonstrated that ionizers prevented 60% of

  16. Does the lipR gene of tubercle bacilli have a role in tuberculosis transmission and pathogenesis?

    PubMed

    Sheline, Katherine D; France, Anne M; Talarico, Sarah; Foxman, Betsy; Zhang, Lixin; Marrs, Carl F; Bates, Joseph H; Cave, M Donald; Yang, Zhenhua

    2009-03-01

    Mycobacterium tuberculosis lipases, a diverse class of enzymes involved in lipid metabolism, may have an important role in tuberculosis (TB) pathogenesis. We explored the association of large sequence polymorphism (LSP) in one of the M. tuberculosis lipase-encoding genes, lipR (Rv3084), with patient characteristics using a population-based sample of clinical isolates to elucidate the potential role of lipR in TB pathogenesis. LSP in lipR was found in 104 (15.6%) of 665 isolates, of which 96% belonged to principal genetic group 3. When linkage by molecular type and epidemiologic evidence were compared, molecularly clustered cases infected with a lipR LSP isolate were more often epidemiologically linked than clustered cases infected with a lipR wild-type isolate. Further epidemiologic and functional studies are necessary to determine if the association between this lipR LSP and recent transmission we identified in this population reflects a functional role of lipR in TB transmission and pathogenesis or other unidentified mechanisms.

  17. Layered material characterization using ultrasonic transmission. An inverse estimation methodology.

    PubMed

    Messineo, María G; Rus, Guillermo; Eliçabe, Guillermo E; Frontini, Gloria L

    2016-02-01

    This paper presents an inverse methodology with the aim to characterize a layered material through the identification of acoustical and mechanical properties of its layers. The framework to accomplish this objective is provided by the Inverse Problems (IPs) theory. Material characterization refers to the detection and localization of discontinuities, as well as to the identification of physical properties, in order to predict the material behaviour. In this particular case, the IP is solved in the form of a parameter estimation problem, in which the goal is the estimation of the characteristic acoustic impedance, transit time, and attenuation of each layer. These parameters are directly related to relevant material properties, such as the speed of sound, density, elastic modulus and elastic energy dissipation constants. The IP solution is obtained by minimizing a cost functional formulated as the least squares error between the waveform calculated using an equivalent model, and the measured waveform obtained from ultrasonic transmission tests. The applied methodology allowed the accurate estimation of the desired parameters in materials composed of up to three layers. As a second contribution, a power law frequency dependence of the wave attenuation was identified for several homogeneous materials, based on the same ultrasonic transmission experiments.

  18. Use of cattle farm resources by badgers (Meles meles) and risk of bovine tuberculosis (Mycobacterium bovis) transmission to cattle.

    PubMed

    Garnett, B T; Delahay, R J; Roper, T J

    2002-07-22

    Nocturnal observations, radio telemetry and time-lapse camera surveillance were used to investigate visits by badgers (Meles meles L.) to two cattle farms. During 59 half-nights (ca. 295 h) of observation and 17 nights (ca. 154 h) of camera surveillance, 139 separate visits to farm buildings, by at least 26 individually identifiable badgers from two social groups, were recorded. The badgers, which included three individuals infected with bovine tuberculosis (Mycobacterium bovis), used cowsheds, feedsheds, barns, haystacks, slurry pits, cattle troughs and farmyards to exploit a range of food resources, including cattle feed and silage. Cattle feed was contaminated with badger faeces and badgers also came into close contact with cattle. The minimum number of badgers visiting farm buildings per night was negatively correlated with local 24 h rainfall. We conclude that exploitation by badgers of resources provided by cattle farms constitutes a potentially important mechanism for tuberculosis transmission from badgers to cattle.

  19. Use of cattle farm resources by badgers (Meles meles) and risk of bovine tuberculosis (Mycobacterium bovis) transmission to cattle.

    PubMed Central

    Garnett, B T; Delahay, R J; Roper, T J

    2002-01-01

    Nocturnal observations, radio telemetry and time-lapse camera surveillance were used to investigate visits by badgers (Meles meles L.) to two cattle farms. During 59 half-nights (ca. 295 h) of observation and 17 nights (ca. 154 h) of camera surveillance, 139 separate visits to farm buildings, by at least 26 individually identifiable badgers from two social groups, were recorded. The badgers, which included three individuals infected with bovine tuberculosis (Mycobacterium bovis), used cowsheds, feedsheds, barns, haystacks, slurry pits, cattle troughs and farmyards to exploit a range of food resources, including cattle feed and silage. Cattle feed was contaminated with badger faeces and badgers also came into close contact with cattle. The minimum number of badgers visiting farm buildings per night was negatively correlated with local 24 h rainfall. We conclude that exploitation by badgers of resources provided by cattle farms constitutes a potentially important mechanism for tuberculosis transmission from badgers to cattle. PMID:12137579

  20. Using DNA fingerprinting to detect transmission of Mycobacterium tuberculosis among AIDS patients in two health-care facilities in Puerto Rico.

    PubMed

    Hennessey, K A; Schulte, J M; Valway, S E; Joglar, O T; Rios, N; Sheppard, J D; Onorato, I M

    2000-08-01

    Fourteen cases of tuberculosis (TB) in Puerto Rico, diagnosed from April 1993 to April 1995, had the same DNA fingerprint, documenting disease caused by the same strain of Mycobacterium tuberculosis. The 14 cases were retrospectively investigated for epidemiologic links. Records were reviewed and staffs of the TB program, hospital/clinic, and AIDS residential facilities were interviewed. Half of the AIDS cases were epidemiologically related, providing evidence of TB transmission in an emergency department, an AIDS inpatient ward, and an AIDS residential facility. DNA fingerprinting allowed detection of M tuberculosis transmission, but contact investigators could have documented it sooner. Factors contributing to transmission included delayed diagnosis, prolonged infectiousness, inadequate discharge planning and infection control procedures, and poor communication between health-care facilities. The numbers of AIDS residential facilities are increasing and must understand proper monitoring of TB patients and infection control measures that prevent transmissions.

  1. Preventing tuberculosis transmission at a maternity hospital by targeted screening radiography of migrants.

    PubMed

    Schechner, V; Lessing, J B; Grisaru-Soen, G; Braun, T; Abu-Hanna, J; Carmeli, Y; Aviram, G

    2015-07-01

    Israel has been the destination of large numbers of illegal migrants from East African countries in recent years. Despite efforts to detect and treat active tuberculosis (TB) at the border, 75% of all active TB cases diagnosed in our hospital were illegal migrants. In 2012, there was a large-scale TB exposure in our maternity ward, neonatal, and paediatric intensive care units following the admission of an infectious but apparently asymptomatic migrant who was in labour. A hospital-wide screening programme was subsequently implemented to prevent exposure of patients and staff to TB. To report the results of the first year of this intervention in the maternity hospital. All illegal migrants from countries where TB is highly prevalent were screened by chest radiography (CR) upon admission to the maternity hospital. The results were immediately categorized by a radiologist as either 'suggestive of active pulmonary TB' or 'non-suggestive'. Patients with CR suggestive of TB were placed in airborne isolation and underwent further evaluation. Four hundred and thirty-one apparently asymptomatic migrant women underwent CR screening. Most (363, 84%) presented in labour. Eleven women (2.6%) had a CR suggestive of active pulmonary TB which was confirmed in three (0.7% of screened women). No TB cases were missed by the CRs. Neither patients nor hospital staff were exposed to TB. Targeted CR screening for TB among high-risk women upon their admission to a maternity hospital had a high yield and was an effective strategy to prevent in-hospital transmission of TB. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  2. Transdisciplinary habitat models for elk and cattle as a proxy for bovine tuberculosis transmission risk.

    PubMed

    Brook, Ryan K; McLachlan, Stéphane M

    2009-10-01

    Zoonotic diseases such as bovine tuberculosis (TB) that infect wildlife and livestock are particularly difficult to eradicate where wild animals make extensive use of agricultural landscapes. Transmission of TB between cattle (Bos taurus) and wild elk (Cervus elaphus) in southwestern Manitoba, Canada remains poorly understood but there is a risk when commingling occurs on summer pasture. Elk use of cattle summer pastures was assessed using ecological data (187 VHF and 25 GPS collared elk monitored over four years representing 8% of the elk population). Local knowledge was documented by conducting interviews and participatory mapping exercises with 86 cattle producers (98% of those within the study area). Of the 294 cattle pastures mapped by farmers, 13% were used by radio-collared elk, 38% were reported by farmers as being used by elk, and 42% were identified as used by elk when both when all datasets were combined. Cattle pastures that had been used by elk and those that had no elk were compared using binary logistic regression based on each of the three datasets (i.e. farmer observations, radio-collared elk on pasture, and combined dataset). For all three datasets, distance to protected area and proportion of forest cover on the cattle pasture were identified as the most and second most important predictor variables, respectively. There was strong agreement among the relative probabilities of elk occurrence on each pasture derived from the resource selection function (RSF) models developed using farmer interviews and elk collaring data. The farmer interview and collar datasets were then combined to generate a final integrated RSF map summarizing the probability of elk-cattle commingling and were contrasted over each of four cattle grazing seasons (spring, early summer, late summer, and autumn). These predictive maps indicate that use of cattle pastures by elk is extensive, particularly in spring and early summer. Farmer observations indicate that elk and cattle

  3. Parameter estimation based synchronization for an epidemic model with application to tuberculosis in Cameroon

    NASA Astrophysics Data System (ADS)

    Bowong, Samuel; Kurths, Jurgen

    2010-10-01

    We propose a method based on synchronization to identify the parameters and to estimate the underlying variables for an epidemic model from real data. We suggest an adaptive synchronization method based on observer approach with an effective guidance parameter to update rule design only from real data. In order, to validate the identifiability and estimation results, numerical simulations of a tuberculosis (TB) model using real data of the region of Center in Cameroon are performed to estimate the parameters and variables. This study shows that some tools of synchronization of nonlinear systems can help to deal with the parameter and state estimation problem in the field of epidemiology. We exploit the close link between mathematical modelling, structural identifiability analysis, synchronization, and parameter estimation to obtain biological insights into the system modelled.

  4. LOSS ESTIMATE FOR ITER ECH TRANSMISSION LINE INCLUDING MULTIMODE PROPAGATION

    SciTech Connect

    Shapiro, Michael; Bigelow, Tim S; Caughman, John B; Rasmussen, David A

    2010-01-01

    The ITER electron cyclotron heating (ECH) transmission lines (TLs) are 63.5-mm-diam corrugated waveguides that will each carry 1 MW of power at 170 GHz. The TL is defined here as the corrugated wave guide system connecting the gyrotron mirror optics unit (MO U) to the entrance of the ECH launcher and includes miter bends and other corrugated wave guide components. The losses on the ITER TL have been calculated for four possible cases corresponding to having HE(11) mode purity at the input of the TL of 100, 97, 90, and 80%. The losses due to coupling, ohmic, and mode conversion loss are evaluated in detail using a numerical code and analytical approaches. Estimates of the calorimetric loss on the line show that the output power is reduced by about 5, +/- 1% because of ohmic loss in each of the four cases. Estimates of the mode conversion loss show that the fraction of output power in the HE(11) mode is similar to 3% smaller than the fraction of input power in the HE(11) mode. High output mode purity therefore can be achieved only with significantly higher input mode purity. Combining both ohmic and mode conversion loss, the efficiency of the TL from the gyrotron MOU to the ECH launcher can be roughly estimated in theory as 92% times the fraction of input power in the HE(11) mode.

  5. Estimating the tuberculosis burden in resource-limited countries: a capture-recapture study in Yemen.

    PubMed

    Bassili, A; Al-Hammadi, A; Al-Absi, A; Glaziou, P; Seita, A; Abubakar, I; Bierrenbach, A L; van Hest, N A

    2013-04-01

    The lack of applicable population-based methods to measure tuberculosis (TB) incidence rates directly at country level emphasises the global need to generate robust TB surveillance data to ascertain trends in disease burden and to assess the performance of TB control programmes in the context of the United Nations Millenium Development Goals and World Health Organization targets for TB control. To estimate the incidence of TB cases (all forms) and sputum smear-positive disease, and the level of under-reporting of TB in Yemen in 2010. Record-linkage and three-source capture-recapture analysis of data collected through active prospective longitudinal surveillance within the public and private non-National Tuberculosis Programme sector in twelve Yemeni governorates, selected by stratified cluster random sampling. For all TB cases, the estimated ratio of notified to incident cases and completeness of case ascertainment after record linkage, i.e., the ratio of detected to incident cases, was respectively 71% (95%CI 64-80) and 75% (95%CI 68-85). For sputum smear-positive TB cases, these ratios were respectively 67% (95%CI 58-75) and 76% (95%CI 66-84). We estimate that there were 13 082 (95%CI 11 610-14 513) TB cases in Yemen in 2010. Under-reporting of TB in Yemen is estimated at 29% (95%CI 20-36).

  6. Monitoring of Transmission of Tuberculosis between Wild Boars and Cattle: Genotypical Analysis of Strains by Molecular Epidemiology Techniques

    PubMed Central

    Serraino, Andrea; Marchetti, Giulia; Sanguinetti, Valeria; Rossi, Maria Cristina; Zanoni, Renato Giulio; Catozzi, Lidia; Bandera, Alessandra; Dini, Walter; Mignone, Walter; Franzetti, Fabio; Gori, Andrea

    1999-01-01

    An epidemiological survey for the monitoring of bovine tuberculosis transmission was carried out in western Liguria, a region in northern Italy. Fifteen Mycobacterium bovis strains were isolated from 63 wild boar samples (62 from mandibular lymph nodes and 1 from a liver specimen). Sixteen mediastinal lymph nodes of 16 head of cattle were collected, and 15 Mycobacterium bovis strains were subsequently cultured. All M. bovis strains isolated from cattle and wild boars were genotyped by spoligotyping and by restriction fragment length polymorphism (RFLP) analysis with the IS6110 and IS1081 probes. All M. bovis strains showed the typical spoligotype characterized by the absence of the 39 to 43 spacers in comparison with the number in M. tuberculosis. A total of nine different clusters were identified by spoligotyping. The largest cluster included 9 strains isolated from wild boars and 11 strains isolated from cattle, thus confirming the possibility of transmission between the two animal species. Fingerprinting by RFLP analysis with the IS6110 probe showed an identical single-band pattern for 29 of 30 strains analyzed, and only 1 strain presented a five-band pattern. The use of IS1081 as a second probe was useful for differentiation of M. bovis from M. bovis BCG but not for differentiation among M. bovis strains, which presented the same undifferentiated genomic profile. In relation to the epidemiological investigation, we hypothesized that the feeding in pastures contaminated by cattle discharges could represent the most probable route of transmission of M. bovis between the two animal species. In conclusion, our results confirmed the higher discriminatory power of spoligotyping in relation to that of RFLP analysis for the differentiation of M. bovis genomic profiles. Our data showed the presence of a common M. bovis genotype in both cattle and wild boars, confirming the possible interspecies transmission of M. bovis. PMID:10449449

  7. The minipig as an animal model to study Mycobacterium tuberculosis infection and natural transmission

    USDA-ARS?s Scientific Manuscript database

    Infants and children with tuberculosis (TB) account for more than 20% of cases in endemic countries. Current animal models study TB during adulthood but animal models for adolescent and infant TB are scarce. Here we propose that minipigs can be used as an animal model to study adult, adolescent and ...

  8. Interpretation of transmissivity estimates from single-well pumping aquifer tests

    USGS Publications Warehouse

    Halford, K.J.; Weight, W.D.; Schreiber, R.P.

    2006-01-01

    Interpretation of single-well tests with the Cooper-Jacob method remains more reasonable than most alternatives. Drawdowns from 628 simulated single-well tests where transmissivity was specified were interpreted with the Cooper-Jacob straight-line method to estimate transmissivity. Error and bias as a function of vertical anisotropy, partial penetration, specific yield, and interpretive technique were investigated for transmissivities that ranged from 10 to 10,000 m2/d. Cooper-Jacob transmissivity estimates in confined aquifers were affected minimally by partial penetration, vertical anisotropy, or analyst. Cooper-Jacob transmissivity estimates of simulated unconfined aquifers averaged twice the known values. Transmissivity estimates of unconfined aquifers were not improved by interpreting results with an unconfined aquifer solution. Judicious interpretation of late-time data consistently improved estimates where transmissivity exceeded 250 m2/d in unconfined aquifers. ?? 2006 National Ground Water Association.

  9. A time lag insensitive approach for estimating HIV-1 transmission direction.

    PubMed

    Yang, Jing; Ge, Meng; Pan, Xian-Ming

    2012-05-15

    Identifying the direction of transmission in transmission pairs is important both for forensic investigations and for the monitoring of HIV epidemics, however, reliable methods are not yet available due to the long time lag between infection and sampling in most real cases. Based on bottleneck effect and coreceptor switching, we aimed at identifying an estimator from sequences of viral gp120 proteins to determine transmission direction between transmission pairs. The estimator should be changed with HIV transmission but was independent of disease progression in an individual. Here, we present a novel and reliable approach for identifying transmission direction. We derived a set of conserved patterns, called common patterns, from the sequences of viruses, which differed in their coreceptor usage. The number of unique common patterns in viral sequences decreased with transmission but remained almost constant with the progress of disease in an individual. We used this number as an estimator to determine transmission direction in 73 transmission pairs for which the transmission direction was already known. Our method predicted transmission direction with an accuracy of up to 94.5%. Of greater importance, our approach was not influenced by time lags between infection and sampling, and even transmission direction for transmission pairs with long time lags ranging from 2 years to more than 18 years were correctly determined. Our approach for accurately determining transmission direction between transmission pairs is irrespective of the time lag between infection and sampling, which means a promising applications prospect.

  10. Growth and cell-division in extensive (XDR) and extremely drug resistant (XXDR) tuberculosis strains: transmission and atomic force observation.

    PubMed

    Farnia, Parissa; Mohammad, Reza Masjedi; Merza, Muayad Aghali; Tabarsi, Payam; Zhavnerko, Gennadii Konstantinovich; Ibrahim, Tengku Azmi; Kuan, Ho Oi; Ghanavei, Jalladein; Farnia, Poopak; Ranjbar, Reza; Poleschuyk, Nikolai Nikolaevich; Titov, Leonid Petrovich; Owlia, Parviz; Kazampour, Mehadi; Setareh, Mohammad; Sheikolslami, Muaryam; Migliori, Giovanni Battista; Velayati, Ali Akbar

    2010-09-30

    The ultra-structure of Mycobacterium tuberculosis (MTB) was examined by transmission electronic (TEM)) and atomic force microscopy (AFM). The study was performed to describe the morphology of susceptible, multidrug-resistant (MDR), extensively drug-resistant (XDR) and extremely drug-resistant tuberculosis isolates (XXDR-TB) during their exponential growth phase. Four types of cell division were observed and described. While three of them (symmetrical, asymmetrical and branching type) occurred in all isolates studied, the fourth one (adapted type) was seen only in XDR and XXDR-TB bacilli. In the fourth type of cell division, a rod shaped mother cell produced a small round shape bacillus (0.3-0.5 μm). These round cells were different from buds or polar division, but similar to terminal endospores without showing the typing heat resistance. Based on the present observation, we suggest that XDR-and XXDR-TB bacilli accommodate changes helping them to overcome the hostile environment. Viewed under AFM, the other frequently detected shapes in MTB isolates were oval, V, Y and multi-branching filaments. These shape variation confirmed pleomorphic phenomena in MTB populations and the specific features of pan-resistant strains.

  11. Vaccine Platform for Prevention of Tuberculosis and Mother-to-Child Transmission of Human Immunodeficiency Virus Type 1 through Breastfeeding▿

    PubMed Central

    Im, Eung-Jun; Saubi, Narcís; Virgili, Goretti; Sander, Clare; Teoh, Denise; Gatell, Jose M.; McShane, Helen; Joseph, Joan; Hanke, Tomáš

    2007-01-01

    Most children in Africa receive their vaccine against tuberculosis at birth. Those infants born to human immunodeficiency virus type 1 (HIV-1)-positive mothers are at high risk of acquiring HIV-1 infection through breastfeeding in the first weeks of their lives. Thus, the development of a vaccine which would protect newborns against both of these major global killers is a logical yet highly scientifically, ethically, and practically challenging aim. Here, a recombinant lysine auxotroph of Mycobacterium bovis bacillus Calmette-Guérin (BCG), a BCG strain that is safer than those currently used and expresses an African HIV-1 clade-derived immunogen, was generated and shown to be stable and to induce durable, high-quality HIV-1-specific CD4+- and CD8+-T-cell responses. Furthermore, when the recombinant BCG vaccine was used in a priming-boosting regimen with heterologous components, the HIV-1-specific responses provided protection against surrogate virus challenge, and the recombinant BCG vaccine alone protected against aerosol challenge with M. tuberculosis. Thus, inserting an HIV-1-derived immunogen into the scheduled BCG vaccine delivered at or soon after birth may prime HIV-1-specific responses, which can be boosted by natural exposure to HIV-1 in the breast milk and/or by a heterologous vaccine such as recombinant modified vaccinia virus Ankara delivering the same immunogen, and decrease mother-to-child transmission of HIV-1 during breastfeeding. PMID:17596303

  12. Evolutionary History and Ongoing Transmission of Phylogenetic Sublineages of Mycobacterium tuberculosis Beijing Genotype in China

    PubMed Central

    Yin, Qing-qin; Liu, Hai-can; Jiao, Wei-wei; Li, Qin-jing; Han, Rui; Tian, Jian-ling; Liu, Zhi-guang; Zhao, Xiu-qin; Li, Ying-jia; Wan, Kang-lin; Shen, A-dong; Mokrousov, Igor

    2016-01-01

    Mycobacterium tuberculosis Beijing genotype originated in China and has undergone a dramatic population growth and global spread in the last century. Here, a collection of M. tuberculosis Beijing family isolates from different provinces across all China was genotyped by high-resolution (24-MIRU-VNTR) and low-resolution, high-rank (modern and ancient sublineages) markers. The molecular profiles and global and local phylogenies were compared to the strain phenotype and patient data. The phylogeographic patterns observed in the studied collection demonstrate that large-scale (but not middle/small-scale) distance remains one of the decisive factors of the genetic divergence of M. tuberculosis populations. Analysis of diversity and network topology of the local collections appears to corroborate a recent intriguing hypothesis about Beijing genotype originating in South China. Placing our results within the Eurasian context suggested that important Russian B0/W148 and Asian/Russian A0/94-32 epidemic clones of the Beijing genotype could trace their origins to the northeastern and northwestern regions of China, respectively. The higher clustering of the modern isolates in children and lack of increased MDR rate in any sublineage suggest that not association with drug resistance but other (e.g., speculatively, virulence-related) properties underlie an enhanced dissemination of the evolutionarily recent, modern sublineage of the Beijing genotype in China. PMID:27681182

  13. INCIDENCE OF MULTIDRUG-RESISTANT TUBERCULOSIS DISEASE IN CHILDREN: SYSTEMATIC REVIEW AND GLOBAL ESTIMATES

    PubMed Central

    Jenkins, Helen E.; Tolman, Arielle W.; Yuen, Courtney M.; Parr, Jonathan B.; Keshavjee, Salmaan; Pérez-Vélez, Carlos M.; Pagano, Marcello; Becerra, Mercedes C.; Cohen, Ted

    2014-01-01

    Background Multidrug-resistant tuberculosis (MDR-TB) threatens to reverse recent reductions in global tuberculosis (TB) incidence. Although children under 15 years of age constitute >25% of the worldwide population, the global incidence of MDR-TB disease in children has never been quantified. Methods Our approach for estimating regional and global annual incidence of MDR-TB in children required development of two models: one to estimate the setting-specific risk of MDR-TB among child TB cases, and a second to estimate the setting-specific incidence of TB disease in children. The model for MDR-TB risk among children with TB required a systematic literature review. We multiplied the setting-specific estimates of MDR-TB risk and TB incidence to estimate regional and global incidence of MDR-TB disease in children in 2010. Findings We identified 3,403 papers, of which 97 studies met inclusion criteria for the systematic review of MDR-TB risk. Thirty-one studies reported the risk of MDR-TB among both children and treatment-naïve adults with TB and were used for evaluating the linear association between MDR-TB risk in these two patient groups. We found that the setting-specific risk of MDR-TB was nearly identical in children and treatment-naïve adults with TB, consistent with the assertion that MDR-TB in both groups reflects the local risk of transmitted MDR-TB. Applying these calculated risks, we estimated that around 1,000,000 (95% Confidence Interval: 938,000 – 1,055,000) children developed TB disease in 2010, among whom 32,000 (95% Confidence Interval: 26,000 – 39,000) had MDR-TB. Interpretation Our estimates highlight a massive detection gap for children with TB and MDR-TB disease. Future estimates can be refined as more and better TB data and new diagnostic tools become available. PMID:24671080

  14. The impact of migrant workers on the tuberculosis transmission: general models and a case study for China.

    PubMed

    Liu, Luju; Wu, Jianhong; Zhao, Xiao-Qiang

    2012-10-01

    A tuberculosis (TB) transmission model involving migrant workers is proposed and investigated. The basic reproduction number R0 is calculated, and is shown to be a threshold parameter for the disease to persist or become extinct in the population. The existence and global attractivity of an endemic equilibrium, if R0 > 1, is also established under some technical conditions. A case study, based on the TB epidemiological and other statistical data in China, indicates that the disease spread can be controlled if effective measures are taken to reduce the reactivation rate of exposed/latent migrant workers. Impact of the migration rate and direction, as well as the duration of home visit stay, on the control of disease spread is also examined numerically.

  15. Evaluating wildlife-cattle contact rates to improve the understanding of dynamics of bovine tuberculosis transmission in Michigan, USA.

    PubMed

    Lavelle, Michael J; Kay, Shannon L; Pepin, Kim M; Grear, Daniel A; Campa, Henry; VerCauteren, Kurt C

    2016-12-01

    Direct and indirect contacts among individuals drive transmission of infectious disease. When multiple interacting species are susceptible to the same pathogen, risk assessment must include all potential host species. Bovine tuberculosis (bTB) is an example of a disease that can be transmitted among several wildlife species and to cattle, although the potential role of several wildlife species in spillback to cattle remains unclear. To better understand the complex network of contacts and factors driving disease transmission, we fitted proximity logger collars to beef and dairy cattle (n=37), white-tailed deer (Odocoileus virginianus; n=29), raccoon (Procyon lotor; n=53), and Virginia opossum (Didelphis virginiana; n=79) for 16 months in Michigan's Lower Peninsula, USA. We determined inter- and intra-species direct and indirect contact rates. Data on indirect contact was calculated when collared animals visited stationary proximity loggers placed at cattle feed and water resources. Most contact between wildlife species and cattle was indirect, with the highest contact rates occurring between raccoons and cattle during summer and fall. Nearly all visits (>99%) to cattle feed and water sources were by cattle, whereas visitation to stored cattle feed was dominated by deer and raccoon (46% and 38%, respectively). Our results suggest that indirect contact resulting from wildlife species visiting cattle-related resources could pose a risk of disease transmission to cattle and deserves continued attention with active mitigation.

  16. Tuberculosis transmission between foreign- and native-born populations in the EU/EEA: a systematic review

    PubMed Central

    Sandgren, Andreas; Sañé Schepisi, Monica; Sotgiu, Giovanni; Huitric, Emma; Migliori, Giovanni Battista; Manissero, Davide; van der Werf, Marieke J.; Girardi, Enrico

    2014-01-01

    Tuberculosis (TB) control programmes of many low TB incidence countries of the European Union/European Economic Area (EU/EEA) perceive challenges in controlling TB due to high numbers of TB in migrants from high-incidence countries. To assess the extent of TB transmission from the foreign-born to the native-born population, we quantitatively investigated the dynamics of TB transmission between these populations in the EU/EEA, using published molecular epidemiological studies. We searched PubMed and EMBASE databases from 1990 to August 2012. We identified 15 studies performed during 1992–2007 covering 12,366 cases, of which median (range) 49.2% (17.7%–86.4%) were foreign-born. The proportion of clustered isolates ranged between 8.5% and 49.1% of the total number of TB cases genotyped and among these, foreign-born cases were equally or more likely to have unique isolates compared to native-born cases. One third of the clusters were “mixed”, i.e. composed of foreign- and native-born cases, involving 0–34.2% of all genotyped cases. Cross-transmission among foreign and native populations was bidirectional, with wide differences across studies. This systematic review provides evidence that TB in a foreign-born population does not have a significant influence on TB in the native population in EU/EEA. PMID:24114966

  17. Global and Regional Burden of Isoniazid-Resistant Tuberculosis

    PubMed Central

    Yuen, Courtney M.; Jenkins, Helen E.; Rodriguez, Carly A.; Keshavjee, Salmaan

    2015-01-01

    BACKGROUND: Isoniazid has been the backbone of tuberculosis chemotherapy for 6 decades. Resistance to isoniazid threatens the efficacy of treatment of tuberculosis disease and infection. To inform policies around treatment of tuberculosis disease and infection in children, we sought to estimate both the proportion of child tuberculosis cases with isoniazid resistance and the number of incident isoniazid-resistant tuberculosis cases in children, by region. METHODS: We determined the relationship between rates of isoniazid resistance among child cases and among treatment-naive adult cases through a systematic literature review. We applied this relationship to regional isoniazid resistance estimates to estimate proportions of childhood tuberculosis cases with isoniazid resistance. We applied these proportions to childhood tuberculosis incidence estimates to estimate numbers of children with isoniazid-resistant tuberculosis. RESULTS: We estimated 12.1% (95% confidence interval [CI] 9.8% to 14.8%) of all children with tuberculosis had isoniazid-resistant disease, representing 120 872 (95% CI 96 628 to 149 059) incident cases of isoniazid-resistant tuberculosis in children in 2010. The majority of these occurred in the Western Pacific and Southeast Asia regions; the European region had the highest proportion of child tuberculosis cases with isoniazid resistance, 26.1% (95% CI: 20.0% to 33.6%). CONCLUSIONS: The burden of isoniazid-resistant tuberculosis in children is substantial, and risk varies considerably by setting. The large number of child cases signals extensive ongoing transmission from adults with isoniazid-resistant tuberculosis. The risk of isoniazid resistance must be considered when evaluating treatment options for children with disease or latent infection to avoid inadequate treatment and consequent poor outcomes. PMID:26034243

  18. Estimating the future burden of multidrug-resistant and extensively drug-resistant tuberculosis in India, the Philippines, Russia, and South Africa: a mathematical modelling study.

    PubMed

    Sharma, Aditya; Hill, Andrew; Kurbatova, Ekaterina; van der Walt, Martie; Kvasnovsky, Charlotte; Tupasi, Thelma E; Caoili, Janice C; Gler, Maria Tarcela; Volchenkov, Grigory V; Kazennyy, Boris Y; Demikhova, Olga V; Bayona, Jaime; Contreras, Carmen; Yagui, Martin; Leimane, Vaira; Cho, Sang Nae; Kim, Hee Jin; Kliiman, Kai; Akksilp, Somsak; Jou, Ruwen; Ershova, Julia; Dalton, Tracy; Cegielski, Peter

    2017-07-01

    Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis are emerging worldwide. The Green Light Committee initiative supported programmatic management of drug-resistant tuberculosis in 90 countries. We used estimates from the Preserving Effective TB Treatment Study to predict MDR and XDR tuberculosis trends in four countries with a high burden of MDR tuberculosis: India, the Philippines, Russia, and South Africa. We calibrated a compartmental model to data from drug resistance surveys and WHO tuberculosis reports to forecast estimates of incident MDR and XDR tuberculosis and the percentage of incident MDR and XDR tuberculosis caused by acquired drug resistance, assuming no fitness cost of resistance from 2000 to 2040 in India, the Philippines, Russia, and South Africa. The model forecasted the percentage of MDR tuberculosis among incident cases of tuberculosis to increase, reaching 12·4% (95% prediction interval 9·4-16·2) in India, 8·9% (4·5-11·7) in the Philippines, 32·5% (27·0-35·8) in Russia, and 5·7% (3·0-7·6) in South Africa in 2040. It also predicted the percentage of XDR tuberculosis among incident MDR tuberculosis to increase, reaching 8·9% (95% prediction interval 5·1-12·9) in India, 9·0% (4·0-14·7) in the Philippines, 9·0% (4·8-14·2) in Russia, and 8·5% (2·5-14·7) in South Africa in 2040. Acquired drug resistance would cause less than 30% of incident MDR tuberculosis during 2000-40. Acquired drug resistance caused 80% of incident XDR tuberculosis in 2000, but this estimate would decrease to less than 50% by 2040. MDR and XDR tuberculosis were forecast to increase in all four countries despite improvements in acquired drug resistance shown by the Green Light Committee-supported programmatic management of drug-resistant tuberculosis. Additional control efforts beyond improving acquired drug resistance rates are needed to stop the spread of MDR and XDR tuberculosis in countries with a high burden of MDR

  19. Trial design to estimate the effect of vaccination on tuberculosis incidence in badgers.

    PubMed

    Aznar, Inma; McGrath, Guy; Murphy, Denise; Corner, Leigh A L; Gormley, Eamonn; Frankena, Klaas; More, Simon J; Martin, Wayne; O'Keeffe, James; De Jong, Mart C M

    2011-07-05

    The principal wildlife reservoir of Mycobacterium bovis in Ireland is the European badger. Studies in the Republic of Ireland (RoI) have shown that badgers culled in association with cattle herd tuberculosis breakdowns (focal culling) have a higher prevalence of infection than the badger population at large. This observation is one rationale for the medium term national strategy of focal badger culling. A vaccination strategy for the control of bovine tuberculosis (bTB) in badgers is a preferred long-term option. The Bacillus Calmette-Guérin (BCG) vaccine has been shown to decrease disease severity in captive badgers under controlled conditions. As the vaccine has been tested in a controlled environment with precise information on infection pressure, it cannot be assumed a priori that the effects of vaccination are similar in the wild, where other environmental and/or ecological factors prevail. For this reason we have designed a vaccine field trial to assess the impact of vaccination on the incidence of TB infection in a wild badger population. The selected study area for the vaccine trial (approximately 755 square kilometers) is divided into three zones each of which has similar characteristics in terms of size, number of main badger setts, cattle herds, cattle and land classification type. Three vaccination levels (100%, 50% and 0%) will be allocated to the three zones in a way that a gradient of vaccination coverage North to South is achieved. The middle zone (zone B) will be vaccinated at a 50% coverage but zone A and C will be randomly allocated with 100% or 0% vaccination coverage. Vaccination within zone B will be done randomly at individual badger level. The objective of this paper is to describe the design of a field tuberculosis vaccination trial for badgers, the epidemiological methods that were used to design the trial and the subsequent data analysis. The analysis will enable us to quantify the magnitude of the observed vaccination effect on M. bovis

  20. A novel Bayesian geospatial method for estimating tuberculosis incidence reveals many missed TB cases in Ethiopia.

    PubMed

    Shaweno, Debebe; Trauer, James M; Denholm, Justin T; McBryde, Emma S

    2017-10-02

    Reported tuberculosis (TB) incidence globally continues to be heavily influenced by expert opinion of case detection rates and ecological estimates of disease duration. Both approaches are recognised as having substantial variability and inaccuracy, leading to uncertainty in true TB incidence and other such derived statistics. We developed Bayesian binomial mixture geospatial models to estimate TB incidence and case detection rate (CDR) in Ethiopia. In these models the underlying true incidence was formulated as a partially observed Markovian process following a mixed Poisson distribution and the detected (observed) TB cases as a binomial distribution, conditional on CDR and true incidence. The models use notification data from multiple areas over several years and account for the existence of undetected TB cases and variability in true underlying incidence and CDR. Deviance information criteria (DIC) were used to select the best performing model. A geospatial model was the best fitting approach. This model estimated that TB incidence in Sheka Zone increased from 198 (95% Credible Interval (CrI) 187, 233) per 100,000 population in 2010 to 232 (95% CrI 212, 253) per 100,000 population in 2014. The model revealed a wide discrepancy between the estimated incidence rate and notification rate, with the estimated incidence ranging from 1.4 (in 2014) to 1.7 (in 2010) times the notification rate (CDR of 71% and 60% respectively). Population density and TB incidence in neighbouring locations (spatial lag) predicted the underlying TB incidence, while health facility availability predicted higher CDR. Our model estimated trends in underlying TB incidence while accounting for undetected cases and revealed significant discrepancies between incidence and notification rates in rural Ethiopia. This approach provides an alternative approach to estimating incidence, entirely independent of the methods involved in current estimates and is feasible to perform from routinely collected

  1. Mathematical model of tuberculosis transmission in a two-strain with vaccination

    NASA Astrophysics Data System (ADS)

    Nainggolan, J.; Supian, S.; Supriatna, A. K.; Anggriani, N.

    2014-02-01

    This paper deals with the mathematical analysis of the spread of tuberculosis with vaccination in a two-strain model. The vaccination reproduction ratio (Rrs) and equilibria quantities for the models are determined and stability of the solution is analyzed. We prove that if the vaccination reproduction ratio Rrs < 1 the disease free equilibrium is locally and asymptotically stable on the nonnegative orthant and if Rrs > 1 of the other equilibria is locally and asymptotically stable. At the end of this study, the numerical computation presented and it shows that vaccination and treatment capable to reduce the number of exposed and infected compartments.

  2. Challenges in Obtaining Estimates of the Risk of Tuberculosis Infection During Overseas Deployment.

    PubMed

    Mancuso, James D; Geurts, Mia

    2015-12-01

    Estimates of the risk of tuberculosis (TB) infection resulting from overseas deployment among U.S. military service members have varied widely, and have been plagued by methodological problems. The purpose of this study was to estimate the incidence of TB infection in the U.S. military resulting from deployment. Three populations were examined: 1) a unit of 2,228 soldiers redeploying from Iraq in 2008, 2) a cohort of 1,978 soldiers followed up over 5 years after basic training at Fort Jackson in 2009, and 3) 6,062 participants in the 2011-2012 National Health and Nutrition Examination Survey (NHANES). The risk of TB infection in the deployed population was low-0.6% (95% confidence interval [CI]: 0.1-2.3%)-and was similar to the non-deployed population. The prevalence of latent TB infection (LTBI) in the U.S. population was not significantly different among deployed and non-deployed veterans and those with no military service. The limitations of these retrospective studies highlight the challenge in obtaining valid estimates of risk using retrospective data and the need for a more definitive study. Similar to civilian long-term travelers, risks for TB infection during deployment are focal in nature, and testing should be targeted to only those at increased risk. © The American Society of Tropical Medicine and Hygiene.

  3. Challenges in Obtaining Estimates of the Risk of Tuberculosis Infection during Overseas Deployment

    PubMed Central

    Mancuso, James D.; Geurts, Mia

    2015-01-01

    Estimates of the risk of tuberculosis (TB) infection resulting from overseas deployment among U.S. military service members have varied widely, and have been plagued by methodological problems. The purpose of this study was to estimate the incidence of TB infection in the U.S. military resulting from deployment. Three populations were examined: 1) a unit of 2,228 soldiers redeploying from Iraq in 2008, 2) a cohort of 1,978 soldiers followed up over 5 years after basic training at Fort Jackson in 2009, and 3) 6,062 participants in the 2011–2012 National Health and Nutrition Examination Survey (NHANES). The risk of TB infection in the deployed population was low—0.6% (95% confidence interval [CI]: 0.1–2.3%)—and was similar to the non-deployed population. The prevalence of latent TB infection (LTBI) in the U.S. population was not significantly different among deployed and non-deployed veterans and those with no military service. The limitations of these retrospective studies highlight the challenge in obtaining valid estimates of risk using retrospective data and the need for a more definitive study. Similar to civilian long-term travelers, risks for TB infection during deployment are focal in nature, and testing should be targeted to only those at increased risk. PMID:26416114

  4. Genetic diversity of Mycobacterium tuberculosis and transmission associated with first-line drug resistance: A first analysis in Jalisco, Mexico.

    PubMed

    Lopez-Avalos, Gladys; Gonzalez-Palomar, Guadalupe; Lopez-Rodriguez, Martín; Vazquez-Chacon, Carlos Arturo; Mora-Aguilera, Gustavo; Gonzalez-Barrios, Juan Antonio; Villanueva-Arias, Juan Carlos; Sandoval-Diaz, Manuel; Miranda-Hernández, Ulises; Alvarez-Maya, Ikuri

    2017-07-28

    To analyze the frequency of gene mutations associated to drug resistant in clinical samples from population of the Jalisco state (Mexico) and then evaluate the genetic variability of TB and MDR-TB strains to describe the frequency of M. tuberculosis families. We analyzed the clinical isolates of M. tuberculosis obtained from Jalisco state of Mexico. Isolates were subjected to drug susceptibility testing and mutations were characterized by sequencing, followed by genotyping using spoligotyping and Interspersed Repetitive Units-Variable Number of Tandem Repeat (MIRU-VNTR). Moreover, the prevalence of mutations were analyzed with phylogenetic lineages. Resistant strains were analyzed by sequencing of katG, inhA, and rpoB genes to determine the presence of resistance mutations associated with isoniazid and rifampicin. In multidrug resistant, mono-resistant, and poly-resistant isolates, mutations were found in 44.1% strains (n=31). The spoligotyping identified six different strain lineages, as follows: T1 (18.75%), H3 (7.81%), MANU (4.68%), X1 (3.12%), EAI5 (1.56%) and LAM1 (1.56%), with the remaining strains identified as orphans. In additional tree-based identification, a dendrogram of spoligotype patterns generated five different similarity clusters. When combine 24-loci MIRU-VNTR and Spoligotyping approaches, the results shows that there is no clusters formation, which indicates a low transmission of the samples. The study using spoligotyping and MIRU-VNTR shows that the strains analyzed are not related to each other, since no two strains were found identical. The families with the highest prevalence in the study were the orphans and the family T denominated new strains. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  5. Estimating malaria transmission from humans to mosquitoes in a noisy landscape.

    PubMed

    Reiner, Robert C; Guerra, Carlos; Donnelly, Martin J; Bousema, Teun; Drakeley, Chris; Smith, David L

    2015-10-06

    A basic quantitative understanding of malaria transmission requires measuring the probability a mosquito becomes infected after feeding on a human. Parasite prevalence in mosquitoes is highly age-dependent, and the unknown age-structure of fluctuating mosquito populations impedes estimation. Here, we simulate mosquito infection dynamics, where mosquito recruitment is modelled seasonally with fractional Brownian noise, and we develop methods for estimating mosquito infection rates. We find that noise introduces bias, but the magnitude of the bias depends on the 'colour' of the noise. Some of these problems can be overcome by increasing the sampling frequency, but estimates of transmission rates (and estimated reductions in transmission) are most accurate and precise if they combine parity, oocyst rates and sporozoite rates. These studies provide a basis for evaluating the adequacy of various entomological sampling procedures for measuring malaria parasite transmission from humans to mosquitoes and for evaluating the direct transmission-blocking effects of a vaccine.

  6. Estimating malaria transmission from humans to mosquitoes in a noisy landscape

    PubMed Central

    Reiner, Robert C.; Guerra, Carlos; Donnelly, Martin J.; Bousema, Teun; Drakeley, Chris; Smith, David L.

    2015-01-01

    A basic quantitative understanding of malaria transmission requires measuring the probability a mosquito becomes infected after feeding on a human. Parasite prevalence in mosquitoes is highly age-dependent, and the unknown age-structure of fluctuating mosquito populations impedes estimation. Here, we simulate mosquito infection dynamics, where mosquito recruitment is modelled seasonally with fractional Brownian noise, and we develop methods for estimating mosquito infection rates. We find that noise introduces bias, but the magnitude of the bias depends on the ‘colour' of the noise. Some of these problems can be overcome by increasing the sampling frequency, but estimates of transmission rates (and estimated reductions in transmission) are most accurate and precise if they combine parity, oocyst rates and sporozoite rates. These studies provide a basis for evaluating the adequacy of various entomological sampling procedures for measuring malaria parasite transmission from humans to mosquitoes and for evaluating the direct transmission-blocking effects of a vaccine. PMID:26400195

  7. Efficient Acoustic Uncertainty Estimation for Transmission Loss Calculations

    DTIC Science & Technology

    2011-09-01

    Soc. Am. Vol. 129, 589-592. PUBLICATIONS [1] Kundu , P.K., Cohen, I.M., and Dowling, D.R., Fluid Mechanics , 5th Ed. (Academic Press, Oxford, 2012), 891 pages. ...Transmission Loss Calculations Kevin R. James Department of Mechanical Engineering University of Michigan Ann Arbor, MI 48109-2133 phone: (734) 998...1807 fax: (734) 764-4256 email: krj@umich.edu David R. Dowling Department of Mechanical Engineering University of Michigan Ann Arbor, MI

  8. Estimates of Crustal Transmission Losses Using MLM Array Processing.

    DTIC Science & Technology

    1982-07-01

    Continue on rovereo de II neceery, end Identfip by block nuinbe.) 1. Array processing 2. Acoustic transmission loss 3. MLM beamforming 20. AUSTRACT...Baggeroer and Falconer,1981). The technique conceptually designs a beamformer based on the input data (hence data adaptive). This beamformer minimizes...output power with the constraint that energy from a specific direction is passed undistorted. We shall see that the structure of this beamformer can be

  9. The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia.

    PubMed

    Altice, Frederick L; Azbel, Lyuba; Stone, Jack; Brooks-Pollock, Ellen; Smyrnov, Pavlo; Dvoriak, Sergii; Taxman, Faye S; El-Bassel, Nabila; Martin, Natasha K; Booth, Robert; Stöver, Heino; Dolan, Kate; Vickerman, Peter

    2016-09-17

    Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-designated countries of Eastern Europe and Central Asia (EECA) that gained independence from the Soviet Union in 1991 constitute the only region where both continue to rise. HIV transmission in EECA is fuelled primarily by injection of opioids, with harsh criminalisation of drug use that has resulted in extraordinarily high levels of incarceration. Consequently, people who inject drugs, including those with HIV, hepatitis C virus, and tuberculosis, are concentrated within prisons. Evidence-based primary and secondary prevention of HIV using opioid agonist therapies such as methadone and buprenorphine is available in prisons in only a handful of EECA countries (methadone or buprenorphine in five countries and needle and syringe programmes in three countries), with none of them meeting recommended coverage levels. Similarly, antiretroviral therapy coverage, especially among people who inject drugs, is markedly under-scaled. Russia completely bans opioid agonist therapies and does not support needle and syringe programmes-with neither available in prisons-despite the country's high incarceration rate and having the largest burden of people with HIV who inject drugs in the region. Mathematical modelling for Ukraine suggests that high levels of incarceration in EECA countries facilitate HIV transmission among people who inject drugs, with 28-55% of all new HIV infections over the next 15 years predicted to be attributable to heightened HIV transmission risk among currently or previously incarcerated people who inject drugs. Scaling up of opioid agonist therapies within prisons and maintaining treatment after release would yield the greatest HIV transmission reduction in people who inject drugs. Additional analyses also suggest that at least 6% of all incident tuberculosis cases, and 75% of incident tuberculosis cases in people who inject drugs are due to incarceration. Interventions that reduce

  10. The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling

    PubMed Central

    Houben, Rein M. G. J.

    2016-01-01

    methodological heterogeneity of direct ARI data, and limited evidence to inform on potential clearance of LTBI. Conclusions We estimate that approximately 1.7 billion individuals were latently infected with Mycobacterium tuberculosis (M.tb) globally in 2014, just under a quarter of the global population. Investment in new tools to improve diagnosis and treatment of those with LTBI at risk of progressing to disease is urgently needed to address this latent reservoir if the 2050 target of eliminating TB is to be reached. PMID:27780211

  11. Estimation of the individual slaughterhouse surveillance sensitivity for bovine tuberculosis in Catalonia (North-Eastern Spain).

    PubMed

    Garcia-Saenz, A; Napp, S; Lopez, S; Casal, J; Allepuz, A

    2015-10-01

    The achievement of the Officially Tuberculosis Free (OTF) status in regions with low bovine Tuberculosis (bTB) herd prevalence, as is the case of North-Eastern Spain (Catalonia), might be a likely option in the medium term. In this context, risk-based approaches could be an alternative surveillance strategy to the costly current strategy. However, before any change in the system may be contemplated, a reliable estimate of the sensitivity of the different surveillance components is needed. In this study, we focused on the slaughterhouse component. The probability of detection of a bTB-infected cattle by the slaughterhouses in Catalonia was estimated as the product of three consecutive probabilities: (P1) the probability that a bTB-infected animal arrived at the slaughterhouse presenting Macroscopically Detectable Lesions (MDL); (P2) the probability that MDL were detected by the routine meat inspection process and (P3) the probability that the veterinary officer suspected bTB and sent the sample for laboratory confirmation. The first probability was obtained from data collected through the bTB eradication program carried out in Catalonia between 2005 and 2008, while the last two were obtained through the expert opinion of the veterinary officers working at the slaughterhouses who fulfilled a questionnaire administered during 2014. The bTB surveillance sensitivity of the different cattle slaughterhouses in Catalonia obtained in this study was 31.4% (CI 95%: 28.6-36.2), and there were important differences among them. The low bTB surveillance sensitivity was mainly related with the low probability that a bTB-infected animal arrived at the slaughterhouse presenting MDL (around 44.8%). The variability of the sensitivity among the different slaughterhouses could be explained by significant associations between some variables included in the survey and P2. For instance, factors like attendance to training courses, number of meat technicians and speed of the slaughter chain

  12. Identifiability and estimation of multiple transmission pathways in cholera and waterborne disease.

    PubMed

    Eisenberg, Marisa C; Robertson, Suzanne L; Tien, Joseph H

    2013-05-07

    Cholera and many waterborne diseases exhibit multiple characteristic timescales or pathways of infection, which can be modeled as direct and indirect transmission. A major public health issue for waterborne diseases involves understanding the modes of transmission in order to improve control and prevention strategies. An important epidemiological question is: given data for an outbreak, can we determine the role and relative importance of direct vs. environmental/waterborne routes of transmission? We examine whether parameters for a differential equation model of waterborne disease transmission dynamics can be identified, both in the ideal setting of noise-free data (structural identifiability) and in the more realistic setting in the presence of noise (practical identifiability). We used a differential algebra approach together with several numerical approaches, with a particular emphasis on identifiability of the transmission rates. To examine these issues in a practical public health context, we apply the model to a recent cholera outbreak in Angola (2006). Our results show that the model parameters-including both water and person-to-person transmission routes-are globally structurally identifiable, although they become unidentifiable when the environmental transmission timescale is fast. Even for water dynamics within the identifiable range, when noisy data are considered, only a combination of the water transmission parameters can practically be estimated. This makes the waterborne transmission parameters difficult to estimate, leading to inaccurate estimates of important epidemiological parameters such as the basic reproduction number (R0). However, measurements of pathogen persistence time in environmental water sources or measurements of pathogen concentration in the water can improve model identifiability and allow for more accurate estimation of waterborne transmission pathway parameters as well as R0. Parameter estimates for the Angola outbreak suggest

  13. Estimation of hepatitis C virus infections resulting from vertical transmission in Egypt.

    PubMed

    Benova, Lenka; Awad, Susanne F; Miller, F DeWolfe; Abu-Raddad, Laith J

    2015-03-01

    Despite having the highest hepatitis C virus (HCV) prevalence in the world, the ongoing level of HCV incidence in Egypt and its drivers are poorly understood. Whereas HCV mother-to-child infection is a well-established transmission route, there are no estimates of HCV infections resulting from vertical transmission for any country, including Egypt. The aim of this study was to estimate the absolute number of new HCV infections resulting from vertical transmission in Egypt. We developed a conceptual framework of HCV vertical transmission, expressed in terms of a mathematical model and based on maternal HCV antibody and viremia. The mathematical model estimated the number of HCV vertical infections nationally and for six subnational areas. Applying two vertical transmission risk estimates to the 2008 Egyptian birth cohort, we estimated that between 3,080 and 5,167 HCV infections resulted from vertical transmission among children born in 2008. HCV vertical transmission may account for half of incident cases in the <5-year age group. Disproportionately higher proportions of vertical infections were estimated in Lower Rural and Upper Rural subnational areas. This geographical clustering was a result of higher-area-level HCV prevalence among women and higher fertility rates. Vertical transmission is one of the primary HCV infection routes among children<5 years in Egypt. The absolute number of vertical transmissions and the young age at infection highlight a public health concern. These findings also emphasize the need to quantify the relative contributions of other transmission routes to HCV incidence in Egypt. © 2014 The Authors. Hepatology published by Wiley Periodicals, Inc., on behalf of the American Association for the Study of Liver Diseases.

  14. Estimation of hepatitis C virus infections resulting from vertical transmission in Egypt

    PubMed Central

    Benova, Lenka; Awad, Susanne F; Miller, F DeWolfe; Abu-Raddad, Laith J

    2015-01-01

    Despite having the highest hepatitis C virus (HCV) prevalence in the world, the ongoing level of HCV incidence in Egypt and its drivers are poorly understood. Whereas HCV mother-to-child infection is a well-established transmission route, there are no estimates of HCV infections resulting from vertical transmission for any country, including Egypt. The aim of this study was to estimate the absolute number of new HCV infections resulting from vertical transmission in Egypt. We developed a conceptual framework of HCV vertical transmission, expressed in terms of a mathematical model and based on maternal HCV antibody and viremia. The mathematical model estimated the number of HCV vertical infections nationally and for six subnational areas. Applying two vertical transmission risk estimates to the 2008 Egyptian birth cohort, we estimated that between 3,080 and 5,167 HCV infections resulted from vertical transmission among children born in 2008. HCV vertical transmission may account for half of incident cases in the <5-year age group. Disproportionately higher proportions of vertical infections were estimated in Lower Rural and Upper Rural subnational areas. This geographical clustering was a result of higher-area-level HCV prevalence among women and higher fertility rates. Conclusion: Vertical transmission is one of the primary HCV infection routes among children <5 years in Egypt. The absolute number of vertical transmissions and the young age at infection highlight a public health concern. These findings also emphasize the need to quantify the relative contributions of other transmission routes to HCV incidence in Egypt. (Hepatology 2015;61:834–842) PMID:25366418

  15. Tuberculosis Infection and Latent Tuberculosis

    PubMed Central

    2016-01-01

    Active tuberculosis (TB) has a greater burden of TB bacilli than latent TB and acts as an infection source for contacts. Latent tuberculosis infection (LTBI) is the state in which humans are infected with Mycobacterium tuberculosis without any clinical symptoms, radiological abnormality, or microbiological evidence. TB is transmissible by respiratory droplet nucleus of 1–5 µm in diameter, containing 1–10 TB bacilli. TB transmission is affected by the strength of the infectious source, infectiousness of TB bacilli, immunoresistance of the host, environmental stresses, and biosocial factors. Infection controls to reduce TB transmission consist of managerial activities, administrative control, engineering control, environmental control, and personal protective equipment provision. However, diagnosis and treatment for LTBI as a national TB control program is an important strategy on the precondition that active TB is not missed. Therefore, more concrete evidences for LTBI management based on clinical and public perspectives are needed. PMID:27790271

  16. Cryogenic transmission electron microscopy of recombinant tuberculosis vaccine antigen with anionic liposomes reveals formation of flattened liposomes.

    PubMed

    Fox, Christopher B; Mulligan, Sean K; Sung, Joyce; Dowling, Quinton M; Fung, H W Millie; Vedvick, Thomas S; Coler, Rhea N

    2014-01-01

    Development of lipid-based adjuvant formulations to enhance the immunogenicity of recombinant vaccine antigens is a focus of modern vaccine research. Characterizing interactions between vaccine antigens and formulation excipients is important for establishing compatibility between the different components and optimizing vaccine stability and potency. Cryogenic transmission electron microscopy (TEM) is a highly informative analytical technique that may elucidate various aspects of protein- and lipid-based structures, including morphology, size, shape, and phase structure, while avoiding artifacts associated with staining-based TEM. In this work, cryogenic TEM is employed to characterize a recombinant tuberculosis vaccine antigen, an anionic liposome formulation, and antigen-liposome interactions. By performing three-dimensional tomographic reconstruction analysis, the formation of a population of protein-containing flattened liposomes, not present in the control samples, was detected. It is shown that cryogenic TEM provides unique information regarding antigen-liposome interactions not detectable by light-scattering-based methods. Employing a suite of complementary analytical techniques is important to fully characterize interactions between vaccine components.

  17. Cryogenic transmission electron microscopy of recombinant tuberculosis vaccine antigen with anionic liposomes reveals formation of flattened liposomes

    PubMed Central

    Fox, Christopher B; Mulligan, Sean K; Sung, Joyce; Dowling, Quinton M; Fung, H W Millie; Vedvick, Thomas S; Coler, Rhea N

    2014-01-01

    Development of lipid-based adjuvant formulations to enhance the immunogenicity of recombinant vaccine antigens is a focus of modern vaccine research. Characterizing interactions between vaccine antigens and formulation excipients is important for establishing compatibility between the different components and optimizing vaccine stability and potency. Cryogenic transmission electron microscopy (TEM) is a highly informative analytical technique that may elucidate various aspects of protein- and lipid-based structures, including morphology, size, shape, and phase structure, while avoiding artifacts associated with staining-based TEM. In this work, cryogenic TEM is employed to characterize a recombinant tuberculosis vaccine antigen, an anionic liposome formulation, and antigen–liposome interactions. By performing three-dimensional tomographic reconstruction analysis, the formation of a population of protein-containing flattened liposomes, not present in the control samples, was detected. It is shown that cryogenic TEM provides unique information regarding antigen–liposome interactions not detectable by light-scattering-based methods. Employing a suite of complementary analytical techniques is important to fully characterize interactions between vaccine components. PMID:24648734

  18. Improving knowledge and behaviours related to the cause, transmission and prevention of Tuberculosis and early case detection: a descriptive study of community led Tuberculosis program in Flores, Indonesia.

    PubMed

    Dewi, Christa; Barclay, Lesley; Passey, Megan; Wilson, Shawn

    2016-08-08

    The community's awareness of Tuberculosis (TB) and delays in health care seeking remain important issues in Indonesia despite the extensive efforts of community-based TB programs delivered by a non-government organisation (NGO). This study explored the knowledge and behaviours in relation to TB and early diagnosis before and after an asset-based intervention designed to improve these issues. Six villages in Flores, Indonesia were purposively selected to participate in this study. Three villages served as intervention villages and the other three villages provided a comparison group. Data collection included interviews, group discussions, observations, field notes and audit of records. In total, 50 participants across six villages were interviewed and three group discussions were conducted in the intervention villages supplemented by 1 - 5 h of observation during monthly visits. Overall, participants in all villages had limited knowledge regarding the cause and transmission of TB before the intervention. The delay in health seeking behaviour was mainly influenced by ignorance of TB symptoms. Health care providers also contributed to delayed diagnosis by ignoring the symptoms of TB suspects at the first visit and failing to examine TB suspects with sputum tests. Stigmatisation of TB patients by the community was reported, although this did not seem to be common. Early case detection was less than 50 % in four of the six villages before the asset-based intervention. Knowledge of TB improved after the intervention in the intervention villages alongside improved education activities. Early case detection also increased in the intervention villages following this intervention. The behaviour changes related to prevention of TB were also obvious in the intervention villages but not the comparison group. This small project demonstrated that an asset-based intervention can result in positive changes in community's knowledge and behaviour in relation to TB and early case

  19. Estimating the Impact of Newly Arrived Foreign-Born Persons on Tuberculosis in the United States

    PubMed Central

    Liu, Yecai; Painter, John A.; Posey, Drew L.; Cain, Kevin P.; Weinberg, Michelle S.; Maloney, Susan A.; Ortega, Luis S.; Cetron, Martin S.

    2012-01-01

    Background Among approximately 163.5 million foreign-born persons admitted to the United States annually, only 500,000 immigrants and refugees are required to undergo overseas tuberculosis (TB) screening. It is unclear what extent of the unscreened nonimmigrant visitors contributes to the burden of foreign-born TB in the United States. Methodology/Principal Findings We defined foreign-born persons within 1 year after arrival in the United States as “newly arrived”, and utilized data from U.S. Department of Homeland Security, U.S. Centers for Disease Control and Prevention, and World Health Organization to estimate the incidence of TB among newly arrived foreign-born persons in the United States. During 2001 through 2008, 11,500 TB incident cases, including 291 multidrug-resistant TB incident cases, were estimated to occur among 20,989,738 person-years for the 1,479,542,654 newly arrived foreign-born persons in the United States. Of the 11,500 estimated TB incident cases, 41.6% (4,783) occurred among immigrants and refugees, 36.6% (4,211) among students/exchange visitors and temporary workers, 13.8% (1,589) among tourists and business travelers, and 7.3% (834) among Canadian and Mexican nonimmigrant visitors without an I-94 form (e.g., arrival-departure record). The top 3 newly arrived foreign-born populations with the largest estimated TB incident cases per 100,000 admissions were immigrants and refugees from high-incidence countries (e.g., 2008 WHO-estimated TB incidence rate of ≥100 cases/100,000 population/year; 235.8 cases/100,000 admissions, 95% confidence interval [CI], 228.3 to 243.3), students/exchange visitors and temporary workers from high-incidence countries (60.9 cases/100,000 admissions, 95% CI, 58.5 to 63.3), and immigrants and refugees from medium-incidence countries (e.g., 2008 WHO-estimated TB incidence rate of 15–99 cases/100,000 population/year; 55.2 cases/100,000 admissions, 95% CI, 51.6 to 58.8). Conclusions/Significance Newly arrived

  20. Gender differentials of pulmonary tuberculosis transmission and reactivation in an endemic area

    PubMed Central

    Jiménez‐Corona, M‐E; García‐García, L; DeRiemer, K; Ferreyra‐Reyes, L; Bobadilla‐del‐Valle, M; Cano‐Arellano, B; Canizales‐Quintero, S; Martínez‐Gamboa, A; Small, P M; Sifuentes‐Osornio, J; Ponce‐de‐León, A

    2006-01-01

    Background In most low income countries there are twice as many cases of tuberculosis (TB) reported among men than among women, a difference commonly attributed to biological and epidemiological characteristics as well as socioeconomic and cultural barriers in access to health care. The World Health Organization has encouraged gender specific comparisons in TB rates to determine whether women with TB are less likely than men with TB to be diagnosed, reported, and treated. A study was undertaken to identify gender based differences in patients with pulmonary TB and to use this information to improve TB control efforts. Methods Individuals with a cough for more than 2 weeks in southern Mexico were screened from March 1995 to April 2003. Clinical and mycobacteriological information (isolation, identification, drug susceptibility testing and IS6110 based genotyping, and spoligotyping) was collected from those with bacteriologically confirmed pulmonary TB. Patients were treated in accordance with official norms and followed to ascertain treatment outcome, retreatment, and vital status. Results 623 patients with pulmonary TB were enrolled. The male:female incidence rate ratio for overall, reactivated, and recently transmitted disease was 1.58 (95% CI 1.34 to 1.86), 1.64 (95% CI 1.36 to 1.98), and 1.41 (95% CI 1.01 to 1.96), respectively. Men were more likely than women to default from treatment (adjusted OR 3.30, 95% CI 1.46 to 7.43), to be retreated (hazard ratio (HR) 3.15, 95% CI 1.38 to 7.22), and to die from TB (HR 2.23, 95% CI 1.25 to 3.99). Conclusions Higher rates of transmitted and reactivated disease and poorer treatment outcomes among men are indicators of gender differentials in the diagnosis and treatment of pulmonary TB, and suggest specific strategies in endemic settings. PMID:16449260

  1. Estimating Dengue Transmission Intensity from Case-Notification Data from Multiple Countries

    PubMed Central

    Imai, Natsuko; Dorigatti, Ilaria; Cauchemez, Simon; Ferguson, Neil M.

    2016-01-01

    Background Despite being the most widely distributed mosquito-borne viral infection, estimates of dengue transmission intensity and associated burden remain ambiguous. With advances in the development of novel control measures, obtaining robust estimates of average dengue transmission intensity is key for assessing the burden of disease and the likely impact of interventions. Methodology/Principle Findings We estimated the force of infection (λ) and corresponding basic reproduction numbers (R0) by fitting catalytic models to age-stratified incidence data identified from the literature. We compared estimates derived from incidence and seroprevalence data and assessed the level of under-reporting of dengue disease. In addition, we estimated the relative contribution of primary to quaternary infections to the observed burden of dengue disease incidence. The majority of R0 estimates ranged from one to five and the force of infection estimates from incidence data were consistent with those previously estimated from seroprevalence data. The baseline reporting rate (or the probability of detecting a secondary infection) was generally low (<25%) and varied within and between countries. Conclusions/Significance As expected, estimates varied widely across and within countries, highlighting the spatio-temporally heterogeneous nature of dengue transmission. Although seroprevalence data provide the maximum information, the incidence models presented in this paper provide a method for estimating dengue transmission intensity from age-stratified incidence data, which will be an important consideration in areas where seroprevalence data are not available. PMID:27399793

  2. Joint estimation of transmissivity and storativity in a bedrock fracture

    NASA Astrophysics Data System (ADS)

    Castagna, Marta; Becker, Matthew W.; Bellin, Alberto

    2011-09-01

    The spatial variability of transmissivity (T) and storativity (S) in a sandstone bedding plane fracture was investigated through field and numerical hydraulic tomography experiments. Cross-hole pumping tests were conducted in a single subhorizontal bedrock fracture, thereby constraining the problem to two dimensions. A Bayesian method implementing pilot points was used to invert the drawdown, under the hypothesis that T and S are independent random space functions, where integral scale, mean, and variance of the random fields were parameters of inversion in addition to pilot point values. An ensemble of 20 Monte Carlo realizations was created for each model scenario. Inversion of the measured cross-hole drawdown resulted in spatially variable T and S fields. To determine the accuracy of the method, a suite of synthetic inversions modeled after the field site were also conducted. The synthetic experiments demonstrate that the assumed spatial structure of S influences the accuracy of both the T and S inversions. When the S field is spatially heterogeneous and is assumed to be heterogeneous in the inversion, a consistent representation of the T and S fields is obtained. When the S field is spatially heterogeneous but is assumed to be homogeneous in the inversion, a consistent representation of the T field is still obtained, but the S field is entirely misrepresented; if the S field is actually homogeneous but assumed to be heterogeneous, a poor representation of the T and S fields is obtained along with high uncertainty in the inversion statistics of confidence.

  3. Preliminary investigation of the transmission of tuberculosis between farmers and their cattle in smallholder farms in northwestern Ethiopia: a cross-sectional study.

    PubMed

    Nuru, Anwar; Mamo, Gezahegne; Zewude, Aboma; Mulat, Yitayal; Yitayew, Gashaw; Admasu, Aschalew; Medhin, Girmay; Pieper, Rembert; Ameni, Gobena

    2017-01-07

    The feeding habits and close physical contact between Ethiopian farmers and their cattle promote the transmission of tuberculosis (TB) between the farmers and their cattle. This study aimed to investigate the transmission of TB between farmers and their cattle in smallholder farms in northwestern Ethiopia. A total of 70 human TB lymphadenitis (TBLN) cases visiting the Felegehiwot Comprehensive Specialized Hospital in Bahir Dar City and 660 cattle were investigated. Half of the cattle were owned by households with TB cases, and the remaining half by TB free households. Among the 70 human TBLN patients interviewed, 65.7% (46 out of 70) of the respondents were not aware of zoonotic TB, and 67.1% (47/70) of them consumed raw milk. Positive cultures of TB were obtained in 40 of the 70 cases where TBLN tests were positive with fine needle aspiration cytology. Spoligotyping resulted in 31 different patterns, of which 25 isolates were Mycobacterium (M.) tuberculosis, and the remaining were M. africanum (4 isolates) and M. bovis (2 isolates). None of the animals showed positive test results for bovine TB by comparative intradermal tuberculin test. Based on the identification of M. bovis from two patients diagnosed with TBLN, we obtained preliminary evidence of zoonotic transmission of TB in northwestern Ethiopia. We did not identify a direct route of transmission between cattle and its owners. This is the objective of further investigations.

  4. Fast and low-cost decentralized surveillance of transmission of tuberculosis based on strain-specific PCRs tailored from whole genome sequencing data: a pilot study.

    PubMed

    Pérez-Lago, L; Martínez Lirola, M; Herranz, M; Comas, I; Bouza, E; García-de-Viedma, D

    2015-03-01

    Molecular epidemiology has transformed our knowledge of how tuberculosis (TB) is transmitted. Whole genome sequencing (WGS) has reached unprecedented levels of accuracy. However, it has increased technical requirements and costs, and analysis of data delays results. Our objective was to find a way to reconcile speed and ease of implementation with the high resolution of WGS. The targeted regional allele-specific oligonucleotide PCR (TRAP) assay presented here is based on allele-specific PCR targeting strain-specific single nucleotide polymorphisms, identified from WGS, and makes it possible to track actively transmitted Mycobacterium tuberculosis strains. A TRAP assay was optimized to track the most actively transmitted strains in a population in Almería, Southeast Spain, with high rates of TB. TRAP was transferred to the local laboratory where transmission was occurring. It performed well from cultured isolates and directly from sputa, enabling new secondary cases of infection from the actively transmitted strains to be detected. TRAP constitutes a fast, simple and low-cost tool that could modify surveillance of TB transmission. This pilot study could help to define a new model to survey TB transmission based on a decentralized multinodal network of local laboratories applying fast and low-cost TRAPs, which are developed by central reference centres, tailored to the specific demands of transmission at each local node.

  5. Bayesian estimation of the transmissivity spatial structure from pumping test data

    NASA Astrophysics Data System (ADS)

    Demir, Mehmet Taner; Copty, Nadim K.; Trinchero, Paolo; Sanchez-Vila, Xavier

    2017-06-01

    Estimating the statistical parameters (mean, variance, and integral scale) that define the spatial structure of the transmissivity or hydraulic conductivity fields is a fundamental step for the accurate prediction of subsurface flow and contaminant transport. In practice, the determination of the spatial structure is a challenge because of spatial heterogeneity and data scarcity. In this paper, we describe a novel approach that uses time drawdown data from multiple pumping tests to determine the transmissivity statistical spatial structure. The method builds on the pumping test interpretation procedure of Copty et al. (2011) (Continuous Derivation method, CD), which uses the time-drawdown data and its time derivative to estimate apparent transmissivity values as a function of radial distance from the pumping well. A Bayesian approach is then used to infer the statistical parameters of the transmissivity field by combining prior information about the parameters and the likelihood function expressed in terms of radially-dependent apparent transmissivities determined from pumping tests. A major advantage of the proposed Bayesian approach is that the likelihood function is readily determined from randomly generated multiple realizations of the transmissivity field, without the need to solve the groundwater flow equation. Applying the method to synthetically-generated pumping test data, we demonstrate that, through a relatively simple procedure, information on the spatial structure of the transmissivity may be inferred from pumping tests data. It is also shown that the prior parameter distribution has a significant influence on the estimation procedure, given the non-uniqueness of the estimation procedure. Results also indicate that the reliability of the estimated transmissivity statistical parameters increases with the number of available pumping tests.

  6. Systematic review on tuberculosis transmission on aircraft and update of the European Centre for Disease Prevention and Control risk assessment guidelines for tuberculosis transmitted on aircraft (RAGIDA-TB).

    PubMed

    Kotila, Saara M; Payne Hallström, Lara; Jansen, Niesje; Helbling, Peter; Abubakar, Ibrahim

    2016-01-01

    As a setting for potential tuberculosis (TB) transmission and contact tracing, aircraft pose specific challenges. Evidence-based guidelines are needed to support the related-risk assessment and contact-tracing efforts. In this study evidence of TB transmission on aircraft was identified to update the Risk Assessment Guidelines for TB Transmitted on Aircraft (RAGIDA-TB) of the European Centre for Disease Prevention and Control (ECDC). Electronic searches were undertaken from Medline (Pubmed), Embase and Cochrane Library until 19 July 2013. Eligible records were identified by a two-stage screening process and data on flight and index case characteristics as well as contact tracing strategies extracted. The systematic literature review retrieved 21 records. Ten of these records were available only after the previous version of the RAGIDA guidelines (2009) and World Health Organization guidelines on TB and air travel (2008) were published. Seven of the 21 records presented some evidence of possible in-flight transmission, but only one record provided substantial evidence of TB transmission on an aircraft. The data indicate that overall risk of TB transmission on aircraft is very low. The updated ECDC guidelines for TB transmission on aircraft have global implications due to inevitable need for international collaboration in contract tracing and risk assessment.

  7. Estimating Dengue Transmission Intensity from Sero-Prevalence Surveys in Multiple Countries

    PubMed Central

    Imai, Natsuko; Dorigatti, Ilaria; Cauchemez, Simon; Ferguson, Neil M.

    2015-01-01

    Background Estimates of dengue transmission intensity remain ambiguous. Since the majority of infections are asymptomatic, surveillance systems substantially underestimate true rates of infection. With advances in the development of novel control measures, obtaining robust estimates of average dengue transmission intensity is key for assessing both the burden of disease from dengue and the likely impact of interventions. Methodology/Principal Findings The force of infection (λ) and corresponding basic reproduction numbers (R0) for dengue were estimated from non-serotype (IgG) and serotype-specific (PRNT) age-stratified seroprevalence surveys identified from the literature. The majority of R0 estimates ranged from 1–4. Assuming that two heterologous infections result in complete immunity produced up to two-fold higher estimates of R0 than when tertiary and quaternary infections were included. λ estimated from IgG data were comparable to the sum of serotype-specific forces of infection derived from PRNT data, particularly when inter-serotype interactions were allowed for. Conclusions/Significance Our analysis highlights the highly heterogeneous nature of dengue transmission. How underlying assumptions about serotype interactions and immunity affect the relationship between the force of infection and R0 will have implications for control planning. While PRNT data provides the maximum information, our study shows that even the much cheaper ELISA-based assays would provide comparable baseline estimates of overall transmission intensity which will be an important consideration in resource-constrained settings. PMID:25881272

  8. Tuberculosis Transmission from Healthcare Workers to Patients and Co-workers: A Systematic Literature Review and Meta-Analysis

    PubMed Central

    Schepisi, Monica Sañé; Sotgiu, Giovanni; Contini, Silvia; Puro, Vincenzo; Ippolito, Giuseppe; Girardi, Enrico

    2015-01-01

    Healthcare workers (HCWs) are at risk of becoming infected with tuberculosis (TB), and potentially of being infectious themselves when they are ill. To assess the magnitude of healthcare-associated TB (HCA-TB) transmission from HCWs to patients and colleagues, we searched three electronic databases up to February 2014 to select primary studies on HCA-TB incidents in which a HCW was the index case and possibly exposed patients and co-workers were screened.We identified 34 studies out of 2,714 citations. In 29 individual investigations, active TB was diagnosed in 3/6,080 (0.05%) infants, 18/3,167 (0.57%) children, 1/3,600 (0.03%) adult patients and 0/2,407 HCWs. The quantitative analysis of 28 individual reports showed that combined proportions of active TB among exposed individuals were: 0.11% (95% CI 0.04–0.21) for infants, 0.38% (95% CI 0.01–1.60) for children, 0.09% (95% CI 0.02–0.22) for adults and 0.00% (95% CI 0.00–0.38) for HCWs. Combined proportions of individuals who acquired TB infection were: 0.57% (95% CI 7.28E-03 – 2.02) for infants, 0.9% (95% CI 0.40–1.60) for children, 4.32% (95% CI 1.43–8.67) for adults and 2.62% (95% CI 1.05–4.88) for HCWs. The risk of TB transmission from HCWs appears to be lower than that recorded in other settings or in the healthcare setting when the index case is not a HCW. To provide a firm evidence base for the screening strategies, more and better information is needed on the infectivity of the source cases, the actual exposure level of screened contacts, and the environmental characteristics of the healthcare setting. PMID:25835507

  9. The evolution of tuberculosis virulence.

    PubMed

    Basu, Sanjay; Galvani, Alison P

    2009-07-01

    The evolution of Mycobacterium tuberculosis presents several challenges for public health. HIV and resistance to antimycobacterial medications have evolutionary implications for how Mycobacterium tuberculosis will evolve, as these factors influence the host environment and transmission dynamics of tuberculosis strains. We present an evolutionary invasion analysis of tuberculosis that characterizes the direction of tuberculosis evolution in the context of different natural and human-driven selective pressures, including changes in tuberculosis treatment and HIV prevalence. We find that the evolution of tuberculosis virulence can be affected by treatment success rates, the relative transmissibility of emerging strains, the rate of reactivation from latency among hosts, and the life expectancy of hosts. We find that the virulence of tuberculosis strains may also increase as a consequence of rising HIV prevalence, requiring faster case detection strategies in areas where the epidemics of HIV and tuberculosis collide.

  10. Bayesian Approach for the Estimation of the Transmissivity Spatial Structure from Hydraulic Tomography Data

    NASA Astrophysics Data System (ADS)

    Demir, M. T.; Copty, N. K.; Trinchero, P.; Sanchez-Vila, X.

    2013-12-01

    Groundwater flow and contaminant transport are strongly influenced by the spatial variability of subsurface flow parameters. However, the interpretation of pumping test data used for subsurface characterization is normally performed using conventional methods that are based on the assumption of aquifer homogeneity. In recent years, hydraulic tomography has been proposed by some researchers to address the limitations of conventional site characterization methods. Hydraulic tomography involves the sequential pumping at one of a series of wells and observing the drawdown due to pumping at adjacent wells. The interpretation of the drawdown data from hydraulic tomography has been mostly performed using formal inverse procedures for the estimation of the spatial variability of the flow parameters. The purpose of this study is to develop a method for the estimation of the statistical spatial structure of the transmissivity from hydraulic tomography data. The method relies on the pumping test interpretation procedure of Copty et al. (2011), which uses the time-drawdown data and its time derivative at each observation well to estimate the spatially averaged transmissivity as a function of radial distance from the pumping well. A Bayesian approach is then used to identify the statistical parameters of the transmissivity field (i.e. variance and integral scale). The approach compares the estimated transmissivity as a function of radial distance from the pumping well to the probability density function of the spatially-averaged transmissivity. The method is evaluated using synthetically-generated pumping test data for a range of input parameters. This application demonstrates that, through a relatively simple procedure, additional information of the spatial structure of the transmissivity may be inferred from pumping tests data. Results indicate that as the number of available pumping tests increases, the reliability of the estimated transmissivity statistical parameters also

  11. Comparison of indoor contact time data in Zambia and Western Cape, South Africa suggests targeting of interventions to reduce Mycobacterium tuberculosis transmission should be informed by local data.

    PubMed

    McCreesh, Nicky; Looker, Clare; Dodd, Peter J; Plumb, Ian D; Shanaube, Kwame; Muyoyeta, Monde; Godfrey-Faussett, Peter; Corbett, Elizabeth L; Ayles, Helen; White, Richard G

    2016-02-09

    In high incidence settings, the majority of Mycobacterium tuberculosis (M.tb) transmission occurs outside the household. Little is known about where people's indoor contacts occur outside the household, and how this differs between different settings. We estimate the number of contact hours that occur between adults and adult/youths and children in different building types in urban areas in Western Cape, South Africa, and Zambia. Data were collected from 3206 adults using a cross-sectional survey, on buildings visited in a 24-h period, including building function, visit duration, and number of adults/youths and children (5-12 years) present. The mean numbers of contact hours per day by building function were calculated. Adults in Western Cape were more likely to visit workplaces, and less likely to visit shops and churches than adults in Zambia. Adults in Western Cape spent longer per visit in other homes and workplaces than adults in Zambia. More adults/youths were present at visits to shops and churches in Western Cape than in Zambia, and fewer at homes and hairdressers. More children were present at visits to shops in Western Cape than in Zambia, and fewer at schools and hairdressers. Overall numbers of adult/youth indoor contact hours were the same at both sites (35.4 and 37.6 h in Western Cape and Zambia respectively, p = 0.4). Child contact hours were higher in Zambia (16.0 vs 13.7 h, p = 0.03). Adult/youth and child contact hours were highest in workplaces in Western Cape and churches in Zambia. Compared to Zambia, adult contact hours in Western Cape were higher in workplaces (15.2 vs 8.0 h, p = 0.004), and lower in churches (3.7 vs 8.6 h, p = 0.002). Child contact hours were higher in other peoples' homes (2.8 vs 1.6 h, p = 0.03) and workplaces (4.9 vs 2.1 h, p = 0.003), and lower in churches (2.5 vs 6.2, p = 0.004) and schools (0.4 vs 1.5, p = 0.01). Patterns of indoor contact between adults and adults/youths and children differ between different sites in

  12. Added value of molecular assay Xpert MTB/RIF compared to sputum smear microscopy to assess the risk of tuberculosis transmission in a low-prevalence country.

    PubMed

    Opota, O; Senn, L; Prod'hom, G; Mazza-Stalder, J; Tissot, F; Greub, G; Jaton, K

    2016-07-01

    Airborne precautions are required at hospital admission for patients with suspected pulmonary tuberculosis. The isolation is maintained until 3 serially collected sputum smears are acid-fast bacilli negative, a time- and labor-intensive method with limited sensitivity and specificity, which has a great impact on patient flow management. We evaluated the possibility of replacing the result of microscopy by the semiquantitative result of the molecular point-of-care test Xpert MTB/RIF to assess patients' transmission risk to quickly guide airborne isolation decisions in low-endemic countries. The performance of the Xpert MTB/RIF, used as a first-line test, was compared to the results of microscopy for specimens (n=242) collected from May 2010 to December 2014 in Lausanne, Switzerland. The sensitivity and specificity of Xpert MTB/RIF were 91.5% (65/71) and 99.6% (170/171), respectively, vs. 64.8% (46/71) and 94.2% (161/171) for microscopy. Samples with negative Xpert MTB/RIF were all smear negative for Mycobacterium tuberculosis (negative predictive value, 100%). The semiquantitative results of Xpert MTB/RIF-high, medium, low or very low-were found to correlate with acid-fast bacilli detection: positive predictive value of 100% (6/6), 96.5% (27/28), 52.2% (12/23) and 11.1% (1/9) respectively. Finally, when including clinical criteria, we identified 11 smear-negative but Xpert MTB/RIF-positive patients with a significant transmission potential. In conclusion, our data support the introduction of an Xpert MTB/RIF-based strategy as a replacement of smear microscopy for a faster and more accurate management of tuberculosis patients' transmission risk in a low-prevalence country.

  13. Estimating transmissivity and storage properties from aquifer tests in the Southern Lihue Basin, Kauai, Hawaii

    USGS Publications Warehouse

    Gingerich, Stephen B.

    1999-01-01

    The results show that transmissivity in the Lihue basin ranges over several orders of magnitude, 42 to 7,900 square feet per day, but is generally lower than reported values of transmissivity of other basaltic aquifers in Hawaii. Estimates of confined-aquifer storage coefficient range from 1.3x10-4 to 8.2x10-2. The hydraulic conductivity estimates obtained using an elliptical-equation method compare favorably with the results obtained from the generally more-accepted curvematching methods. No significant difference is apparent between the estimated transmissivity of the Koloa Volcanics and the Waimea Canyon Basalt in the study area. An analysis of the lithology penetrated by the wells indicates the transmissivity is probably controlled mainly by the stratigraphic position of the layers penetrated by the well. The range of transmissivity values estimated for the southern Lihue basin is lower than reported values from aquifer tests at wells penetrating postshield-stage or rejuvenation-stage lava flows on other Hawaiian islands. This range is one to four orders of magnitude lower than most reported values for dike-free basalt aquifers in Hawaii.

  14. Estimating the risk of rabies transmission to humans in the U.S.: a Delphi analysis.

    PubMed

    Vaidya, Sagar A; Manning, Susan E; Dhankhar, Praveen; Meltzer, Martin I; Rupprecht, Charles; Hull, Harry F; Fishbein, Daniel B

    2010-05-26

    In the United States, the risk of rabies transmission to humans in most situations of possible exposure is unknown. Controlled studies on rabies are clearly not possible. Thus, the limited data on risk has led to the frequent administration of rabies post-exposure prophylaxis (PEP), often in inappropriate circumstances. We used the Delphi method to obtain an expert group consensus estimate of the risk of rabies transmission to humans in seven scenarios of potential rabies exposure. We also surveyed and discussed the merits of recommending rabies PEP for each scenario. The median risk of rabies transmission without rabies PEP for a bite exposure by a skunk, bat, cat, and dog was estimated to be 0.05, 0.001, 0.001, and 0.00001, respectively. Rabies PEP was unanimously recommended in these scenarios. However, rabies PEP was overwhelmingly not recommended for non-bite exposures (e.g. dog licking hand but unavailable for subsequent testing), estimated to have less than 1 in 1,000,000 (0.000001) risk of transmission. Our results suggest that there are many common situations in which the risk of rabies transmission is so low that rabies PEP should not be recommended. These risk estimates also provide a key parameter for cost-effective models of human rabies prevention and can be used to educate health professionals about situation-specific administration of rabies PEP.

  15. The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

    PubMed Central

    Altice, Frederick L; Azbel, Lyuba; Stone, Jack; Brooks-Pollock, Ellen; Smyrnov, Pavlo; Dvoriak, Sergii; Taxman, Faye S; El-Bassel, Nabila; Martin, Natasha K; Booth, Robert; Stöver, Heino; Dolan, Kate; Vickerman, Peter

    2016-01-01

    Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-designated countries of Eastern Europe and Central Asia (EECA) that gained independence from the Soviet Union in 1991 constitute the only region where both continue to rise. HIV transmission in EECA is fuelled primarily by injection of opioids, with harsh criminalisation of drug use that has resulted in extraordinarily high levels of incarceration. Consequently, people who inject drugs, including those with HIV, hepatitis C virus, and tuberculosis, are concentrated within prisons. Evidence-based primary and secondary prevention of HIV using opioid agonist therapies such as methadone and buprenorphine is available in prisons in only a handful of EECA countries (methadone or buprenorphine in five countries and needle and syringe programmes in three countries), with none of them meeting recommended coverage levels. Similarly, antiretroviral therapy coverage, especially among people who inject drugs, is markedly under-scaled. Russia completely bans opioid agonist therapies and does not support needle and syringe programmes—with neither available in prisons—despite the country’s high incarceration rate and having the largest burden of people with HIV who inject drugs in the region. Mathematical modelling for Ukraine suggests that high levels of incarceration in EECA countries facilitate HIV transmission among people who inject drugs, with 28–55% of all new HIV infections over the next 15 years predicted to be attributable to heightened HIV transmission risk among currently or previously incarcerated people who inject drugs. Scaling up of opioid agonist therapies within prisons and maintaining treatment after release would yield the greatest HIV transmission reduction in people who inject drugs. Additional analyses also suggest that at least 6% of all incident tuberculosis cases, and 75% of incident tuberculosis cases in people who inject drugs are due to incarceration. Interventions that

  16. Protocol for a population-based molecular epidemiology study of tuberculosis transmission in a high HIV-burden setting: the Botswana Kopanyo study

    PubMed Central

    Zetola, N M; Modongo, C; Moonan, P K; Click, E; Oeltmann, J E; Shepherd, J; Finlay, A

    2016-01-01

    Introduction Mycobacterium tuberculosis (Mtb) is transmitted from person to person via airborne droplet nuclei. At the community level, Mtb transmission depends on the exposure venue, infectiousness of the tuberculosis (TB) index case and the susceptibility of the index case's social network. People living with HIV infection are at high risk of TB, yet the factors associated with TB transmission within communities with high rates of TB and HIV are largely undocumented. The primary aim of the Kopanyo study is to better understand the demographic, clinical, social and geospatial factors associated with TB and multidrug-resistant TB transmission in 2 communities in Botswana, a country where 60% of all patients with TB are also infected with HIV. This manuscript describes the methods used in the Kopanyo study. Methods and analysis The study will be conducted in greater Gaborone, which has high rates of HIV and a mobile population; and in Ghanzi, a rural community with lower prevalence of HIV infection and home to the native San population. Kopanyo aims to enrol all persons diagnosed with TB during a 4-year study period. From each participant, sputum will be cultured, and for all Mtb isolates, molecular genotyping (24-locus mycobacterial interspersed repetitive units-variable number of tandem repeats) will be performed. Patients with matching genotype results will be considered members of a genotype cluster, a proxy for recent transmission. Demographic, behavioural, clinical and social information will be collected by interview. Participant residence, work place, healthcare facilities visited and social gathering venues will be geocoded. We will assess relationships between these factors and cluster involvement to better plan interventions for reducing TB transmission. Ethics Ethical approval from the Independent Review Boards at the University of Pennsylvania, US Centers for Disease Control and Prevention, Botswana Ministry of Health and University of Botswana has been

  17. Estimation of the transmission of foot-and-mouth disease virus from infected sheep to cattle.

    PubMed

    Bravo de Rueda, Carla; de Jong, Mart C M; Eblé, Phaedra L; Dekker, Aldo

    2014-05-27

    The quantitative role of sheep in the transmission of foot-and-mouth disease virus (FMDV) is not well known. To estimate the role of sheep in the transmission of FMDV, a direct contact transmission experiment with 10 groups of animals each consisting of 2 infected lambs and 1 contact calf was performed. Secretions and excretions (oral swabs, blood, urine, faeces and probang samples) from all animals were tested for the presence of FMDV by virus isolation (VI) and/or RT-PCR. Serum was tested for the presence of antibodies against FMDV. To estimate FMDV transmission, the VI, RT-PCR and serology results were used. The partial reproduction ratio R0p i.e. the average number of new infections caused by one infected sheep introduced into a population of susceptible cattle, was estimated using either data of the whole infection chain of the experimental epidemics (the transient state method) or the final sizes of the experimental epidemics (the final size method). Using the transient state method, R0p was estimated as 1.0 (95% CI 0.2 - 6.0) using virus isolation results and 1.4 (95% CI 0.3 - 8.0) using RT-PCR results. Using the final size method, R0p was estimated as 0.9 (95% CI 0.2 - 3.0). Finally, R0p was compared to the R0's obtained in previous transmission studies with sheep or cattle only. This comparison showed that the infectivity of sheep is lower than that of cattle and that sheep and cattle are similarly susceptible to FMD. These results indicate that in a mixed population of sheep and cattle, sheep play a more limited role in the transmission of FMDV than cattle.

  18. Estimation of the transmission of foot-and-mouth disease virus from infected sheep to cattle

    PubMed Central

    2014-01-01

    The quantitative role of sheep in the transmission of foot-and-mouth disease virus (FMDV) is not well known. To estimate the role of sheep in the transmission of FMDV, a direct contact transmission experiment with 10 groups of animals each consisting of 2 infected lambs and 1 contact calf was performed. Secretions and excretions (oral swabs, blood, urine, faeces and probang samples) from all animals were tested for the presence of FMDV by virus isolation (VI) and/or RT-PCR. Serum was tested for the presence of antibodies against FMDV. To estimate FMDV transmission, the VI, RT-PCR and serology results were used. The partial reproduction ratio R0p i.e. the average number of new infections caused by one infected sheep introduced into a population of susceptible cattle, was estimated using either data of the whole infection chain of the experimental epidemics (the transient state method) or the final sizes of the experimental epidemics (the final size method). Using the transient state method, R0p was estimated as 1.0 (95% CI 0.2 - 6.0) using virus isolation results and 1.4 (95% CI 0.3 - 8.0) using RT-PCR results. Using the final size method, R0p was estimated as 0.9 (95% CI 0.2 - 3.0). Finally, R0p was compared to the R0’s obtained in previous transmission studies with sheep or cattle only. This comparison showed that the infectivity of sheep is lower than that of cattle and that sheep and cattle are similarly susceptible to FMD. These results indicate that in a mixed population of sheep and cattle, sheep play a more limited role in the transmission of FMDV than cattle. PMID:24886222

  19. Testing branching process estimators of cascading failure with data from a simulation of transmission line outages.

    PubMed

    Dobson, Ian; Kim, Janghoon; Wierzbicki, Kevin R

    2010-04-01

    We suggest a statistical estimator to quantify the propagation of cascading transmission line failures in large blackouts of electric power systems. We use a Galton-Watson branching process model of cascading failure and the standard Harris estimator of the mean propagation modified to work when the process saturates at a maximum number of components. If the mean number of initial failures and the mean propagation are estimated, then the branching process model predicts the distribution of the total number of failures. We initially test this prediction on failure data generated by a simulation of cascading transmission line outages on two standard test systems. We discuss the effectiveness of the estimator in terms of how many cascades need to be simulated to predict the distribution of the total number of line outages accurately.

  20. X-ray spectrum estimation from transmission measurements by an exponential of a polynomial model

    NASA Astrophysics Data System (ADS)

    Perkhounkov, Boris; Stec, Jessika; Sidky, Emil Y.; Pan, Xiaochuan

    2016-04-01

    There has been much recent research effort directed toward spectral computed tomography (CT). An important step in realizing spectral CT is determining the spectral response of the scanning system so that the relation between material thicknesses and X-ray transmission intensity is known. We propose a few parameter spectrum model that can accurately model the X-ray transmission curves and has a form which is amenable to simultaneous spectral CT image reconstruction and CT system spectrum calibration. While the goal is to eventually realize the simultaneous image reconstruction/spectrum estimation algorithm, in this work we investigate the effectiveness of the model on spectrum estimation from simulated transmission measurements through known thicknesses of known materials. The simulated transmission measurements employ a typical X-ray spectrum used for CT and contain noise due to the randomness in detecting finite numbers of photons. The proposed model writes the X-ray spectrum as the exponential of a polynomial (EP) expansion. The model parameters are obtained by use of a standard software implementation of the Nelder-Mead simplex algorithm. The performance of the model is measured by the relative error between the predicted and simulated transmission curves. The estimated spectrum is also compared with the model X-ray spectrum. For reference, we also employ a polynomial (P) spectrum model and show performance relative to the proposed EP model.

  1. Cost estimation of HVDC transmission system of Bangka’s NPP candidates

    SciTech Connect

    Liun, Edwaren Suparman

    2014-09-30

    Regarding nuclear power plant development in Bangka Island, it can be estimated that produced power will be oversupply for the Bangka Island and needs to transmit to Sumatra or Java Island. The distance between the regions or islands causing considerable loss of power in transmission by alternating current, and a wide range of technical and economical issues. The objective of this paper addresses to economics analysis of direct current transmission system to overcome those technical problem. Direct current transmission has a stable characteristic, so that the power delivery from Bangka to Sumatra or Java in a large scale efficiently and reliably can be done. HVDC system costs depend on the power capacity applied to the system and length of the transmission line in addition to other variables that may be different.

  2. Location estimation of an in vivo robotic capsule relative to arrayed power transmission coils.

    PubMed

    Kim, Jong Dae; Ryu, Munho; Hwang, Ji Soo; Kim, Jongwon

    2008-06-01

    A tracking method is presented here for an in vivo robotic capsule with power supplied from one of the multiple power transmission coils. The proposed method aims to select the best coupled coil among the array of power transmission coils. It relies on the fact that the driving current of the power transmitter increases with inductive coupling of the receiver coil inside the capsule with the transmitter coil. Investigation of the current increase characteristic according to its location relative to the transmission coils allows development of a strategy for the in vivo robotic capsule. This study shows results with two transmission coils and a two-dimensional power receiver. Experimental results present the possibility of selecting the best coil by estimating the relative location of the capsule.

  3. Stochastic BER estimation for coherent QPSK transmission systems with digital carrier phase recovery.

    PubMed

    Zhang, Fan; Gao, Yan; Luo, Yazhi; Chen, Zhangyuan; Xu, Anshi

    2010-04-26

    We propose a stochastic bit error ratio estimation approach based on a statistical analysis of the retrieved signal phase for coherent optical QPSK systems with digital carrier phase recovery. A family of the generalized exponential function is applied to fit the probability density function of the signal samples. The method provides reasonable performance estimation in presence of both linear and nonlinear transmission impairments while reduces the computational intensity greatly compared to Monte Carlo simulation.

  4. Transmission of Mycobacterium tuberculosis in a High School and School-Based Supervision of an Isoniazid-Rifapentine Regimen for Preventing Tuberculosis - Colorado, 2011-2012.

    PubMed

    2013-10-04

    Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB), is spread from person to person by the airborne route. It can be transmitted extensively in congregate settings, making investigating exposures and treating infected contacts challenging. In December 2011, a student at a Colorado high school with 1,381 students and school personnel received a diagnosis of pulmonary TB disease. One of five household contacts had TB disease, and the other four had latent M. tuberculosis infection (LTBI). Screening of 1,249 school contacts (90%) found one person with pulmonary TB disease, who was fully treated, and 162 with LTBI, of whom 159 started an LTBI treatment regimen for preventing progression to TB disease and 153 completed a regimen. Only the index patient required inpatient care for TB, and TB caused no deaths. Use of short-course treatment regimens, either 12-dose weekly isoniazid and rifapentine directly observed at school or 4 months of self-supervised rifampin daily, facilitated treatment completion. State and county incident command structures led by county TB control authorities guided a response team from multiple jurisdictions. News media reports brought public scrutiny, but meetings with the community addressed the concerns and enhanced public participation. Two contacts of the index patient outside of the school had TB disease diagnosed after the school investigation. As of July 2013, no additional TB disease associated with in-school exposure had been found. An emergency plan for focusing widespread resources, an integral public communications strategy, and new, efficient interventions should be considered in other large TB contact investigations.

  5. Estimating Transmissivity from the Water Level Fluctuations of a Sinusoidally Forced Well

    USGS Publications Warehouse

    Mehnert, E.; Valocchi, A.J.; Heidari, M.; Kapoor, S.G.; Kumar, P.

    1999-01-01

    The water levels in wells are known to fluctuate in response to earth tides and changes in atmospheric pressure. These water level fluctuations can be analyzed to estimate transmissivity (T). A new method to estimate transmissivity, which assumes that the atmospheric pressure varies in a sinusoidal fashion, is presented. Data analysis for this simplified method involves using a set of type curves and estimating the ratio of the amplitudes of the well response over the atmospheric pressure. Type curves for this new method were generated based on a model for ground water flow between the well and aquifer developed by Cooper et al. (1965). Data analysis with this method confirmed these published results: (1) the amplitude ratio is a function of transmissivity, the well radius, and the frequency of the sinusoidal oscillation; and (2) the amplitude ratio is a weak function of storativity. Compared to other methods, the developed method involves simpler, more intuitive data analysis and allows shorter data sets to be analyzed. The effect of noise on estimating the amplitude ratio was evaluated and found to be more significant at lower T. For aquifers with low T, noise was shown to mask the water level fluctuations induced by atmospheric pressure changes. In addition, reducing the length of the data series did not affect the estimate of T, but the variance of the estimate was higher for the shorter series of noisy data.

  6. Tracing Mycobacterium tuberculosis transmission by whole genome sequencing in a high incidence setting: a retrospective population-based study in East Greenland

    PubMed Central

    Bjorn-Mortensen, K.; Soborg, B.; Koch, A.; Ladefoged, K.; Merker, M.; Lillebaek, T.; Andersen, A. B.; Niemann, S.; Kohl, T. A.

    2016-01-01

    In East Greenland, a dramatic increase of tuberculosis (TB) incidence has been observed in recent years. Classical genotyping suggests a genetically similar Mycobacterium tuberculosis (Mtb) strain population as cause, however, precise transmission patterns are unclear. We performed whole genome sequencing (WGS) of Mtb isolates from 98% of culture-positive TB cases through 21 years (n = 182) which revealed four genomic clusters of the Euro-American lineage (mainly sub-lineage 4.8 (n = 134)). The time to the most recent common ancestor of lineage 4.8 strains was found to be 100 years. This sub-lineage further diversified in the 1970s, and massively expanded in the 1990s, a period of lowered TB awareness in Greenland. Despite the low genetic strain diversity, WGS data revealed several recent short-term transmission events in line with the increasing incidence in the region. Thus, the isolated setting and the uniformity of circulating Mtb strains indicated that the majority of East Greenlandic TB cases originated from one or few strains introduced within the last century. Thereby, the study shows the consequences of even short interruptions in TB control efforts in previously TB high incidence areas and demonstrates the potential role of WGS in detecting ongoing micro epidemics, thus guiding public health efforts in the future. PMID:27615360

  7. Use of whole genome sequencing to estimate the mutation rate of Mycobacterium tuberculosis during latent infection

    PubMed Central

    Ford, Christopher B.; Lin, Philana Ling; Chase, Michael; Shah, Rupal R.; Iartchouk, Oleg; Galagan, James; Mohaideen, Nilofar; Ioerger, Thomas R.; Sacchettini, James C.; Lipsitch, Marc; Flynn, JoAnne L.; Fortune, Sarah M.

    2011-01-01

    Mycobacterium tuberculosis (Mtb) has generated a global health catastrophe that has been compounded by the emergence of drug resistant Mtb strains. We used whole genome sequencing to compare the accumulation of mutations in Mtb isolated from cynomolgus macaques with active, latent and reactivated disease. Based on the distribution of SNPs observed, we calculated the mutation rates for these disease states. Our data suggest that Mtb acquires a similar number of chromosomal mutations during latency as occurs during active disease or in a logarithmically growing culture over the same period of time despite reduced bacterial replication during latent infection. The pattern of polymorphisms suggests that the mutational burden in vivo is due to oxidative DNA damage. Thus, we demonstrate that Mtb continues to acquire mutations during latency and provide a novel explanation for the observation that isoniazid monotherapy for latent tuberculosis is a risk factor for the emergence of INH resistance1,2. PMID:21516081

  8. Estimating the transmissibility of H5N1 and the effect of vaccination in Indonesia.

    PubMed

    Walker, P G T; Jost, C; Ghani, A C; Cauchemez, S; Bett, B; Azhar, M; Murahman, J; Widiastuti, T; Daju, D; Mariner, J

    2015-04-01

    The spread of H5N1 avian influenza continues to pose an economic burden and a public health risk worldwide. Despite this, estimates of the transmissibility of infection exist in only a handful of settings and vary considerably. Using final size methods and flock-level infection data from a field trial of mass vaccination, we obtained the first estimates of the transmissibility of infection between and within flocks in Indonesia. We also found that outbreaks in areas designated as vaccination zones were less transmissible than in non-vaccination zones. However, this reduction is only comparable with a limited degree of protective vaccination coverage. Quantifying the overall effect of vaccination in these zones remains challenging. However, this result would appear to imply that, although the interventions applied in vaccination zones were not sufficient to completely prevent transmission in all areas, when outbreaks occur, they are less transmissible than those in areas where vaccination was not applied. This could be either a direct or an indirect effect of vaccination. Given the dynamism of small-scale poultry production in Indonesia, more regular vaccination may be required to ensure that infection is fully controlled in vaccination zones. © 2013 Blackwell Verlag GmbH.

  9. Estimation of torque transmitted by clutch during shifting process for dry dual clutch transmission

    NASA Astrophysics Data System (ADS)

    Zhao, Zhiguo; He, Lu; Yang, Yunyun; Wu, Chaochun; Li, Xueyan; Karl Hedrick, J.

    2016-06-01

    The key toward realizing no-impact gear shifting for dual clutch transmission (DCT) lies in the coordination control between the engine and dual clutches, as well as the accurate closed-loop control of torque transmitted by each clutch and the output torque of the engine. However, the implementation and control precision of closed-loop control are completely dependent on the effective measurement or estimation of the instant transmission torque of the clutch. This study analyzes the DCT shifting process, and builds a three-dimensional (3D) clutch model and mathematical model of a DCT vehicle powertrain system. The torque transmitted by a twin clutch during the upshifting process is estimated by applying the unscented Kalman filter (UKF) algorithm. Then, the torque estimation algorithm is verified using a DCT prototype vehicle installed with a torque sensor on the drive half-shaft. The experimental results show that the designed UKF torque estimation algorithm can estimate the transmission torques of two clutches in real time; further, it can be directly used for DCT shift control and improving the shifting quality.

  10. Estimating the transmission potential of supercritical processes based on the final size distribution of minor outbreaks.

    PubMed

    Nishiura, Hiroshi; Yan, Ping; Sleeman, Candace K; Mode, Charles J

    2012-02-07

    Use of the final size distribution of minor outbreaks for the estimation of the reproduction numbers of supercritical epidemic processes has yet to be considered. We used a branching process model to derive the final size distribution of minor outbreaks, assuming a reproduction number above unity, and applying the method to final size data for pneumonic plague. Pneumonic plague is a rare disease with only one documented major epidemic in a spatially limited setting. Because the final size distribution of a minor outbreak needs to be normalized by the probability of extinction, we assume that the dispersion parameter (k) of the negative-binomial offspring distribution is known, and examine the sensitivity of the reproduction number to variation in dispersion. Assuming a geometric offspring distribution with k=1, the reproduction number was estimated at 1.16 (95% confidence interval: 0.97-1.38). When less dispersed with k=2, the maximum likelihood estimate of the reproduction number was 1.14. These estimates agreed with those published from transmission network analysis, indicating that the human-to-human transmission potential of the pneumonic plague is not very high. Given only minor outbreaks, transmission potential is not sufficiently assessed by directly counting the number of offspring. Since the absence of a major epidemic does not guarantee a subcritical process, the proposed method allows us to conservatively regard epidemic data from minor outbreaks as supercritical, and yield estimates of threshold values above unity.

  11. Estimating infectious disease transmission distances using the overall distribution of cases.

    PubMed

    Salje, Henrik; Cummings, Derek A T; Lessler, Justin

    2016-12-01

    The average spatial distance between transmission-linked cases is a fundamental property of infectious disease dispersal. However, the distance between a case and their infector is rarely measurable. Contact-tracing investigations are resource intensive or even impossible, particularly when only a subset of cases are detected. Here, we developed an approach that uses onset dates, the generation time distribution and location information to estimate the mean transmission distance. We tested our method using outbreak simulations. We then applied it to the 2001 foot-and-mouth outbreak in Cumbria, UK, and compared our results to contact-tracing activities. In simulations with a true mean distance of 106m, the average mean distance estimated was 109m when cases were fully observed (95% range of 71-142). Estimates remained consistent with the true mean distance when only five percent of cases were observed, (average estimate of 128m, 95% range 87-165). Estimates were robust to spatial heterogeneity in the underlying population. We estimated that both the mean and the standard deviation of the transmission distance during the 2001 foot-and-mouth outbreak was 8.9km (95% CI: 8.4km-9.7km). Contact-tracing activities found similar values of 6.3km (5.2km-7.4km) and 11.2km (9.5km-12.8km), respectively. We were also able to capture the drop in mean transmission distance over the course of the outbreak. Our approach is applicable across diseases, robust to under-reporting and can inform interventions and surveillance. Copyright © 2016 The Author(s). Published by Elsevier B.V. All rights reserved.

  12. Vegetation Height Estimation Near Power transmission poles Via satellite Stereo Images using 3D Depth Estimation Algorithms

    NASA Astrophysics Data System (ADS)

    Qayyum, A.; Malik, A. S.; Saad, M. N. M.; Iqbal, M.; Abdullah, F.; Rahseed, W.; Abdullah, T. A. R. B. T.; Ramli, A. Q.

    2015-04-01

    Monitoring vegetation encroachment under overhead high voltage power line is a challenging problem for electricity distribution companies. Absence of proper monitoring could result in damage to the power lines and consequently cause blackout. This will affect electric power supply to industries, businesses, and daily life. Therefore, to avoid the blackouts, it is mandatory to monitor the vegetation/trees near power transmission lines. Unfortunately, the existing approaches are more time consuming and expensive. In this paper, we have proposed a novel approach to monitor the vegetation/trees near or under the power transmission poles using satellite stereo images, which were acquired using Pleiades satellites. The 3D depth of vegetation has been measured near power transmission lines using stereo algorithms. The area of interest scanned by Pleiades satellite sensors is 100 square kilometer. Our dataset covers power transmission poles in a state called Sabah in East Malaysia, encompassing a total of 52 poles in the area of 100 km. We have compared the results of Pleiades satellite stereo images using dynamic programming and Graph-Cut algorithms, consequently comparing satellites' imaging sensors and Depth-estimation Algorithms. Our results show that Graph-Cut Algorithm performs better than dynamic programming (DP) in terms of accuracy and speed.

  13. Comparing methods for estimating R0 from the size distribution of subcritical transmission chains.

    PubMed

    Blumberg, S; Lloyd-Smith, J O

    2013-09-01

    Many diseases exhibit subcritical transmission (i.e. 0transmission heterogeneity, we present a unified analysis of existing R0 estimation methods. Simulation studies show that the degree of transmission heterogeneity, when improperly modeled, can significantly impact the bias of R0 estimation methods designed for imperfect observation. These studies also highlight the importance of isolated cases in assessing whether an estimation technique is consistent with observed data. Analysis of data from measles outbreaks shows that likelihood scores are highest for models that allow a flexible degree of transmission heterogeneity. Aggregating intermediate sized chains often has similar performance to analyzing a complete chain size distribution. However, truncating isolated cases is beneficial only when surveillance systems clearly favor full observation of large chains but not small chains. Meanwhile, if data on the type and proportion of cases that are unobserved were known, we demonstrate that maximum likelihood inference of R0 could be adjusted accordingly. This motivates the need for future empirical and theoretical work to quantify observation error and incorporate relevant mechanisms into stuttering chain models used

  14. Prevalence of previously undetected tuberculosis and underlying risk factors for transmission in a prison setting in Ibadan, south-western Nigeria

    PubMed Central

    Adesokan, HK; Cadmus, EO; Adeyemi, WB; Lawal, O.; Ogunlade, C.O.; Osman, E.; Olaleye, OD; Cadmus, SIB

    2014-01-01

    Summary People with congregational tendencies such as the prison inmates constitute an important target group in the global efforts towards the control of tuberculosis (TB). The prison setting in most developing countries particularly Nigeria, currently does not have routine diagnostic procedures for TB despite the existing risks that could facilitate disease transmission. We conducted a cross sectional study among the inmates in a major prison in south-western Nigeria for TB by screening their sputum samples using a simple random sampling method coupled with questionnaire interview, on the assumption of sub-clinical pulmonary TB infection. The overall TB prevalence found was 1.2% (2/164). Significant risk factors that could facilitate disease transmission in the prison included lack of BCG immunization (p = 0.017); history of contact with TB patients (p = 0.020); prolonged cough (p = 0.016) and drug abuse (p = 0.019). Our findings of 1.2% undetected pulmonary TB infection among the inmates though low; still reiterate previous observation that the prison setting constitutes a veritable environment for TB transmission and a threat to public health. Efforts are therefore needed to institute routine screening and reduce the risk factors associated with TB transmission among prison inmates in Nigeria. PMID:26689165

  15. Stochastic estimation of hydraulic transmissivity fields using flow connectivity indicator data

    NASA Astrophysics Data System (ADS)

    Freixas, G.; Fernà ndez-Garcia, D.; Sanchez-Vila, X.

    2017-01-01

    Most methods for hydraulic test interpretation rely on a number of simplified assumptions regarding the homogeneity and isotropy of the underlying porous media. This way, the actual heterogeneity of any natural parameter, such as transmissivity (T), is transferred to the corresponding estimates in a way heavily dependent on the interpretation method used. An example is a long-term pumping test interpreted by means of the Cooper-Jacob method, which implicitly assumes a homogeneous isotropic confined aquifer. The estimates obtained from this method are not local values, but still have a clear physical meaning; the estimated T represents a regional-scale effective value, while the log-ratio of the normalized estimated storage coefficient, indicated by ω', is an indicator of flow connectivity, representative of the scale given by the distance between the pumping and the observation wells. In this work we propose a methodology to use ω', together with sampled local measurements of transmissivity at selected points, to map the expected value of local T values using a technique based on cokriging. Since the interpolation involves two variables measured at different support scales, a critical point is the estimation of the covariance and crosscovariance matrices. The method is applied to a synthetic field displaying statistical anisotropy, showing that the inclusion of connectivity indicators in the estimation method provide maps that effectively display preferential flow pathways, with direct consequences in solute transport.

  16. Estimating Contact Process Saturation in Sylvatic Transmission of Trypanosoma cruzi in the United States

    PubMed Central

    Kribs-Zaleta, Christopher

    2010-01-01

    Although it has been known for nearly a century that strains of Trypanosoma cruzi, the etiological agent for Chagas' disease, are enzootic in the southern U.S., much remains unknown about the dynamics of its transmission in the sylvatic cycles that maintain it, including the relative importance of different transmission routes. Mathematical models can fill in gaps where field and lab data are difficult to collect, but they need as inputs the values of certain key demographic and epidemiological quantities which parametrize the models. In particular, they determine whether saturation occurs in the contact processes that communicate the infection between the two populations. Concentrating on raccoons, opossums, and woodrats as hosts in Texas and the southeastern U.S., and the vectors Triatoma sanguisuga and Triatoma gerstaeckeri, we use an exhaustive literature review to derive estimates for fundamental parameters, and use simple mathematical models to illustrate a method for estimating infection rates indirectly based on prevalence data. Results are used to draw conclusions about saturation and which population density drives each of the two contact-based infection processes (stercorarian/bloodborne and oral). Analysis suggests that the vector feeding process associated with stercorarian transmission to hosts and bloodborne transmission to vectors is limited by the population density of vectors when dealing with woodrats, but by that of hosts when dealing with raccoons and opossums, while the predation of hosts on vectors which drives oral transmission to hosts is limited by the population density of hosts. Confidence in these conclusions is limited by a severe paucity of data underlying associated parameter estimates, but the approaches developed here can also be applied to the study of other vector-borne infections. PMID:20436914

  17. Link-state-estimation-based transmission power control in wireless body area networks.

    PubMed

    Kim, Seungku; Eom, Doo-Seop

    2014-07-01

    This paper presents a novel transmission power control protocol to extend the lifetime of sensor nodes and to increase the link reliability in wireless body area networks (WBANs). We first experimentally investigate the properties of the link states using the received signal strength indicator (RSSI). We then propose a practical transmission power control protocol based on both short- and long-term link-state estimations. Both the short- and long-term link-state estimations enable the transceiver to adapt the transmission power level and target the RSSI threshold range, respectively, to simultaneously satisfy the requirements of energy efficiency and link reliability. Finally, the performance of the proposed protocol is experimentally evaluated in two experimental scenarios-body posture change and dynamic body motion-and compared with the typical WBAN transmission power control protocols, a real-time reactive scheme, and a dynamic postural position inference mechanism. From the experimental results, it is found that the proposed protocol increases the lifetime of the sensor nodes by a maximum of 9.86% and enhances the link reliability by reducing the packet loss by a maximum of 3.02%.

  18. Application of satellite estimates of rainfall distribution to simulate the potential for malaria transmission in Africa

    NASA Astrophysics Data System (ADS)

    Yamana, T. K.; Eltahir, E. A.

    2009-12-01

    The Hydrology, Entomology and Malaria Transmission Simulator (HYDREMATS) is a mechanistic model developed to assess malaria risk in areas where the disease is water-limited. This model relies on precipitation inputs as its primary forcing. Until now, applications of the model have used ground-based precipitation observations. However, rain gauge networks in the areas most affected by malaria are often sparse. The increasing availability of satellite based rainfall estimates could greatly extend the range of the model. The minimum temporal resolution of precipitation data needed was determined to be one hour. The CPC Morphing technique (CMORPH ) distributed by NOAA fits this criteria, as it provides 30-minute estimates at 8km resolution. CMORPH data were compared to ground observations in four West African villages, and calibrated to reduce overestimation and false alarm biases. The calibrated CMORPH data were used to force HYDREMATS, resulting in outputs for mosquito populations, vectorial capacity and malaria transmission.

  19. Estimating risks of importation and local transmission of Zika virus infection.

    PubMed

    Nah, Kyeongah; Mizumoto, Kenji; Miyamatsu, Yuichiro; Yasuda, Yohei; Kinoshita, Ryo; Nishiura, Hiroshi

    2016-01-01

    Background. An international spread of Zika virus (ZIKV) infection has attracted global attention. ZIKV is conveyed by a mosquito vector, Aedes species, which also acts as the vector species of dengue and chikungunya viruses. Methods. Arrival time of ZIKV importation (i.e., the time at which the first imported case was diagnosed) in each imported country was collected from publicly available data sources. Employing a survival analysis model in which the hazard is an inverse function of the effective distance as informed by the airline transportation network data, and using dengue and chikungunya virus transmission data, risks of importation and local transmission were estimated. Results. A total of 78 countries with imported case(s) have been identified, with the arrival time ranging from 1 to 44 weeks since the first ZIKV was identified in Brazil, 2015. Whereas the risk of importation was well explained by the airline transportation network data, the risk of local transmission appeared to be best captured by additionally accounting for the presence of dengue and chikungunya viruses. Discussion. The risk of importation may be high given continued global travel of mildly infected travelers but, considering that the public health concerns over ZIKV infection stems from microcephaly, it is more important to focus on the risk of local and widespread transmission that could involve pregnant women. The predicted risk of local transmission was frequently seen in tropical and subtropical countries with dengue or chikungunya epidemic experience.

  20. Estimating risks of importation and local transmission of Zika virus infection

    PubMed Central

    Nah, Kyeongah; Mizumoto, Kenji; Miyamatsu, Yuichiro; Yasuda, Yohei; Kinoshita, Ryo

    2016-01-01

    Background. An international spread of Zika virus (ZIKV) infection has attracted global attention. ZIKV is conveyed by a mosquito vector, Aedes species, which also acts as the vector species of dengue and chikungunya viruses. Methods. Arrival time of ZIKV importation (i.e., the time at which the first imported case was diagnosed) in each imported country was collected from publicly available data sources. Employing a survival analysis model in which the hazard is an inverse function of the effective distance as informed by the airline transportation network data, and using dengue and chikungunya virus transmission data, risks of importation and local transmission were estimated. Results. A total of 78 countries with imported case(s) have been identified, with the arrival time ranging from 1 to 44 weeks since the first ZIKV was identified in Brazil, 2015. Whereas the risk of importation was well explained by the airline transportation network data, the risk of local transmission appeared to be best captured by additionally accounting for the presence of dengue and chikungunya viruses. Discussion. The risk of importation may be high given continued global travel of mildly infected travelers but, considering that the public health concerns over ZIKV infection stems from microcephaly, it is more important to focus on the risk of local and widespread transmission that could involve pregnant women. The predicted risk of local transmission was frequently seen in tropical and subtropical countries with dengue or chikungunya epidemic experience. PMID:27069825

  1. An EM algorithm for estimating SPECT emission and transmission parameters from emissions data only.

    PubMed

    Krol, A; Bowsher, J E; Manglos, S H; Feiglin, D H; Tornai, M P; Thomas, F D

    2001-03-01

    A maximum-likelihood (ML) expectation-maximization (EM) algorithm (called EM-IntraSPECT) is presented for simultaneously estimating single photon emission computed tomography (SPECT) emission and attenuation parameters from emission data alone. The algorithm uses the activity within the patient as transmission tomography sources, with which attenuation coefficients can be estimated. For this initial study, EM-IntraSPECT was tested on computer-simulated attenuation and emission maps representing a simplified human thorax as well as on SPECT data obtained from a physical phantom. Two evaluations were performed. First, to corroborate the idea of reconstructing attenuation parameters from emission data, attenuation parameters (mu) were estimated with the emission intensities (lambda) fixed at their true values. Accurate reconstructions of attenuation parameters were obtained. Second, emission parameters lambda and attenuation parameters mu were simultaneously estimated from the emission data alone. In this case there was crosstalk between estimates of lambda and mu and final estimates of lambda and mu depended on initial values. Estimates degraded significantly as the support extended out farther from the body, and an explanation for this is proposed. In the EM-IntraSPECT reconstructed attenuation images, the lungs, spine, and soft tissue were readily distinguished and had approximately correct shapes and sizes. As compared with standard EM reconstruction assuming a fix uniform attenuation map, EM-IntraSPECT provided more uniform estimates of cardiac activity in the physical phantom study and in the simulation study with tight support, but less uniform estimates with a broad support. The new EM algorithm derived here has additional applications, including reconstructing emission and transmission projection data under a unified statistical model.

  2. Accurate distortion estimation and optimal bandwidth allocation for scalable H.264 video transmission over MIMO systems.

    PubMed

    Jubran, Mohammad K; Bansal, Manu; Kondi, Lisimachos P; Grover, Rohan

    2009-01-01

    In this paper, we propose an optimal strategy for the transmission of scalable video over packet-based multiple-input multiple-output (MIMO) systems. The scalable extension of H.264/AVC that provides a combined temporal, quality and spatial scalability is used. For given channel conditions, we develop a method for the estimation of the distortion of the received video and propose different error concealment schemes. We show the accuracy of our distortion estimation algorithm in comparison with simulated wireless video transmission with packet errors. In the proposed MIMO system, we employ orthogonal space-time block codes (O-STBC) that guarantee independent transmission of different symbols within the block code. In the proposed constrained bandwidth allocation framework, we use the estimated end-to-end decoder distortion to optimally select the application layer parameters, i.e., quantization parameter (QP) and group of pictures (GOP) size, and physical layer parameters, i.e., rate-compatible turbo (RCPT) code rate and symbol constellation. Results show the substantial performance gain by using different symbol constellations across the scalable layers as compared to a fixed constellation.

  3. Estimating the variance and integral scale of the transmissivity field using head residual increments

    USGS Publications Warehouse

    Zheng, Lingyun; Silliman, S.E.

    2000-01-01

    A modification of previously published solutions regarding the spatial variation of hydraulic heads is discussed whereby the semivariogram of increments of head residuals (termed head residual increments HRIs) are related to the variance and integral scale of the transmissivity field. A first-order solution is developed for the case of a transmissivity field which is isotropic and whose second-order behavior can be characterized by an exponential covariance structure. The estimates of the variance ??(Y)/2 and the integral scale ?? of the log transmissivity field are then obtained via fitting a theoretical semivariogram for the HRI to its sample semivariogram. This approach is applied to head data sampled from a series of two-dimensional, simulated aquifers with isotropic, exponential covariance structures and varying degrees of heterogeneity (??(Y)/2 = 0.25, 0.5, 1.0, 2.0, and 5.0). The results show that this method provided reliable estimates for both ?? and ??(Y)/2 in aquifers with the value of ??(Y)/2 up to 2.0, but the errors in those estimates were higher for ??(Y)/2 equal to 5.0. It is also demonstrated through numerical experiments and theoretical arguments that the head residual increments will provide a sample semivariogram with a lower variance than will the use of the head residuals without calculation of increments.

  4. Design and cost estimate of an 800 MVA superconducting power transmission

    SciTech Connect

    Alex, P.; Ernst, A. ); Forsyth, E.; Gibbs, R.; Thomas, R.; Muller, T. )

    1990-10-18

    Numerous studies involving cost estimates have been performed for superconducting power transmission systems. As these systems were usually aimed at providing transmission from large clusters of generation the base power rating of the corridor was very high; in the case of the most comprehensive study it was 10,000 MVA. The purpose of this study is to examine a system which is very closely based on the prototype 1000 MVA system which was operated at Brookhaven National Laboratory over a four year period. The purpose of the study is to provide cost estimates for the superconducting system and to compare these estimates with a design based on the use of advanced but conventional cable designs. The work is supported by funding from the Office of Energy Research's Industry/Laboratory Technology Exchange Program. This program is designed to commercialize energy technologies. The technical design of the superconducting system was prepared by the BNL staff, the design of the 800 MVA conventional cable system was done by engineers from Underground Systems Incorporated. Both institutions worked on the cost estimate of the superconducting system. The description and cost estimate of the conventional cable system is given in the Appendix. 5 refs.

  5. Parameter estimation and simulations of a mathematical model of Corynebacterium pseudotuberculosis transmission in sheep.

    PubMed

    O'Reilly, K M; Green, L E; Malone, F E; Medley, G F

    2008-03-17

    Caseous lymphadenitis (CLA) is an infectious disease of sheep caused by Corynebacterium pseudotuberculosis. It is prevalent in most sheep producing countries and was introduced into the UK sheep population in 1991. The pathogen invades the host through epithelium and forms an abscess in the local draining lymph node. Typically, disease presents as clinical, with overt (externally visible) swollen lymph nodes (the parotid, submandibular, prefemoral, prescapular, popliteal or mammary) or sub-clinical, with abscesses in the lungs and associated thoracic (bronchial and mediastinal) lymph nodes. We present a mathematical model in which disease is categorised as overt and/or respiratory (sub-clinical), using the above groupings. In both situations sheep may be infected and may or may not be infectious. In the model, overt abscesses may resolve and respiratory abscesses are considered to be present for life. Using the location of the abscesses, three routes of transmission are postulated: overt to overt, respiratory to overt and respiratory to respiratory. Data from four naturally infected flocks were used to describe populations of sheep with epidemic CLA and to estimate transmission coefficients for each of the postulated transmission routes. The infection process parameters were derived from literature where possible. Parameters were estimated using maximum likelihood methods and compared to the data using a multinomial distribution. The distribution of abscesses in the flocks was similar to endemic data reported in other studies. In the model most infected sheep developed abscesses, and approximately 36% of sheep with overt abscesses recovered from infection. The average time for respiratory abscesses to become infectious was 41 days. In these data, overt to overt transmission was the most frequent route of transmission since it had the highest coefficient in the model compared with respiratory to overt and respiratory to respiratory transmission. Transmission

  6. Block Transmissions over Doubly Selective Channels: Iterative Channel Estimation and Turbo Equalization

    NASA Astrophysics Data System (ADS)

    Fang, Kun; Rugini, Luca; Leus, Geert

    2010-12-01

    Modern wireless communication systems require high transmission rates, giving rise to frequency selectivity due to multipath propagation. In addition, high-mobility terminals and scatterers induce Doppler shifts that introduce time selectivity. Therefore, advanced techniques are needed to accurately model the time- and frequency-selective (i.e., doubly selective) channels and to counteract the related performance degradation. In this paper, we develop new receivers for orthogonal frequency-division multiplexing (OFDM) systems and single-carrier (SC) systems in doubly selective channels by embedding the channel estimation task within low-complexity block turbo equalizers. Linear minimum mean-squared error (MMSE) pilot-assisted channel estimators are presented, and the soft data estimates from the turbo equalizers are used to improve the quality of the channel estimates.

  7. Improving Estimation Performance in Networked Control Systems Applying the Send-on-delta Transmission Method

    PubMed Central

    Nguyen, Vinh Hao; Suh, Young Soo

    2007-01-01

    This paper is concerned with improving performance of a state estimation problem over a network in which a send-on-delta (SOD) transmission method is used. The SOD method requires that a sensor node transmit data to the estimator node only if its measurement value changes more than a given specified δ value. This method has been explored and applied by researchers because of its efficiency in the network bandwidth improvement. However, when this method is used, it is not ensured that the estimator node receives data from the sensor nodes regularly at every estimation period. Therefore, we propose a method to reduce estimation error in case of no sensor data reception. When the estimator node does not receive data from the sensor node, the sensor value is known to be in a (−δi,+δi) interval from the last transmitted sensor value. This implicit information has been used to improve estimation performance in previous studies. The main contribution of this paper is to propose an algorithm, where the sensor value interval is reduced to (−δi/2,+δi/2) in certain situations. Thus, the proposed algorithm improves the overall estimation performance without any changes in the send-on-delta algorithms of the sensor nodes. Through numerical simulations, we demonstrate the feasibility and the usefulness of the proposed method.

  8. Geostatistical estimation of the transmissivity in a highly fractured metamorphic and crystalline aquifer (Man-Danane Region, Western Ivory Coast)

    NASA Astrophysics Data System (ADS)

    Razack, Moumtaz; Lasm, Théophile

    2006-06-01

    This work is aimed at estimating the transmissivity of highly fractured hard rock aquifers using a geostatistical approach. The studied aquifer is formed by the crystalline and metamorphic rocks of the Western Ivory Coast (West Africa), in the Man Danané area. The study area covers 7290 km 2 (90 km×81 km). The fracturing network is dense and well connected, without a marked fracture direction. A data base comprising 118 transmissivity ( T) values and 154 specific capacity ( Q/ s) values was compiled. A significant empirical relationship between T and Q/ s was found, which enabled the transmissivity data to be supplemented. The variographic analysis of the two variables showed that the variograms of T and Q/ s (which are lognormal variables) are much more structured than those of log T and log Q/ s (which are normal variables). This result is contrary to what was previously published and raises the question whether normality is necessary in geostatistical analysis. Several input and geostatistical estimations of the transmissivity were tested using the cross validation procedure: measured transmissivity data; supplemented transmissivity data; kriging; cokriging. The cross validation results showed that the best estimation is provided using the kriging procedure, the transmissivity field represented by the whole data sample (measured+estimated using specific capacity) and the structural model evaluated solely on the measured transmissivity. The geostatistical approach provided in fine a reliable estimation of the transmissivity of the Man Danané aquifer, which will be used as an input in forthcoming modelling.

  9. Determining the Risk of Intra-Community Transmission of Tuberculosis in the Northwest of Iran Through 15 Loci Miru-Vntr Typing

    PubMed Central

    Afaghi-Gharamaleki, Ali; Moaddab, Seyyedreza; Darbouy, Mojtaba; Ansarin, Khalil; Hanifian, Shahram

    2017-01-01

    This study was carried out in order to investigating the effect of travelling on the transmission of tuberculosis from high- to low-burden TB countries. Mycobacteria samples isolated from patients of distinct and relatively co-related countries (Azerbaijan Republic and Tabriz [located in the northwest of Iran]) were analyzed through 15 loci MIRU-VNTR typing method. PCR was done using special primers for each of the loci; then the number of allele repeats for all loci were determined by the size of their fragments. Finally, the created numeric patterns for each isolate were analyzed and clustered, using MIRU-VNTRplus.org website. All 119 isolates dispersing at 106 distinct patterns were composed of 10 clusters with 23 members and 96 unique patterns. Nine and five loci had high and moderate discriminatory power, respectively, but only one of them was poor in clustering. The study showed that 89.08% of TB cases involved resulted from the reactivation pattern and 10.92% were related to ongoing transmission. Although Azerbaijan Republic is a higher-burden TB region than Tabriz and Azerbaijan people make frequent tours to Tabriz to receive low or free medical services, the findings showed no TB transmission from the regions at least during the year of the study. PMID:28386470

  10. An angle-dependent estimation of CT x-ray spectrum from rotational transmission measurements

    SciTech Connect

    Lin, Yuan Samei, Ehsan; Ramirez-Giraldo, Juan Carlos; Gauthier, Daniel J.; Stierstorfer, Karl

    2014-06-15

    Purpose: Computed tomography (CT) performance as well as dose and image quality is directly affected by the x-ray spectrum. However, the current assessment approaches of the CT x-ray spectrum require costly measurement equipment and complicated operational procedures, and are often limited to the spectrum corresponding to the center of rotation. In order to address these limitations, the authors propose an angle-dependent estimation technique, where the incident spectra across a wide range of angular trajectories can be estimated accurately with only a single phantom and a single axial scan in the absence of the knowledge of the bowtie filter. Methods: The proposed technique uses a uniform cylindrical phantom, made of ultra-high-molecular-weight polyethylene and positioned in an off-centered geometry. The projection data acquired with an axial scan have a twofold purpose. First, they serve as a reflection of the transmission measurements across different angular trajectories. Second, they are used to reconstruct the cross sectional image of the phantom, which is then utilized to compute the intersection length of each transmission measurement. With each CT detector element recording a range of transmission measurements for a single angular trajectory, the spectrum is estimated for that trajectory. A data conditioning procedure is used to combine information from hundreds of collected transmission measurements to accelerate the estimation speed, to reduce noise, and to improve estimation stability. The proposed spectral estimation technique was validated experimentally using a clinical scanner (Somatom Definition Flash, Siemens Healthcare, Germany) with spectra provided by the manufacturer serving as the comparison standard. Results obtained with the proposed technique were compared against those obtained from a second conventional transmission measurement technique with two materials (i.e., Cu and Al). After validation, the proposed technique was applied to measure

  11. An angle-dependent estimation of CT x-ray spectrum from rotational transmission measurements.

    PubMed

    Lin, Yuan; Ramirez-Giraldo, Juan Carlos; Gauthier, Daniel J; Stierstorfer, Karl; Samei, Ehsan

    2014-06-01

    Computed tomography (CT) performance as well as dose and image quality is directly affected by the x-ray spectrum. However, the current assessment approaches of the CT x-ray spectrum require costly measurement equipment and complicated operational procedures, and are often limited to the spectrum corresponding to the center of rotation. In order to address these limitations, the authors propose an angle-dependent estimation technique, where the incident spectra across a wide range of angular trajectories can be estimated accurately with only a single phantom and a single axial scan in the absence of the knowledge of the bowtie filter. The proposed technique uses a uniform cylindrical phantom, made of ultra-high-molecular-weight polyethylene and positioned in an off-centered geometry. The projection data acquired with an axial scan have a twofold purpose. First, they serve as a reflection of the transmission measurements across different angular trajectories. Second, they are used to reconstruct the cross sectional image of the phantom, which is then utilized to compute the intersection length of each transmission measurement. With each CT detector element recording a range of transmission measurements for a single angular trajectory, the spectrum is estimated for that trajectory. A data conditioning procedure is used to combine information from hundreds of collected transmission measurements to accelerate the estimation speed, to reduce noise, and to improve estimation stability. The proposed spectral estimation technique was validated experimentally using a clinical scanner (Somatom Definition Flash, Siemens Healthcare, Germany) with spectra provided by the manufacturer serving as the comparison standard. Results obtained with the proposed technique were compared against those obtained from a second conventional transmission measurement technique with two materials (i.e., Cu and Al). After validation, the proposed technique was applied to measure spectra from the

  12. Predominant Mycobacterium tuberculosis Families and High Rates of Recent Transmission among New Cases Are Not Associated with Primary Multidrug Resistance in Lima, Peru.

    PubMed

    Barletta, Francesca; Otero, Larissa; de Jong, Bouke C; Iwamoto, Tomotada; Arikawa, Kentaro; Van der Stuyft, Patrick; Niemann, Stefan; Merker, Matthias; Uwizeye, Cécile; Seas, Carlos; Rigouts, Leen

    2015-06-01

    Sputum samples from new tuberculosis (TB) cases were collected over 2 years as part of a prospective study in the northeastern part of Lima, Peru. To measure the contribution of recent transmission to the high rates of multidrug resistance (MDR) in this area, Mycobacterium tuberculosis complex (MTBc) isolates were tested for drug susceptibility to first-line drugs and were genotyped by spoligotyping and 15-locus mycobacterial interspersed repetitive-unit (MIRU-15)-variable-number tandem repeat (VNTR) analysis. MDR was found in 6.8% of 844 isolates, of which 593 (70.3%) were identified as belonging to a known MTBc lineage, whereas 198 isolates (23.5%) could not be assigned to these lineages and 12 (1.4%) represented mixed infections. Lineage 4 accounted for 54.9% (n = 463) of the isolates, most of which belonged to the Haarlem family (n = 279). MIRU-15 analysis grouped 551/791 isolates (69.7%) in 102 clusters, with sizes ranging from 2 to 46 strains. The overall high clustering rate suggests a high level of recent transmission in this population, especially among younger patients (odds ratio [OR], 1.6; P = 0.01). Haarlem strains were more prone to cluster, compared to the other families taken together (OR, 2.0; P < 0.0001), while Beijing (OR, 0.6; P = 0.006) and LAM (OR, 0.7; P = 0.07) strains clustered less. Whereas streptomycin-resistant strains were more commonly found in clusters (OR, 1.8; P = 0.03), clustering rates did not differ between MDR and non-MDR strains (OR, 1.8; P = 0.1). Furthermore, only 16/51 MDR strains clustered with other MDR strains, suggesting that patients with primary MDR infections acquired the infections mostly from index cases outside the study population, such as retreated cases.

  13. Predominant Mycobacterium tuberculosis Families and High Rates of Recent Transmission among New Cases Are Not Associated with Primary Multidrug Resistance in Lima, Peru

    PubMed Central

    Otero, Larissa; de Jong, Bouke C.; Iwamoto, Tomotada; Arikawa, Kentaro; Van der Stuyft, Patrick; Niemann, Stefan; Merker, Matthias; Uwizeye, Cécile; Seas, Carlos; Rigouts, Leen

    2015-01-01

    Sputum samples from new tuberculosis (TB) cases were collected over 2 years as part of a prospective study in the northeastern part of Lima, Peru. To measure the contribution of recent transmission to the high rates of multidrug resistance (MDR) in this area, Mycobacterium tuberculosis complex (MTBc) isolates were tested for drug susceptibility to first-line drugs and were genotyped by spoligotyping and 15-locus mycobacterial interspersed repetitive-unit (MIRU-15)-variable-number tandem repeat (VNTR) analysis. MDR was found in 6.8% of 844 isolates, of which 593 (70.3%) were identified as belonging to a known MTBc lineage, whereas 198 isolates (23.5%) could not be assigned to these lineages and 12 (1.4%) represented mixed infections. Lineage 4 accounted for 54.9% (n = 463) of the isolates, most of which belonged to the Haarlem family (n = 279). MIRU-15 analysis grouped 551/791 isolates (69.7%) in 102 clusters, with sizes ranging from 2 to 46 strains. The overall high clustering rate suggests a high level of recent transmission in this population, especially among younger patients (odds ratio [OR], 1.6; P = 0.01). Haarlem strains were more prone to cluster, compared to the other families taken together (OR, 2.0; P < 0.0001), while Beijing (OR, 0.6; P = 0.006) and LAM (OR, 0.7; P = 0.07) strains clustered less. Whereas streptomycin-resistant strains were more commonly found in clusters (OR, 1.8; P = 0.03), clustering rates did not differ between MDR and non-MDR strains (OR, 1.8; P = 0.1). Furthermore, only 16/51 MDR strains clustered with other MDR strains, suggesting that patients with primary MDR infections acquired the infections mostly from index cases outside the study population, such as retreated cases. PMID:25809979

  14. How good are estimates of transmissivity from slug tests in fractured rock?

    USGS Publications Warehouse

    Shapiro, A.M.; Hsieh, P.A.

    1998-01-01

    Slug tests in fractured rock usually are interpreted with models that assume homogeneous formation properties, even though hydraulic properties of fractures can vary by many orders of magnitude over the length of boreholes. To investigate the impact of heterogeneity on the interpretation of slug tests in fractured rock, slug tests were conducted over large intervals of boreholes in crystalline rock in central New Hampshire, and interpreted using a homogeneous model. The results of the slug tests were then compared with estimates of transmissivity from fluid-injection tests conducted over shorter intervals in the same boreholes. The fluid-injection tests showed transmissivity to vary more than six orders of magnitude over the length of the boreholes; however, the sum of the transmissivities from the fluid-injection tests were within an order of magnitude of the transmissivity estimated from the slug tests. Although the two estimates of transmissivity were within an order of magnitude of each other, the water level responses during the slug tests did not exactly match the responses predicted by the homogeneous model. To investigate the effect of heterogeneity on water level responses during slug tests, a Laplace-transform solution was developed for slug tests conducted in boreholes containing multiple fractures with hydraulic properties that vary over the length of the borehole. A comparison of this solution with the homogeneous model shows no difference between the shape of water level responses in a homogeneous formation and a (layered) heterogeneous formation. Furthermore, the transmissivity estimated using a homogeneous model is within an order of magnitude of the prescribed transmissivity in the heterogeneous model. Thus, differences between responses predicted from a homogeneous model and measured water levels during slug tests can be attributed to phenomena such as nonradial flow in the vicinity of the borehole, and not heterogeneous hydraulic properties over

  15. First Eigenmode Transmission by High Efficient CSI Estimation for Multiuser Massive MIMO Using Millimeter Wave Bands

    PubMed Central

    Maruta, Kazuki; Iwakuni, Tatsuhiko; Ohta, Atsushi; Arai, Takuto; Shirato, Yushi; Kurosaki, Satoshi; Iizuka, Masataka

    2016-01-01

    Drastic improvements in transmission rate and system capacity are required towards 5th generation mobile communications (5G). One promising approach, utilizing the millimeter wave band for its rich spectrum resources, suffers area coverage shortfalls due to its large propagation loss. Fortunately, massive multiple-input multiple-output (MIMO) can offset this shortfall as well as offer high order spatial multiplexing gain. Multiuser MIMO is also effective in further enhancing system capacity by multiplexing spatially de-correlated users. However, the transmission performance of multiuser MIMO is strongly degraded by channel time variation, which causes inter-user interference since null steering must be performed at the transmitter. This paper first addresses the effectiveness of multiuser massive MIMO transmission that exploits the first eigenmode for each user. In Line-of-Sight (LoS) dominant channel environments, the first eigenmode is chiefly formed by the LoS component, which is highly correlated with user movement. Therefore, the first eigenmode provided by a large antenna array can improve the robustness against the channel time variation. In addition, we propose a simplified beamforming scheme based on high efficient channel state information (CSI) estimation that extracts the LoS component. We also show that this approximate beamforming can achieve throughput performance comparable to that of the rigorous first eigenmode transmission. Our proposed multiuser massive MIMO scheme can open the door for practical millimeter wave communication with enhanced system capacity. PMID:27399715

  16. First Eigenmode Transmission by High Efficient CSI Estimation for Multiuser Massive MIMO Using Millimeter Wave Bands.

    PubMed

    Maruta, Kazuki; Iwakuni, Tatsuhiko; Ohta, Atsushi; Arai, Takuto; Shirato, Yushi; Kurosaki, Satoshi; Iizuka, Masataka

    2016-07-08

    Drastic improvements in transmission rate and system capacity are required towards 5th generation mobile communications (5G). One promising approach, utilizing the millimeter wave band for its rich spectrum resources, suffers area coverage shortfalls due to its large propagation loss. Fortunately, massive multiple-input multiple-output (MIMO) can offset this shortfall as well as offer high order spatial multiplexing gain. Multiuser MIMO is also effective in further enhancing system capacity by multiplexing spatially de-correlated users. However, the transmission performance of multiuser MIMO is strongly degraded by channel time variation, which causes inter-user interference since null steering must be performed at the transmitter. This paper first addresses the effectiveness of multiuser massive MIMO transmission that exploits the first eigenmode for each user. In Line-of-Sight (LoS) dominant channel environments, the first eigenmode is chiefly formed by the LoS component, which is highly correlated with user movement. Therefore, the first eigenmode provided by a large antenna array can improve the robustness against the channel time variation. In addition, we propose a simplified beamforming scheme based on high efficient channel state information (CSI) estimation that extracts the LoS component. We also show that this approximate beamforming can achieve throughput performance comparable to that of the rigorous first eigenmode transmission. Our proposed multiuser massive MIMO scheme can open the door for practical millimeter wave communication with enhanced system capacity.

  17. Geostatistics and Bayesian updating for transmissivity estimation in a multiaquifer system in Manitoba, Canada.

    PubMed

    Kennedy, Paula L; Woodbury, Allan D

    2002-01-01

    In ground water flow and transport modeling, the heterogeneous nature of porous media has a considerable effect on the resulting flow and solute transport. Some method of generating the heterogeneous field from a limited dataset of uncertain measurements is required. Bayesian updating is one method that interpolates from an uncertain dataset using the statistics of the underlying probability distribution function. In this paper, Bayesian updating was used to determine the heterogeneous natural log transmissivity field for a carbonate and a sandstone aquifer in southern Manitoba. It was determined that the transmissivity in m2/sec followed a natural log normal distribution for both aquifers with a mean of -7.2 and - 8.0 for the carbonate and sandstone aquifers, respectively. The variograms were calculated using an estimator developed by Li and Lake (1994). Fractal nature was not evident in the variogram from either aquifer. The Bayesian updating heterogeneous field provided good results even in cases where little data was available. A large transmissivity zone in the sandstone aquifer was created by the Bayesian procedure, which is not a reflection of any deterministic consideration, but is a natural outcome of updating a prior probability distribution function with observations. The statistical model returns a result that is very reasonable; that is homogeneous in regions where little or no information is available to alter an initial state. No long range correlation trends or fractal behavior of the log-transmissivity field was observed in either aquifer over a distance of about 300 km.

  18. Estimation of the Rate of Unrecognized Cross-Contamination with Mycobacterium tuberculosis in London Microbiology Laboratories

    PubMed Central

    Ruddy, M.; McHugh, T. D.; Dale, J. W.; Banerjee, D.; Maguire, H.; Wilson, P.; Drobniewski, F.; Butcher, P.; Gillespie, S. H.

    2002-01-01

    Isolates from patients with confirmed tuberculosis from London were collected over 2.5 years between 1995 and 1997. Restriction fragment length polymorphism (RFLP) analysis was performed by the international standard technique as part of a multicenter epidemiological study. A total of 2,779 samples representing 2,500 individual patients from 56 laboratories were examined. Analysis of these samples revealed a laboratory cross-contamination rate of between 0.54%, when only presumed cases of cross-contamination were considered, and 0.93%, when presumed and possible cases were counted. Previous studies suggest an extremely wide range of laboratory cross-contamination rates of between 0.1 and 65%. These data indicate that laboratory cross-contamination has not been a common problem in routine practice in the London area, but in several incidents patients did receive full courses of therapy that were probably unnecessary. PMID:12409381

  19. The use of streambed temperatures to estimate transmission losses on an experimental channel.

    SciTech Connect

    Ramon C. Naranjo; Michael H. Young; Richard Niswonger; Julianne J. Miller; Richard H. French

    2001-10-18

    Quantifying channel transmission losses in arid environments is important for a variety of reasons, from engineering design of flood control structures to evaluating recharge. To quantify the losses in an alluvial channel, an experiment was performed on a 2-km reach of an alluvial fan located on the Nevada Test Site. The channel was subjected to three separate flow events. Transmission losses were estimated using standard discharge monitoring and subsurface temperature modeling approach. Four stations were equipped to continuously monitor stage, temperature, and water content. Streambed temperatures measured at 0, 30, 50 and 100 cm depths were used to calibrate VS2DH, a two-dimensional, variably saturated flow model. Average losses based on the difference in flow between each station indicate that 21 percent, 27 percent, and 53 percent of the flow was reduced downgradient of the source. Results from the temperature monitoring identified locations with large thermal gradients, suggesting a conduction-dominated heat transfer on streambed sediments where caliche-cemented surfaces were present. Transmission losses at the lowermost segment corresponded to the smallest thermal gradient, suggesting an advection-dominated heat transfer. Losses predicted by VS2DH are within an order of magnitude of the estimated losses based on discharge measurements. The differences in losses are a result of the spatial extent to which the modeling results are applied and lateral subsurface flow.

  20. Estimating Magnetic Fields of Homes Near Transmission Lines in the California Power Line Study

    PubMed Central

    Vergara, Ximena P.; Kavet, Robert; Crespi, Catherine M.; Hooper, Chris; Silva, J. Michael; Kheifets, Leeka

    2015-01-01

    The California Power Line Study is a case-control study investigating the relation between residences near transmission lines and risk of childhood leukemia. It includes 5788 childhood leukemia cases and 5788 matched primary controls born between 1986 and 2007. We describe the methodology for estimating magnetic fields at study residences as well as for characterizing sources of uncertainty in these estimates. Birth residences of study subjects were geocoded and their distances to transmission lines were ascertained. 302 residences were deemed sufficiently close to transmission lines to have non-zero magnetic fields attributable to the lines. These residences were visited and detailed data, describing the physical configuration and dimensions of the lines contributing to the magnetic field at the residence, were collected. Phasing, loading, and directional load flow data for years of birth and diagnosis for each subject as well as for the day of site visit were obtained from utilities when available; when yearly average load for a particular year was not available, extrapolated values based on expert knowledge and prediction models were obtained. These data were used to estimate the magnetic fields at the center, closest and farthest point of each residence. We found good correlation between calculated fields and spot measurements of fields taken on site during visits. Our modeling strategies yielded similar calculated field estimates, and they were in high agreement with utility extrapolations. Phasing was known for over 90% of the lines. Important sources of uncertainty included a lack of information on the precise location of residences located within apartment buildings or other complexes. Our findings suggest that we were able to achieve high specificity in exposure assessment, which is essential for examining the association between distance to or magnetic fields from power lines and childhood leukemia risk. PMID:26005950

  1. Estimating magnetic fields of homes near transmission lines in the California Power Line Study.

    PubMed

    Vergara, Ximena P; Kavet, Robert; Crespi, Catherine M; Hooper, Chris; Silva, J Michael; Kheifets, Leeka

    2015-07-01

    The California Power Line Study is a case-control study investigating the relation between residences near transmission lines and risk of childhood leukemia. It includes 5788 childhood leukemia cases and 5788 matched primary controls born between 1986 and 2007. We describe the methodology for estimating magnetic fields at study residences as well as for characterizing sources of uncertainty in these estimates. Birth residences of study subjects were geocoded and their distances to transmission lines were ascertained. 302 residences were deemed sufficiently close to transmission lines to have non-zero magnetic fields attributable to the lines. These residences were visited and detailed data, describing the physical configuration and dimensions of the lines contributing to the magnetic field at the residence, were collected. Phasing, loading, and directional load flow data for years of birth and diagnosis for each subject as well as for the day of site visit were obtained from utilities when available; when yearly average load for a particular year was not available, extrapolated values based on expert knowledge and prediction models were obtained. These data were used to estimate the magnetic fields at the center, closest and farthest point of each residence. We found good correlation between calculated fields and spot measurements of fields taken on site during visits. Our modeling strategies yielded similar calculated field estimates, and they were in high agreement with utility extrapolations. Phasing was known for over 90% of the lines. Important sources of uncertainty included a lack of information on the precise location of residences located within apartment buildings or other complexes. Our findings suggest that we were able to achieve high specificity in exposure assessment, which is essential for examining the association between distance to or magnetic fields from power lines and childhood leukemia risk. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Modified transfer path analysis considering transmissibility functions for accurate estimation of vibration source

    NASA Astrophysics Data System (ADS)

    Kim, Ba-Leum; Jung, Jin-Young; Oh, Il-Kwon

    2017-06-01

    In this study, we developed a modified transfer path analysis (MTPA) method to more accurately estimate the operational force of the main vibration source in a complicated system subjected to multiple vibration sources, base excitation and several disturbances. In the proposed method, transmissibility functions are adopted to compensate the disturbances due to base excitation or to reject transferred forces from other vibration sources. The MTPA method was verified numerically using a simple beam model and was practically applied to estimate vibration forces of a compressor in an outdoor air conditioner unit. Present results show that the MTPA method is feasible for predicting the pure operation forces of the compressor in an outdoor air conditioner unit regardless of the vibration sources due to a rotating fan and base excitations. The proposed MTPA method has very important advantages that it can be used to more accurately estimates the operational force of the main vibration source, properly rejecting other vibration sources and disturbances.

  3. Analytical estimation of phase noise influence in coherent transmission system with digital dispersion equalization.

    PubMed

    Xu, Tianhua; Jacobsen, Gunnar; Popov, Sergei; Li, Jie; Friberg, Ari T; Zhang, Yimo

    2011-04-11

    We present a novel investigation on the enhancement of phase noise in coherent optical transmission system due to electronic chromatic dispersion compensation. Two types of equalizers, including a time domain fiber dispersion finite impulse response (FD-FIR) filter and a frequency domain blind look-up (BLU) filter are applied to mitigate the chromatic dispersion in a 112-Gbit/s polarization division multiplexed quadrature phase shift keying (PDM-QPSK) transmission system. The bit-error-rate (BER) floor in phase estimation using an optimized one-tap normalized least-mean-square (NLMS) filter, and considering the equalization enhanced phase noise (EEPN) is evaluated analytically including the correlation effects. The numerical simulations are implemented and compared with the performance of differential QPSK demodulation system. © 2011 Optical Society of America

  4. Terabit Nyquist PDM-32QAM signal transmission with training sequence based time domain channel estimation.

    PubMed

    Zhang, Fan; Wang, Dan; Ding, Rui; Chen, Zhangyuan

    2014-09-22

    We propose a time domain structure of channel estimation for coherent optical communication systems, which employs training sequence based equalizer and is transparent to arbitrary quadrature amplitude modulation (QAM) formats. Enabled with this methodology, 1.02 Tb/s polarization division multiplexed 32 QAM Nyquist pulse shaping signal with a net spectral efficiency of 7.46 b/s/Hz is transmitted over standard single-mode fiber link with Erbium-doped fiber amplifier only amplification. After 1190 km transmission, the average bit-error rate is lower than the 20% hard-decision forward error correction threshold of 1.5 × 10(-2). The transmission distance can be extended to 1428 km by employing intra-subchannel nonlinear compensation with the digital back-propagation method.

  5. Rapid Test for Identification of a Highly Transmissible Mycobacterium tuberculosis Beijing Strain of Sub-Saharan Origin

    PubMed Central

    Alonso, Henar; Gavín, Patricia; Hernández-Febles, Melissa; Campos-Herrero, María Isolina; Copado, Rodolfo; Cañas, Fernando; Kremer, Kristin; Caminero, José Antonio; Martín, Carlos; Samper, Sofía

    2012-01-01

    The development of a rapid test to identify Mycobacterium tuberculosis Beijing isolates and specifically strain GC1237, coming from a sub-Saharan country, is needed due to its alarming wide spread on Gran Canaria Island (Spain). A rapid test that detects IS6110 present between dnaA and dnaN in the Beijing strains and in a specific site for GC1237 (Rv2180c) has been developed. This test would be a useful tool in the surveillance of subsequent cases. PMID:22116140

  6. Accurate and efficient velocity estimation using Transmission matrix formalism based on the domain decomposition method

    NASA Astrophysics Data System (ADS)

    Wang, Benfeng; Jakobsen, Morten; Wu, Ru-Shan; Lu, Wenkai; Chen, Xiaohong

    2017-03-01

    Full waveform inversion (FWI) has been regarded as an effective tool to build the velocity model for the following pre-stack depth migration. Traditional inversion methods are built on Born approximation and are initial model dependent, while this problem can be avoided by introducing Transmission matrix (T-matrix), because the T-matrix includes all orders of scattering effects. The T-matrix can be estimated from the spatial aperture and frequency bandwidth limited seismic data using linear optimization methods. However the full T-matrix inversion method (FTIM) is always required in order to estimate velocity perturbations, which is very time consuming. The efficiency can be improved using the previously proposed inverse thin-slab propagator (ITSP) method, especially for large scale models. However, the ITSP method is currently designed for smooth media, therefore the estimation results are unsatisfactory when the velocity perturbation is relatively large. In this paper, we propose a domain decomposition method (DDM) to improve the efficiency of the velocity estimation for models with large perturbations, as well as guarantee the estimation accuracy. Numerical examples for smooth Gaussian ball models and a reservoir model with sharp boundaries are performed using the ITSP method, the proposed DDM and the FTIM. The estimated velocity distributions, the relative errors and the elapsed time all demonstrate the validity of the proposed DDM.

  7. Analysis of HIV early infant diagnosis data to estimate rates of perinatal HIV transmission in Zambia.

    PubMed

    Torpey, Kwasi; Mandala, Justin; Kasonde, Prisca; Bryan-Mofya, Gail; Bweupe, Maximillian; Mukundu, Jonathan; Zimba, Chilunje; Mwale, Catherine; Lumano, Hilary; Welsh, Michael

    2012-01-01

    Mother-to-child transmission of HIV (MTCT) remains the most prevalent source of pediatric HIV infection. Most PMTCT (prevention of mother-to-child transmission of HIV) programs have concentrated monitoring and evaluation efforts on process rather than on outcome indicators. In this paper, we review service data from 28,320 children born to HIV-positive mothers to estimate MTCT rates. This study analyzed DNA PCR results and PMTCT data from perinatally exposed children zero to 12 months of age from five Zambian provinces between September 2007 and July 2010. The majority of children (58.6%) had a PCR test conducted between age six weeks and six months. Exclusive breastfeeding (56.8%) was the most frequent feeding method. An estimated 45.9% of mothers were below 30 years old and 93.3% had disclosed their HIV status. In terms of ARV regimen for PMTCT, 32.7% received AZT+single dose NVP (sdNVP), 30.9% received highly active antiretroviral treatment (HAART), 19.6% received sdNVP only and 12.9% received no ARVs. Transmission rates at six weeks when ARVs were received by both mother and baby, mother only, baby only, and none were 5.8%, 10.5%, 15.8% and 21.8% respectively. Transmission rates at six weeks where mother received HAART, AZT+sd NVP, sdNVP, and no intervention were 4.2%, 6.8%, 8.7% and 20.1% respectively. Based on adjusted analysis including ARV exposures and non ARV-related parameters, lower rates of positive PCR results were associated with 1) both mother and infant receiving prophylaxis, 2) children never breastfed and 3) mother being 30 years old or greater. Overall between September 2007 and July 2010, 12.2% of PCR results were HIV positive. Between September 2007 and January 2009, then between February 2009 and July 2010, proportions of positive PCR results were 15.1% and 11% respectively, a significant difference. The use of ARV drugs reduces vertical transmission of HIV in a program setting. Non-chemoprophylactic factors also play a significant role in

  8. Sampling Bias in the Molecular Epidemiology of Tuberculosis

    PubMed Central

    2002-01-01

    Among the goals of the molecular epidemiology of infectious disease are to quantify the extent of ongoing transmission of infectious agents and to identify host- and strain-specific risk factors for disease spread. I demonstrate the potential bias in estimates of recent transmission and the impact of risk factors for clustering by using computer simulations to reconstruct populations of tuberculosis patients and sample from them. The bias consistently results in underestimating recent transmission and the impact of risk factors for recent transmission. PMID:11971768

  9. Estimation of the transmission dynamics of African swine fever virus within a swine house.

    PubMed

    Nielsen, J P; Larsen, T S; Halasa, T; Christiansen, L E

    2017-10-01

    The spread of African swine fever virus (ASFV) threatens to reach further parts of Europe. In countries with a large swine production, an outbreak of ASF may result in devastating economic consequences for the swine industry. Simulation models can assist decision makers setting up contingency plans. This creates a need for estimation of parameters. This study presents a new analysis of a previously published study. A full likelihood framework is presented including the impact of model assumptions on the estimated transmission parameters. As animals were only tested every other day, an interpretation was introduced to cover the weighted infectiousness on unobserved days for the individual animals (WIU). Based on our model and the set of assumptions, the within- and between-pen transmission parameters were estimated to β w = 1·05 (95% CI 0·62-1·72), β b = 0·46 (95% CI 0·17-1·00), respectively, and the WIU = 1·00 (95% CI 0-1). Furthermore, we simulated the spread of ASFV within a pig house using a modified SEIR-model to establish the time from infection of one animal until ASFV is detected in the herd. Based on a chosen detection limit of 2·55% equivalent to 10 dead pigs out of 360, the disease would be detected 13-19 days after introduction.

  10. Transmissivity and storage coefficient estimates from slug tests, Naval Air Warfare Center, West Trenton, New Jersey

    USGS Publications Warehouse

    Fiore, Alex R.

    2014-01-01

    Slug tests were conducted on 56 observation wells open to bedrock at the former Naval Air Warfare Center (NAWC) in West Trenton, New Jersey. Aquifer transmissivity (T) and storage coefficient (S) values for most wells were estimated from slug-test data using the Cooper-Bredehoeft-Papadopulos method. Test data from three wells exhibited fast, underdamped water-level responses and were analyzed with the Butler high-K method. The range of T at NAWC was approximately 0.07 to 10,000 square feet per day. At 11 wells, water levels did not change measurably after 20 minutes following slug insertion; transmissivity at these 11 wells was estimated to be less than 0.07 square feet per day. The range of S was approximately 10-10 to 0.01, the mode being 10-10. Water-level responses for tests at three wells fit poorly to the type curves of both methods, indicating that these methods were not appropriate for adequately estimating T and S from those data.

  11. Estimating the effect of lay knowledge and prior contact with pulmonary TB patients, on health-belief model in a high-risk pulmonary TB transmission population.

    PubMed

    Zein, Rizqy Amelia; Suhariadi, Fendy; Hendriani, Wiwin

    2017-01-01

    The research aimed to investigate the effect of lay knowledge of pulmonary tuberculosis (TB) and prior contact with pulmonary TB patients on a health-belief model (HBM) as well as to identify the social determinants that affect lay knowledge. Survey research design was conducted, where participants were required to fill in a questionnaire, which measured HBM and lay knowledge of pulmonary TB. Research participants were 500 residents of Semampir, Asemrowo, Bubutan, Pabean Cantian, and Simokerto districts, where the risk of pulmonary TB transmission is higher than other districts in Surabaya. Being a female, older in age, and having prior contact with pulmonary TB patients significantly increase the likelihood of having a higher level of lay knowledge. Lay knowledge is a substantial determinant to estimate belief in the effectiveness of health behavior and personal health threat. Prior contact with pulmonary TB patients is able to explain the belief in the effectiveness of a health behavior, yet fails to estimate participants' belief in the personal health threat. Health authorities should prioritize males and young people as their main target groups in a pulmonary TB awareness campaign. The campaign should be able to reconstruct people's misconception about pulmonary TB, thereby bringing around the health-risk perception so that it is not solely focused on improving lay knowledge.

  12. Key transmission parameters of an institutional outbreak during the 1918 influenza pandemic estimated by mathematical modelling

    PubMed Central

    Sertsou, Gabriel; Wilson, Nick; Baker, Michael; Nelson, Peter; Roberts, Mick G

    2006-01-01

    Aim To estimate the key transmission parameters associated with an outbreak of pandemic influenza in an institutional setting (New Zealand 1918). Methods Historical morbidity and mortality data were obtained from the report of the medical officer for a large military camp. A susceptible-exposed-infectious-recovered epidemiological model was solved numerically to find a range of best-fit estimates for key epidemic parameters and an incidence curve. Mortality data were subsequently modelled by performing a convolution of incidence distribution with a best-fit incidence-mortality lag distribution. Results Basic reproduction number (R0) values for three possible scenarios ranged between 1.3, and 3.1, and corresponding average latent period and infectious period estimates ranged between 0.7 and 1.3 days, and 0.2 and 0.3 days respectively. The mean and median best-estimate incidence-mortality lag periods were 6.9 and 6.6 days respectively. This delay is consistent with secondary bacterial pneumonia being a relatively important cause of death in this predominantly young male population. Conclusion These R0 estimates are broadly consistent with others made for the 1918 influenza pandemic and are not particularly large relative to some other infectious diseases. This finding suggests that if a novel influenza strain of similar virulence emerged then it could potentially be controlled through the prompt use of major public health measures. PMID:17137517

  13. Evaluating use of cattle winter feeding areas by elk and white-tailed deer: implications for managing bovine tuberculosis transmission risk from the ground up.

    PubMed

    Brook, Ryan K; Wal, Eric Vander; van Beest, Floris M; McLachlan, Stéphane M

    2013-02-01

    Transmission of bovine tuberculosis (Mycobacterium bovis) among wildlife and livestock has created important risks for conservation and agriculture. Management strategies aimed at controlling TB have typically been top-down, regionally focused, and government-led programs that were at best only partially successful. The purpose of this study was to quantify co-mingling of elk and white-tailed deer (WTD) with cattle at multiple spatial scales (i.e., the regional farm scale and winter cattle feeding area patch) in southwestern Manitoba, Canada, to assess the potential for bovine tuberculosis transmission and identify alternative management strategies. For each spatial scale we quantified use of cattle farms by elk and white-tailed deer. We mailed questionnaires to rural households and then conducted personal interviews with 86 cattle farmers to map the spatial distribution of their cattle winter feeding areas at a fine scale. We deployed Global Positioning System (GPS) collars on 48 wild elk and 16 wild white-tailed deer from 2003 to 2011. Elk were observed on farms by 66% of cattle producers, including 5% and 20% who observed direct and indirect contact, respectively, between elk and cattle. Cattle producers consistently (≈100%) observed white-tailed deer on their farms, including 11% and 47% whom observed direct and indirect contact, respectively, between white-tailed deer and cattle. A higher probability of white-tailed deer-cattle contact at the regional scale occurs on farms that (1) left crop residues specifically for wildlife, (2) had larger cattle herds, (3) used round bale feeders, and (4) were farther away from protected areas. None of the GPS-collared elk locations overlapped with cattle winter feeding areas. In contrast, 21% of GPS-collared white-tailed deer locations overlapped with winter cattle winter feeding areas (22% of these were from male WTD and 78% were from female WTD). White-tailed deer selected cattle winter feeding areas with higher (1

  14. Towards Risk-Based Test Protocols: Estimating the Contribution of Intensive Testing to the UK Bovine Tuberculosis Problem

    PubMed Central

    van Dijk, Jan

    2013-01-01

    Eradicating disease from livestock populations involves the balancing act of removing sufficient numbers of diseased animals without removing too many healthy individuals in the process. As ever more tests for bovine tuberculosis (BTB) are carried out on the UK cattle herd, and each positive herd test triggers more testing, the question arises whether ‘false positive’ results contribute significantly to the measured BTB prevalence. Here, this question is explored using simple probabilistic models of test behaviour. When the screening test is applied to the average UK herd, the estimated proportion of test-associated false positive new outbreaks is highly sensitive to small fluctuations in screening test specificity. Estimations of this parameter should be updated as a priority. Once outbreaks have been confirmed in screening-test positive herds, the following rounds of intensive testing with more sensitive, albeit less specific, tests are highly likely to remove large numbers of false positive animals from herds. Despite this, it is unlikely that significantly more truly infected animals are removed. BTB test protocols should become based on quantified risk in order to prevent the needless slaughter of large numbers of healthy animals. PMID:23717517

  15. Transmission

    SciTech Connect

    Sugano, K.

    1988-12-27

    A transmission is described which consists of: an input shaft; an output shaft; a first planetary gear set including a first sun gear selectively connectable by a first clutch to the input shaft, a first carrier selectively connectable by a second clutch to the input shaft and a first ring gear connected to the output shaft. The first sun gear selectively held stationary by a first brake, the first carrier is allowed to rotate in the same forward direction as the input shaft when the second clutch is engaged, but prevented from rotating in a reverse direction opposite to the forward direction by a first one-way clutch, the first carrier being selectively held stationary by a second brake; a second planetary gear set including a second sun gear connected to the input shaft, a second carrier connected to the first ring gear and also the the output shaft, and a second ring gear.

  16. Estimating enhanced prevaccination measles transmission hotspots in the context of cross-scale dynamics

    PubMed Central

    Becker, Alexander D.; Birger, Ruthie B.; Teillant, Aude; Gastanaduy, Paul A.; Wallace, Gregory S.; Grenfell, Bryan T.

    2016-01-01

    A key question in clarifying human–environment interactions is how dynamic complexity develops across integrative scales from molecular to population and global levels. Apart from its public health importance, measles is an excellent test bed for such an analysis. Simple mechanistic models have successfully illuminated measles dynamics at the city and country levels, revealing seasonal forcing of transmission as a major driver of long-term epidemic behavior. Seasonal forcing ties closely to patterns of school aggregation at the individual and community levels, but there are few explicit estimates of school transmission due to the relative lack of epidemic data at this scale. Here, we use data from a 1904 measles outbreak in schools in Woolwich, London, coupled with a stochastic Susceptible-Infected-Recovered model to analyze measles incidence data. Our results indicate that transmission within schools and age classes is higher than previous population-level serological data would suggest. This analysis sheds quantitative light on the role of school-aged children in measles cross-scale dynamics, as we illustrate with references to the contemporary vaccination landscape. PMID:27872300

  17. Experimental demonstration of a cognitive quality of transmission estimator for optical communication systems.

    PubMed

    Caballero, Antonio; Aguado, Juan Carlos; Borkowski, Robert; Saldaña, Silvia; Jiménez, Tamara; de Miguel, Ignacio; Arlunno, Valeria; Durán, Ramón J; Zibar, Darko; Jensen, Jesper B; Lorenzo, Rubén M; Abril, Evaristo J; Monroy, Idelfonso Tafur

    2012-12-10

    The impact of physical layer impairments in optical network design and operation has received significant attention in the last years, thereby requiring estimation techniques to predict the quality of transmission (QoT) of optical connections before being established. In this paper, we report on the experimental demonstration of a case-based reasoning (CBR) technique to predict whether optical channels fulfill QoT requirements, thus supporting impairment-aware networking. The validation of the cognitive QoT estimator is performed in a WDM 80 Gb/s PDM-QPSK testbed, and we demonstrate that even with a very small and not optimized underlying knowledge base, it achieves between 79% and 98.7% successful classifications based on the error vector magnitude (EVM) parameter, and approximately 100% when the classification is based on the optical signal to noise ratio (OSNR).

  18. Epidemiology and Treatment of Multidrug Resistant Tuberculosis

    PubMed Central

    Mitnick, Carole D.; Appleton, Sasha C.; Shin, Sonya S.

    2010-01-01

    Multidrug resistant tuberculosis is now thought to afflict between 1 and 2 million patients annually. Although significant regional variability in the distribution of disease has been recorded, surveillance data are limited by several factors. The true burden of disease is likely underestimated. Nevertheless, the estimated burden is substantial enough to warrant concerted action. A range of approaches is possible, but all appropriate interventions require scale-up of laboratories and early treatment with regimens containing a sufficient number of second-line drugs. Ambulatory treatment for most patients, and improved infection control, can facilitate scale-up with decreased risk of nosocomial transmission. Several obstacles have been considered to preclude worldwide scale-up of treatment, mostly attributable to inadequate human, drug, and financial resources. Further delays in scale-up, however, risk continued generation and transmission of resistant tuberculosis, as well as associated morbidity and mortality. PMID:18810684

  19. Interhuman transmissibility of Middle East respiratory syndrome coronavirus: estimation of pandemic risk.

    PubMed

    Breban, Romulus; Riou, Julien; Fontanet, Arnaud

    2013-08-24

    The new Middle East respiratory syndrome coronavirus (MERS-CoV) infection shares many clinical, epidemiological, and virological similarities with that of severe acute respiratory syndrome (SARS)-CoV. We aimed to estimate virus transmissibility and the epidemic potential of MERS-CoV, and to compare the results with similar findings obtained for prepandemic SARS. We retrieved data for MERS-CoV clusters from the WHO summary and subsequent reports, and published descriptions of cases, and took into account 55 of the 64 laboratory-confirmed cases of MERS-CoV reported as of June 21, 2013, excluding cases notified in the previous 2 weeks. To assess the interhuman transmissibility of MERS-CoV, we used Bayesian analysis to estimate the basic reproduction number (R0) and compared it to that of prepandemic SARS. We considered two scenarios, depending on the interpretation of the MERS-CoV cluster-size data. With our most pessimistic scenario (scenario 2), we estimated MERS-CoV R0 to be 0·69 (95% CI 0·50-0·92); by contrast, the R0 for prepandemic SARS-CoV was 0·80 (0·54-1·13). Our optimistic scenario (scenario 1) yielded a MERS-CoV R0 of 0·60 (0·42-0·80). Because of recent implementation of effective contact tracing and isolation procedures, further MERS-CoV transmission data might no longer describe an entire cluster, but only secondary infections directly caused by the index patient. Hence, we calculated that, under scenario 2, eight or more secondary infections caused by the next index patient would translate into a 5% or higher chance that the revised MERS-CoV R0 would exceed 1--ie, that MERS-CoV might have pandemic potential. Our analysis suggests that MERS-CoV does not yet have pandemic potential. We recommend enhanced surveillance, active contact tracing, and vigorous searches for the MERS-CoV animal hosts and transmission routes to human beings. Agence Nationale de la Recherche (Labex Integrative Biology of Emerging Infectious Diseases), and the European

  20. Control strategies for wildlife tuberculosis in Ireland.

    PubMed

    Gormley, E; Corner, L A L

    2013-11-01

    The principal domestic maintenance host for Mycobacterium bovis is infected cattle. In countries where comprehensive surveillance schemes have been applied, tuberculosis rarely affects an animal to the extent that it presents with clinical disease. In the latter stages of an eradication campaign, the aim is to maintain the disease-free status of clear herds and eliminate foci of infection in herds as well as restricting movement of infected animals from these herds, other than to slaughter. However, the eradication of tuberculosis from cattle herds may be compromised if infected wildlife species, such as Eurasian badgers (Meles meles), share the same environment and contribute to transmission of infection. The options for dealing with tuberculosis in the wildlife reservoir hosts are limited to segregation of domestic animals from the wildlife, culling of the wildlife host or vaccination. Options are further limited by conservation and social reasons, particularly where culling is concerned. In Ireland and the UK, vaccination of badgers against M. bovis, if successfully employed, could directly facilitate the completion of bovine tuberculosis eradication. Programmes of research into vaccination of badgers are being undertaken in both countries, and there is clear evidence that vaccination induces protection. Vaccine trials in captive badgers have established that the M. bovis bacille Calmette-Guérin (BCG) vaccine can induce a protective response that limits the distribution and severity of tuberculosis disease following experimental challenge. In Ireland, a large-scale field trial of oral BCG vaccination is being conducted to measure the protection generated in wild badgers subjected to natural transmission of infection and to estimate vaccine efficacy. The results will provide a framework for the development and implementation of a national strategy to address the disease in badger populations and if successful will remove this major impediment to tuberculosis

  1. Molecular Epidemiology of Mycobacterium tuberculosis among South African Gold Miners

    PubMed Central

    Lewis, James J.; Connors, Jeremy; Chihota, Violet N.; Shashkina, Elena; van der Meulen, Minty; Graviss, Edward A.; Ha, Ngan P.; Kreiswirth, Barry N.; Grant, Alison D.; Fielding, Katherine L.; Dorman, Susan E.; Churchyard, Gavin J.

    2015-01-01

    Rationale: HIV-associated tuberculosis remains a major health problem among the gold-mining workforce in South Africa. We postulate that high levels of recent transmission, indicated by strain clustering, are fueling the tuberculosis epidemic among gold miners. Objectives: To combine molecular and epidemiologic data to describe Mycobacterium tuberculosis genetic diversity, estimate levels of transmission, and examine risk factors for clustering. Methods: We conducted a cross-sectional study of culture-positive M. tuberculosis isolates in 15 gold mine shafts across three provinces in South Africa. All isolates were subject IS6110-based restriction fragment length polymorphisms, and we performed spoligotyping analysis and combined it with basic demographic and clinical information. Measurements and Main Results: Of the 1,602 M. tuberculosis patient isolates, 1,240 (78%) had genotyping data available for analysis. A highly diverse bacillary population was identified, comprising a total of 730 discrete genotypes. Four genotypic families (Latin American Mediterranean spoligotype family; W-Beijing; AH or X; and T1–T4) accounted for over 50% of all strains. Overall, 45% (560/1,240) of strains were genotypically clustered. The minimum estimate for recent transmission (n − 1 method) was 32% (range, 27–34%). There were no individual-level risk factors for clustering, apart from borderline evidence for being non–South African and having self-reported HIV infection. Conclusions: The high M. tuberculosis genetic diversity and lack of risk factors for clustering are indicative of a universal risk for disease among gold miners and likely mixing with nonmining populations. Our results underscore the urgent need to intensify interventions to interrupt transmission across the entire gold-mining workforce in South Africa. PMID:25419914

  2. An energy-efficient data transmission scheme for remote state estimation and applications to a water-tank system.

    PubMed

    Li, Yunji; Li, Peng; Chen, Wen

    2017-09-01

    An energy-efficient data transmission scheme for remote state estimation is proposed and experimentally evaluated in this paper. This new transmission strategy is presented by proving an upper bound of the system performance. Stability of the remote estimator is proved under the condition that some of the observation measurements are lost in a random probability. An experimental platform of two coupled water tanks with a wireless sensor node is established to evaluate and verify the proposed transmission scheme. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

  3. Estimating uncertainty in subsurface glider position using transmissions from fixed acoustic tomography sources.

    PubMed

    Van Uffelen, Lora J; Nosal, Eva-Marie; Howe, Bruce M; Carter, Glenn S; Worcester, Peter F; Dzieciuch, Matthew A; Heaney, Kevin D; Campbell, Richard L; Cross, Patrick S

    2013-10-01

    Four acoustic Seagliders were deployed in the Philippine Sea November 2010 to April 2011 in the vicinity of an acoustic tomography array. The gliders recorded over 2000 broadband transmissions at ranges up to 700 km from moored acoustic sources as they transited between mooring sites. The precision of glider positioning at the time of acoustic reception is important to resolve the fundamental ambiguity between position and sound speed. The Seagliders utilized GPS at the surface and a kinematic model below for positioning. The gliders were typically underwater for about 6.4 h, diving to depths of 1000 m and traveling on average 3.6 km during a dive. Measured acoustic arrival peaks were unambiguously associated with predicted ray arrivals. Statistics of travel-time offsets between received arrivals and acoustic predictions were used to estimate range uncertainty. Range (travel time) uncertainty between the source and the glider position from the kinematic model is estimated to be 639 m (426 ms) rms. Least-squares solutions for glider position estimated from acoustically derived ranges from 5 sources differed by 914 m rms from modeled positions, with estimated uncertainty of 106 m rms in horizontal position. Error analysis included 70 ms rms of uncertainty due to oceanic sound-speed variability.

  4. Optimal Fusion Estimation with Multi-Step Random Delays and Losses in Transmission

    PubMed Central

    Caballero-Águila, Raquel; Hermoso-Carazo, Aurora; Linares-Pérez, Josefa

    2017-01-01

    This paper is concerned with the optimal fusion estimation problem in networked stochastic systems with bounded random delays and packet dropouts, which unavoidably occur during the data transmission in the network. The measured outputs from each sensor are perturbed by random parameter matrices and white additive noises, which are cross-correlated between the different sensors. Least-squares fusion linear estimators including filter, predictor and fixed-point smoother, as well as the corresponding estimation error covariance matrices are designed via the innovation analysis approach. The proposed recursive algorithms depend on the delay probabilities at each sampling time, but do not to need to know if a particular measurement is delayed or not. Moreover, the knowledge of the signal evolution model is not required, as the algorithms need only the first and second order moments of the processes involved. Some of the practical situations covered by the proposed system model with random parameter matrices are analyzed and the influence of the delays in the estimation accuracy are examined in a numerical example. PMID:28524112

  5. Refining the risk estimate for transfusion-transmission of occult hepatitis B virus.

    PubMed

    Seed, C R; Kiely, P; Hoad, V C; Keller, A J

    2017-01-01

    We previously published a model to estimate the residual risk (RR) for occult hepatitis B infection (OBI) in the absence of universal anti-HBc testing. To incorporate new information on the epidemiology of OBI, we describe model refinements and estimate a more accurate HBV RR due to OBI in Australia. In our original model, the OBI risk, p(OBI), was defined by the rate of 'non-detection' by the HBV DNA screening test in use, p(NAT non-detection), and the average infectivity of blood components from OBI donors, p(transmission). We revised the model by integrating three refinements: that donations with anti-HBs levels of >10 IU/l, or donations solely for manufactured plasma products, be excluded from the risk calculation, and an updated estimate of p(transmission). Refining our OBI RR model resulted in a more than 10-fold reduction in the reported RR risk to recipients from OBI in our donor population. Based on the use of a common data set, the mean OBI RR risk decreased from 1 in 374 354 donations (95% CI: 1 in 191 940-1 072 681) to 1 in 3 984 033 (95% CI: 1 in 1 146 188-65 268 257) for the refined model. Our model refinements provide a more realistic measure of the HBV RR in the donor population. Unlike the previous model, the new model demonstrates that the risk of HBV due to OBI in the Australian blood donor population is negligible, and further potentially cost-ineffective risk management strategies are not currently warranted. © 2016 International Society of Blood Transfusion.

  6. Optimal estimation of spatially variable recharge and transmissivity fields under steady-state groundwater flow. Part 1. Theory

    NASA Astrophysics Data System (ADS)

    Graham, Wendy D.; Tankersley, Claude D.

    1994-05-01

    Stochastic methods are used to analyze two-dimensional steady groundwater flow subject to spatially variable recharge and transmissivity. Approximate partial differential equations are developed for the covariances and cross-covariances between the random head, transmissivity and recharge fields. Closed-form solutions of these equations are obtained using Fourier transform techniques. The resulting covariances and cross-covariances can be incorporated into a Bayesian conditioning procedure which provides optimal estimates of the recharge, transmissivity and head fields given available measurements of any or all of these random fields. Results show that head measurements contain valuable information for estimating the random recharge field. However, when recharge is treated as a spatially variable random field, the value of head measurements for estimating the transmissivity field can be reduced considerably. In a companion paper, the method is applied to a case study of the Upper Floridan Aquifer in NE Florida.

  7. Estimated generic prices for novel treatments for drug-resistant tuberculosis.

    PubMed

    Gotham, Dzintars; Fortunak, Joseph; Pozniak, Anton; Khoo, Saye; Cooke, Graham; Nytko, Frederick E; Hill, Andrew

    2017-04-01

    The estimated worldwide annual incidence of MDR-TB is 480 000, representing 5% of TB incidence, but 20% of mortality. Multiple drugs have recently been developed or repurposed for the treatment of MDR-TB. Currently, treatment for MDR-TB costs thousands of dollars per course. To estimate generic prices for novel TB drugs that would be achievable given large-scale competitive manufacture. Prices for linezolid, moxifloxacin and clofazimine were estimated based on per-kilogram prices of the active pharmaceutical ingredient (API). Other costs were added, including formulation, packaging and a profit margin. The projected costs for sutezolid were estimated to be equivalent to those for linezolid, based on chemical similarity. Generic prices for bedaquiline, delamanid and pretomanid were estimated by assessing routes of synthesis, costs/kg of chemical reagents, routes of synthesis and per-step yields. Costing algorithms reflected variable regulatory requirements and efficiency of scale based on demand, and were validated by testing predictive ability against widely available TB medicines. Estimated generic prices were US$8-$17/month for bedaquiline, $5-$16/month for delamanid, $11-$34/month for pretomanid, $4-$9/month for linezolid, $4-$9/month for sutezolid, $4-$11/month for clofazimine and $4-$8/month for moxifloxacin. The estimated generic prices were 87%-94% lower than the current lowest available prices for bedaquiline, 95%-98% for delamanid and 94%-97% for linezolid. Estimated generic prices were $168-$395 per course for the STREAM trial modified Bangladesh regimens (current costs $734-$1799), $53-$276 for pretomanid-based three-drug regimens and $238-$507 for a delamanid-based four-drug regimen. Competitive large-scale generic manufacture could allow supplies of treatment for 5-10 times more MDR-TB cases within current procurement budgets.

  8. Estimating the role of casual contact from the community in transmission of Bordetella pertussis to young infants

    PubMed Central

    Wendelboe, Aaron M; Hudgens, Michael G; Poole, Charles; Van Rie, Annelies

    2007-01-01

    The proportion of infant pertussis cases due to transmission from casual contact in the community has not been estimated since before the introduction of pertussis vaccines in the 1950s. This study aimed to estimate the proportion of pertussis transmission due to casual contact using demographic and clinical data from a study of 95 infant pertussis cases and their close contacts enrolled at 14 hospitals in France, Germany, Canada, and the U.S. between February 2003 and September 2004. A complete case analysis was conducted as well as multiple imputation (MI) to account for missing data for participants and close contacts who did not participate. By considering all possible close contacts, the MI analysis estimated 66% of source cases were close contacts, implying the minimum attributable proportion of infant cases due to transmission from casual contact with community members was 34% (95% CI = 24%, 44%). Estimates from the complete case analysis were comparable but less precise. Results were sensitive to changes in the operational definition of a source case, which broadened the range of MI point estimates of transmission from casual community contact to 20%–47%. We conclude that casual contact appears to be responsible for a substantial proportion of pertussis transmission to young infants. Medical subject headings (MeSH): multiple imputation, pertussis, transmission, casual contact, sensitivity analysis, missing data, community. PMID:17949498

  9. On-Farm Mitigation of Transmission of Tuberculosis from White-Tailed Deer to Cattle: Literature Review and Recommendations

    PubMed Central

    Walter, W. David; Anderson, Charles W.; Smith, Rick; Vanderklok, Mike; Averill, James J.; VerCauteren, Kurt C.

    2012-01-01

    The Animal Industry Division of the Michigan Department of Agriculture and Rural Development (MDARD) has been challenged with assisting farmers with modifying farm practices to reduce potential for exposure to Mycobacterium bovis from wildlife to cattle. The MDARD recommendations for on-farm risk mitigation practices were developed from experiences in the US, UK and Ireland and a review of the scientific literature. The objectives of our study were to review the present state of knowledge on M. bovis excretion, transmission, and survival in the environment and the interactions of wildlife and cattle with the intention of determining if the current recommendations by MDARD on farm practices are adequate and to identify additional changes to farm practices that may help to mitigate the risk of transmission. This review will provide agencies with a comprehensive summary of the scientific literature on mitigation of disease transmission between wildlife and cattle and to identify lacunae in published research. PMID:22991687

  10. Transmission Bottleneck Size Estimation from Pathogen Deep-Sequencing Data, with an Application to Human Influenza A Virus.

    PubMed

    Sobel Leonard, Ashley; Weissman, Daniel B; Greenbaum, Benjamin; Ghedin, Elodie; Koelle, Katia

    2017-07-15

    The bottleneck governing infectious disease transmission describes the size of the pathogen population transferred from the donor to the recipient host. Accurate quantification of the bottleneck size is particularly important for rapidly evolving pathogens such as influenza virus, as narrow bottlenecks reduce the amount of transferred viral genetic diversity and, thus, may decrease the rate of viral adaptation. Previous studies have estimated bottleneck sizes governing viral transmission by using statistical analyses of variants identified in pathogen sequencing data. These analyses, however, did not account for variant calling thresholds and stochastic viral replication dynamics within recipient hosts. Because these factors can skew bottleneck size estimates, we introduce a new method for inferring bottleneck sizes that accounts for these factors. Through the use of a simulated data set, we first show that our method, based on beta-binomial sampling, accurately recovers transmission bottleneck sizes, whereas other methods fail to do so. We then apply our method to a data set of influenza A virus (IAV) infections for which viral deep-sequencing data from transmission pairs are available. We find that the IAV transmission bottleneck size estimates in this study are highly variable across transmission pairs, while the mean bottleneck size of 196 virions is consistent with a previous estimate for this data set. Furthermore, regression analysis shows a positive association between estimated bottleneck size and donor infection severity, as measured by temperature. These results support findings from experimental transmission studies showing that bottleneck sizes across transmission events can be variable and influenced in part by epidemiological factors.IMPORTANCE The transmission bottleneck size describes the size of the pathogen population transferred from the donor to the recipient host and may affect the rate of pathogen adaptation within host populations. Recent

  11. Population estimation and trappability of the European badger (Meles meles): implications for tuberculosis management.

    PubMed

    Byrne, Andrew W; O'Keeffe, James; Green, Stuart; Sleeman, D Paddy; Corner, Leigh A L; Gormley, Eamonn; Murphy, Denise; Martin, S Wayne; Davenport, John

    2012-01-01

    Estimates of population size and trappability inform vaccine efficacy modelling and are required for adaptive management during prolonged wildlife vaccination campaigns. We present an analysis of mark-recapture data from a badger vaccine (Bacille Calmette-Guérin) study in Ireland. This study is the largest scale (755 km(2)) mark-recapture study ever undertaken with this species. The study area was divided into three approximately equal-sized zones, each with similar survey and capture effort. A mean badger population size of 671 (SD: 76) was estimated using a closed-subpopulation model (CSpM) based on data from capturing sessions of the entire area and was consistent with a separate multiplicative model. Minimum number alive estimates calculated from the same data were on average 49-51% smaller than the CSpM estimates, but these are considered severely negatively biased when trappability is low. Population densities derived from the CSpM estimates were 0.82-1.06 badgers km(-2), and broadly consistent with previous reports for an adjacent area. Mean trappability was estimated to be 34-35% per session across the population. By the fifth capture session, 79% of the adult badgers caught had been marked previously. Multivariable modelling suggested significant differences in badger trappability depending on zone, season and age-class. There were more putatively trap-wary badgers identified in the population than trap-happy badgers, but wariness was not related to individual's sex, zone or season of capture. Live-trapping efficacy can vary significantly amongst sites, seasons, age, or personality, hence monitoring of trappability is recommended as part of an adaptive management regime during large-scale wildlife vaccination programs to counter biases and to improve efficiencies.

  12. Achievable information rates estimates in optically amplified transmission systems using nonlinearity compensation and probabilistic shaping.

    PubMed

    Semrau, Daniel; Xu, Tianhua; Shevchenko, Nikita A; Paskov, Milen; Alvarado, Alex; Killey, Robert I; Bayvel, Polina

    2017-01-01

    Achievable information rates (AIRs) of wideband optical communication systems using a ∼40  nm (∼5  THz) erbium-doped fiber amplifier and ∼100  nm (∼12.5  THz) distributed Raman amplification are estimated based on a first-order perturbation analysis. The AIRs of each individual channel have been evaluated for DP-64QAM, DP-256QAM, and DP-1024QAM modulation formats. The impact of full-field nonlinear compensation (FF-NLC) and probabilistically shaped constellations using a Maxwell-Boltzmann distribution were studied and compared to electronic dispersion compensation. It has been found that a probabilistically shaped DP-1024QAM constellation, combined with FF-NLC, yields achievable information rates of ∼75  Tbit/s for the EDFA scheme and ∼223  Tbit/s for the Raman amplification scheme over a 2000 km standard single-mode fiber transmission.

  13. Capacity estimates for optical transmission based on the nonlinear Fourier transform

    NASA Astrophysics Data System (ADS)

    Derevyanko, Stanislav A.; Prilepsky, Jaroslaw E.; Turitsyn, Sergei K.

    2016-09-01

    What is the maximum rate at which information can be transmitted error-free in fibre-optic communication systems? For linear channels, this was established in classic works of Nyquist and Shannon. However, despite the immense practical importance of fibre-optic communications providing for >99% of global data traffic, the channel capacity of optical links remains unknown due to the complexity introduced by fibre nonlinearity. Recently, there has been a flurry of studies examining an expected cap that nonlinearity puts on the information-carrying capacity of fibre-optic systems. Mastering the nonlinear channels requires paradigm shift from current modulation, coding and transmission techniques originally developed for linear communication systems. Here we demonstrate that using the integrability of the master model and the nonlinear Fourier transform, the lower bound on the capacity per symbol can be estimated as 10.7 bits per symbol with 500 GHz bandwidth over 2,000 km.

  14. Estimating frame bulk and shear moduli of two double porosity layers by ultrasound transmission.

    PubMed

    Bai, Ruonan; Tinel, Alain; Alem, Abdellah; Franklin, Hervé; Wang, Huaqing

    2016-08-01

    The acoustic plane wave transmission by water saturated double porosity media is investigated. Two samples of double porosity media assumed to obey Berryman and Wang (BW) extension (Berryman and Wang, 1995, 2000) of Biot's theory in the low frequency regime are under consideration: ROBU® (pure binder-free borosilicate glass 3.3 manufactured to form the individual grains) and Tobermorite 11Å (the individual porous cement grains show irregular shapes). The de facto gap existing between theoretical and experimental data can be minimized by modifying adequately two of the parameters estimated from triaxial tests: the frame bulk and shear moduli. The frequency dependent imaginary parts that follow necessary from the minimization are in relation with the energy losses due to contact relaxation and friction between grains. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Tracheobronchial tuberculosis

    PubMed Central

    Pathak, Vikas; Shepherd, Ray W.

    2016-01-01

    Tracheobronchial tuberculosis (TBTB) is reported in approximately 10% to 39% of the patients with pulmonary tuberculosis. It is defined as the tubercle infection of the trachea and or bronchi. Due to its non-specific presentation, insidious onset and normal chest radiography in about 10–20% of the patients, the diagnosis is delayed. Bronchoscopy is the most definite method of diagnosis which provides adequate specimens for microbiological and histopathological diagnosis. Tracheobronchial stenosis is one of the most common long term complications of TBTB resulting in significant morbidity. It is estimated that 90% of patients with TBTB have some degree of tracheal and or bronchial stenosis. In this review article, we will discuss the pathogenesis, symptoms, imaging, bronchoscopic findings, and treatment of TBTB and management of tracheobronchial stenosis. PMID:28149582

  16. Whole-Genome Sequences of Mycobacterium tuberculosis TB282 and TB284, a Widespread and a Unique Strain, Respectively, Identified in a Previous Study of Tuberculosis Transmission in Central Los Angeles, California, USA

    PubMed Central

    Yang, Zhenhua

    2017-01-01

    ABSTRACT We report here the genome sequences of two Mycobacterium tuberculosis clinical isolates previously identified in central Los Angeles, CA, in the 1990s using a PacBio platform. Isolate TB282 represents a large-cluster strain that caused 27% of the tuberculosis cases, while TB284 represents a strain that caused disease in only one patient. PMID:28082486

  17. Estimating the Relative Role of Various Subcategories of Food, Water, and Animal Contact Transmission of 28 Enteric Diseases in Canada

    PubMed Central

    Butler, Ainslie J.; Thomas, M. Kate

    2016-01-01

    Abstract Objective: Enteric illness represents a significant burden of illness in Canada and internationally. Building on previous research, an expert elicitation was undertaken to explore the routes of transmission for 28 pathogens involved in enteric illness in Canada. This article considers the subcategories of foodborne, waterborne, and animal contact transmission. Methods: As part of an expert elicitation, 31 experts were asked to provide estimates of source attribution for subcategories of foodborne (n = 15), waterborne (n = 10), and animal contact (n = 3) transmission. The results from an online survey were combined using triangular probability distributions, and median and 90% credible intervals were produced. The total proportion and estimated number of cases of enteric illness attributable to each type of food commodity, water source, and animal exposure route were calculated using results from the larger elicitation survey and from a recent Canadian foodborne burden of illness study (Thomas et al., 2013). Results: Thirty experts provided foodborne subcategory estimates for 15/28 pathogens, waterborne subcategory estimates for 14/28 pathogens and animal contact subcategory estimates for 5/28. The elicitation identified raw produce, recreational water, and farm animal contact as important risk factors for enteric illness. These results also highlighted the complexity of transmission, with greater uncertainty for certain pathogens and routes of transmission. Conclusions: This study is the first of its kind to explore subcategories of foodborne, waterborne, and animal contact transmission across such a range of enteric pathogens. Despite inherent uncertainty, these estimates present an important quantitative synthesis of the roles of foodborne commodities, water sources, and pathways of animal contact in the transmission of enteric illness in Canada. PMID:26863428

  18. Estimating the Relative Role of Various Subcategories of Food, Water, and Animal Contact Transmission of 28 Enteric Diseases in Canada.

    PubMed

    Butler, Ainslie J; Pintar, Katarina D M; Thomas, M Kate

    2016-02-01

    Enteric illness represents a significant burden of illness in Canada and internationally. Building on previous research, an expert elicitation was undertaken to explore the routes of transmission for 28 pathogens involved in enteric illness in Canada. This article considers the subcategories of foodborne, waterborne, and animal contact transmission. As part of an expert elicitation, 31 experts were asked to provide estimates of source attribution for subcategories of foodborne (n = 15), waterborne (n = 10), and animal contact (n = 3) transmission. The results from an online survey were combined using triangular probability distributions, and median and 90% credible intervals were produced. The total proportion and estimated number of cases of enteric illness attributable to each type of food commodity, water source, and animal exposure route were calculated using results from the larger elicitation survey and from a recent Canadian foodborne burden of illness study (Thomas et al., 2013). Thirty experts provided foodborne subcategory estimates for 15/28 pathogens, waterborne subcategory estimates for 14/28 pathogens and animal contact subcategory estimates for 5/28. The elicitation identified raw produce, recreational water, and farm animal contact as important risk factors for enteric illness. These results also highlighted the complexity of transmission, with greater uncertainty for certain pathogens and routes of transmission. This study is the first of its kind to explore subcategories of foodborne, waterborne, and animal contact transmission across such a range of enteric pathogens. Despite inherent uncertainty, these estimates present an important quantitative synthesis of the roles of foodborne commodities, water sources, and pathways of animal contact in the transmission of enteric illness in Canada.

  19. Estimation of multipath transmission parameters for quantitative ultrasound measurements of bone.

    PubMed

    Dencks, Stefanie; Schmitz, Georg

    2013-09-01

    When applying quantitative ultrasound (QUS) measurements to bone for predicting osteoporotic fracture risk, the multipath transmission of sound waves frequently occurs. In the last 10 years, the interest in separating multipath QUS signals for their analysis awoke, and led to the introduction of several approaches. Here, we compare the performances of the two fastest algorithms proposed for QUS measurements of bone: the modified least-squares Prony method (MLSP), and the space alternating generalized expectation maximization algorithm (SAGE) applied in the frequency domain. In both approaches, the parameters of the transfer functions of the sound propagation paths are estimated. To provide an objective measure, we also analytically derive the Cramér-Rao lower bound of variances for any estimator and arbitrary transmit signals. In comparison with results of Monte Carlo simulations, this measure is used to evaluate both approaches regarding their accuracy and precision. Additionally, with simulations using typical QUS measurement settings, we illustrate the limitations of separating two superimposed waves for varying parameters with focus on their temporal separation. It is shown that for good SNRs around 100 dB, MLSP yields better results when two waves are very close. Additionally, the parameters of the smaller wave are more reliably estimated. If the SNR decreases, the parameter estimation with MLSP becomes biased and inefficient. Then, the robustness to noise of the SAGE clearly prevails. Because a clear influence of the interrelation between the wavelength of the ultrasound signals and their temporal separation is observable on the results, these findings can be transferred to QUS measurements at other sites. The choice of the suitable algorithm thus depends on the measurement conditions.

  20. Patterns of Cattle Farm Visitation by White-Tailed Deer in Relation to Risk of Disease Transmission in a Previously Infected Area with Bovine Tuberculosis in Minnesota, USA.

    PubMed

    Ribeiro-Lima, J; Carstensen, M; Cornicelli, L; Forester, J D; Wells, S J

    2017-10-01

    The main objective of this study was to characterize spatial patterns of white-tailed deer (Odocoileus virginianus) movement related to bovine tuberculosis (bTB) transmission risk to cattle in north-western Minnesota. Twenty-one adult deer (16 females and 5 males) were captured during winter (January-March) 2011 in areas adjacent to where an outbreak (2005-2009) of bTB occurred in deer and cattle. Deer were fitted with GPS collars programmed to collect deer location information every 90 min over a 15-month period. The exact locations of cattle, cattle feeding areas, and stored forage that were available to collared deer were assessed seasonally. In total, 47% (n = 9) of collared deer survived to the end of the study. Causes of mortality included wolves (n = 6), hunters (n = 1) and unknown (n = 2); additionally, 2 deer were censored due to collar malfunctions. Our results indicated that 5 deer (25%) had home ranges that included 6 cattle farms (20%). Most (77%) of the deer visits occurred in areas where cattle were present, with most visits (60%) from 00:00 to 06:00. March to May revealed the most farm visitations by deer (37%). This study provided baseline information regarding cattle-deer interactions critical to transmission of bTB in this region and suggested that risk mitigation practices should be implemented to separate wildlife and domestic livestock when feasible. © 2016 Blackwell Verlag GmbH.

  1. Tuberculosis Infection in the United States: Prevalence Estimates from the National Health and Nutrition Examination Survey, 2011-2012

    PubMed Central

    Miramontes, Roque; Hill, Andrew N.; Yelk Woodruff, Rachel S.; Lambert, Lauren A.; Navin, Thomas R.; Castro, Kenneth G.; LoBue, Philip A.

    2015-01-01

    Background Reexamining the prevalence of persons infected with tuberculosis (TB) is important to determine trends over time. In 2011–2012 a TB component was included in the National Health and Nutrition Examination Survey (NHANES) to estimate the reservoir of persons infected with TB. Methods Civilian, noninstitutionalized U.S. population survey participants aged 6 years and older were interviewed regarding their TB history and eligibility for the tuberculin skin test (TST) and interferon gamma release assay (IGRA) blood test. Once eligibility was confirmed, both tests were conducted. Prevalence and numbers of TST positive (10 mm or greater), IGRA positive, and both TST and IGRA positive were calculated by adjusting for the complex survey design after applying corrections for item nonresponse and digit preference in TST induration measurements. To examine TST positivity over time, data from NHANES 1999–2000 were reanalyzed using the same statistical methods. The TST was performed using Tubersol, a commercially available purified protein derivative (PPD), rather than PPD-S, which was the antigen used in NHANES 1999–2000. Prior patient history of TB vaccination was not collected in this study nor were patients examined for the presence of a Bacillus of Calmette and Guerin (BCG) vaccine scar. Results For NHANES 2011–2012, TST and IGRA results were available for 6,128 (78.4%) and 7,107 (90.9%) eligible participants, respectively. There was no significant difference between the percentage of the U.S. population that was TST positive in 2011–2012 (4.7% [95% CI 3.4–6.3]; 13,276,000 persons) compared with 1999–2000 (4.3%; 3.5–5.3). In 2011–2012 the percentage that was IGRA positive was 5.0% (4.2–5.8) and double TST and IGRA positivity was 2.1% (1.5–2.8). The point estimate of IGRA positivity prevalence in foreign-born persons (15.9%; 13.5–18.7) was lower than for TST (20.5%; 16.1–25.8) in 2011–2012. The point estimate of IGRA positivity

  2. Spatial transmission and meteorological determinants of tuberculosis incidence in Qinghai Province, China: a spatial clustering panel analysis.

    PubMed

    Rao, Hua-Xiang; Zhang, Xi; Zhao, Lei; Yu, Juan; Ren, Wen; Zhang, Xue-Lei; Ma, Yong-Cheng; Shi, Yan; Ma, Bin-Zhong; Wang, Xiang; Wei, Zhen; Wang, Hua-Fang; Qiu, Li-Xia

    2016-06-02

    Tuberculosis (TB) is the notifiable infectious disease with the second highest incidence in the Qinghai province, a province with poor primary health care infrastructure. Understanding the spatial distribution of TB and related environmental factors is necessary for developing effective strategies to control and further eliminate TB. Our TB incidence data and meteorological data were extracted from the China Information System of Disease Control and Prevention and statistical yearbooks, respectively. We calculated the global and local Moran's I by using spatial autocorrelation analysis to detect the spatial clustering of TB incidence each year. A spatial panel data model was applied to examine the associations of meteorological factors with TB incidence after adjustment of spatial individual effects and spatial autocorrelation. The Local Moran's I method detected 11 counties with a significantly high-high spatial clustering (average annual incidence: 294/100 000) and 17 counties with a significantly low-low spatial clustering (average annual incidence: 68/100 000) of TB annual incidence within the examined five-year period; the global Moran's I values ranged from 0.40 to 0.58 (all P-values < 0.05). The TB incidence was positively associated with the temperature, precipitation, and wind speed (all P-values < 0.05), which were confirmed by the spatial panel data model. Each 10 °C, 2 cm, and 1 m/s increase in temperature, precipitation, and wind speed associated with 9 % and 3 % decrements and a 7 % increment in the TB incidence, respectively. High TB incidence areas were mainly concentrated in south-western Qinghai, while low TB incidence areas clustered in eastern and north-western Qinghai. Areas with low temperature and precipitation and with strong wind speeds tended to have higher TB incidences.

  3. The Impact of Prior Information on Estimates of Disease Transmissibility Using Bayesian Tools

    PubMed Central

    Moser, Carlee B.; Gupta, Mayetri; Archer, Brett N.; White, Laura F.

    2015-01-01

    The basic reproductive number (R₀) and the distribution of the serial interval (SI) are often used to quantify transmission during an infectious disease outbreak. In this paper, we present estimates of R₀ and SI from the 2003 SARS outbreak in Hong Kong and Singapore, and the 2009 pandemic influenza A(H1N1) outbreak in South Africa using methods that expand upon an existing Bayesian framework. This expanded framework allows for the incorporation of additional information, such as contact tracing or household data, through prior distributions. The results for the R₀ and the SI from the influenza outbreak in South Africa were similar regardless of the prior information (R^0 = 1.36–1.46, μ^ = 2.0–2.7, μ^ = mean of the SI). The estimates of R₀ and μ for the SARS outbreak ranged from 2.0–4.4 and 7.4–11.3, respectively, and were shown to vary depending on the use of contact tracing data. The impact of the contact tracing data was likely due to the small number of SARS cases relative to the size of the contact tracing sample. PMID:25793993

  4. Transmission parameters estimated for Salmonella typhimurium in swine using susceptible-infectious-resistant models and a Bayesian approach

    PubMed Central

    2014-01-01

    Background Transmission models can aid understanding of disease dynamics and are useful in testing the efficiency of control measures. The aim of this study was to formulate an appropriate stochastic Susceptible-Infectious-Resistant/Carrier (SIR) model for Salmonella Typhimurium in pigs and thus estimate the transmission parameters between states. Results The transmission parameters were estimated using data from a longitudinal study of three Danish farrow-to-finish pig herds known to be infected. A Bayesian model framework was proposed, which comprised Binomial components for the transition from susceptible to infectious and from infectious to carrier; and a Poisson component for carrier to infectious. Cohort random effects were incorporated into these models to allow for unobserved cohort-specific variables as well as unobserved sources of transmission, thus enabling a more realistic estimation of the transmission parameters. In the case of the transition from susceptible to infectious, the cohort random effects were also time varying. The number of infectious pigs not detected by the parallel testing was treated as unknown, and the probability of non-detection was estimated using information about the sensitivity and specificity of the bacteriological and serological tests. The estimate of the transmission rate from susceptible to infectious was 0.33 [0.06, 1.52], from infectious to carrier was 0.18 [0.14, 0.23] and from carrier to infectious was 0.01 [0.0001, 0.04]. The estimate for the basic reproduction ration (R 0 ) was 1.91 [0.78, 5.24]. The probability of non-detection was estimated to be 0.18 [0.12, 0.25]. Conclusions The proposed framework for stochastic SIR models was successfully implemented to estimate transmission rate parameters for Salmonella Typhimurium in swine field data. R 0 was 1.91, implying that there was dissemination of the infection within pigs of the same cohort. There was significant temporal-cohort variability, especially at the

  5. Estimating the risk of cattle exposure to tuberculosis posed by wild deer relative to badgers in England and Wales.

    PubMed

    Ward, Alastair I; Smith, Graham C; Etherington, Thomas R; Delahay, Richard J

    2009-10-01

    Wild deer populations in Great Britain are expanding in range and probably in numbers, and relatively high prevalence of bovine tuberculosis (bTB, caused by infection with Mycobacterium bovis) in deer occurs locally in parts of southwest England. To evaluate the M. bovis exposure risk posed to cattle by wild deer relative to badgers in England and Wales, we constructed and parameterized a quantitative risk model with the use of information from the literature (on deer densities, activity patterns, bTB epidemiology, and pathology) and contemporary data on deer, cattle, and badger (Meles meles) distribution and abundance. The median relative risk score for each of the four deer species studied--red (Cervus elaphus), fallow (Dama dama), and roe (Capreolus capreolus) deer, and muntjac (Muntiacus reevesi)--was lower than unity (the relative risk set for badgers, the putative main wildlife reservoir of M. bovis in England and Wales). However, the 95th percentiles associated with risk estimates were large, and the upper limits for all four deer species exceeded unity. Although M. bovis exposure risks to cattle from deer at pasture are likely to be lower than those from badgers across most areas of England and Wales where cattle are affected by bTB because these areas coincide with high-density badger populations but not high-density deer populations, we predict the presence of localized areas where relative risks posed by deer may be considerable. Moreover, wherever deer are infected, risks to cattle may be additive to those posed by badgers. There are considerable knowledge gaps associated with bTB in deer, badgers, and cattle, and data available for model parameterization were generally of low quality and high variability, and consequently model output were subject to some uncertainty. Improved estimates of the proportion of time that deer of each species spend at pasture, the likelihood and magnitude of M. bovis excretion, and local badger and deer densities appear

  6. A mathematical framework for estimating pathogen transmission fitness and inoculum size using data from a competitive mixtures animal model.

    PubMed

    McCaw, James M; Arinaminpathy, Nimalan; Hurt, Aeron C; McVernon, Jodie; McLean, Angela R

    2011-04-01

    We present a method to measure the relative transmissibility ("transmission fitness") of one strain of a pathogen compared to another. The model is applied to data from "competitive mixtures" experiments in which animals are co-infected with a mixture of two strains. We observe the mixture in each animal over time and over multiple generations of transmission. We use data from influenza experiments in ferrets to demonstrate the approach. Assessment of the relative transmissibility between two strains of influenza is important in at least three contexts: 1) Within the human population antigenically novel strains of influenza arise and compete for susceptible hosts. 2) During a pandemic event, a novel sub-type of influenza competes with the existing seasonal strain(s). The unfolding epidemiological dynamics are dependent upon both the population's susceptibility profile and the inherent transmissibility of the novel strain compared to the existing strain(s). 3) Neuraminidase inhibitors (NAIs), while providing significant potential to reduce transmission of influenza, exert selective pressure on the virus and so promote the emergence of drug-resistant strains. Any adverse outcome due to selection and subsequent spread of an NAI-resistant strain is exquisitely dependent upon the transmission fitness of that strain. Measurement of the transmission fitness of two competing strains of influenza is thus of critical importance in determining the likely time-course and epidemiology of an influenza outbreak, or the potential impact of an intervention measure such as NAI distribution. The mathematical framework introduced here also provides an estimate for the size of the transmitted inoculum. We demonstrate the framework's behaviour using data from ferret transmission studies, and through simulation suggest how to optimise experimental design for assessment of transmissibility. The method introduced here for assessment of mixed transmission events has applicability beyond

  7. Use of simulation modeling to estimate herd-level sensitivity, specificity, and predictive values of diagnostic tests for detection of tuberculosis in cattle.

    PubMed

    Norby, Bo; Bartlett, Paul C; Grooms, Daniel L; Kaneene, John B; Bruning-Fann, Colleen S

    2005-07-01

    To estimate herd-level sensitivity (HSe), specificity (HSp), and predictive values for a positive (HPVP) and negative (HPVN) test result for several testing scenarios for detection of tuberculosis in cattle by use of simulation modeling. Empirical distributions of all herds (15,468) and herds in a 10-county area (1,016) in Michigan. 5 test scenarios were simulated: scenario 1, serial interpretation of the caudal fold tuberculin (CFT) test and comparative cervical test (CCT); scenario 2, serial interpretation of the CFT test and CCT, microbial culture for mycobacteria, and polymerase chain reaction assay; scenario 3, same as scenario 2 but specificity was fixed at 1.0; and scenario 4, sensitivity was 0.9 (scenario 4a) or 0.95 (scenario 4b), and specificity was fixed at 1.0. Estimates for HSe were reasonably high, ranging between 0.712 and 0.840. Estimates for HSp were low when specificity was not fixed at 1.0. Estimates of HPVP were low for scenarios 1 and 2 (0.042 and 0.143, respectively) but increased to 1.0 when specificity was fixed at 1.0. The HPVN remained high for all 5 scenarios, ranging between 0.995 and 0.997. As herd size increased, HSe increased and HSp and HPVP decreased. However, fixing specificity at 1.0 had only minor effects on HSp and HPVN, but HSe was low when the herd size was small. Tests used for detecting cattle herds infected with tuberculosis work well on a herd basis. Herds with < approximately 100 cattle should be tested more frequently or for a longer duration than larger herds to ensure that these small herds are free of tuberculosis.

  8. A Dynamic Model of Human and Livestock Tuberculosis Spread and Control in Urumqi, Xinjiang, China

    PubMed Central

    Liu, Shan; Li, Aiqiao; Feng, Xiaomei; Zhang, Xueliang

    2016-01-01

    We establish a dynamical model for tuberculosis of humans and cows. For the model, we firstly give the basic reproduction number R0. Furthermore, we discuss the dynamical behaviors of the model. By epidemiological investigation of tuberculosis among humans and livestock from 2007 to 2014 in Urumqi, Xinjiang, China, we estimate the parameters of the model and study the transmission trend of the disease in Urumqi, Xinjiang, China. The reproduction number in Urumqi for the model is estimated to be 0.1811 (95% confidence interval: 0.123–0.281). Finally, we perform some sensitivity analysis of several model parameters and give some useful comments on controlling the transmission of tuberculosis. PMID:27525034

  9. Estimating the burden of tuberculosis among foreign-born persons acquired prior to entering the U.S., 2005-2009.

    PubMed

    Ricks, Philip M; Cain, Kevin P; Oeltmann, John E; Kammerer, J Steve; Moonan, Patrick K

    2011-01-01

    The true burden of reactivation of remote latent tuberculosis infection (reactivation TB) among foreign-born persons with tuberculosis (TB) within the United States is not known. Our study objectives were to estimate the proportion of foreign-born persons with TB due reactivation TB and to describe characteristics of foreign-born persons with reactivation TB. We conducted a cross-sectional study of patients with an M. tuberculosis isolate genotyped by the U.S. National TB Genotyping Service, 2005-2009. TB cases were attributed to reactivation TB if they were not a member of a localized cluster of cases. Localized clusters were determined by a spatial scan statistic of cases with isolates with matching TB genotype results. Crude odds ratios and 95% confidence intervals were used to assess relations between reactivation TB and select factors among foreign-born persons. Among the 36,860 cases with genotyping and surveillance data reported, 22,151 (60%) were foreign-born. Among foreign-born persons with TB, 18,540 (83.7%) were attributed to reactivation TB. Reactivation TB among foreign-born persons was associated with increasing age at arrival, incidence of TB in the country of origin, and decreased time in the U.S. at the time of TB diagnosis. Four out of five TB cases among foreign-born persons can be attributed to reactivation TB and present the largest challenge to TB elimination in the U.S. TB control strategies among foreign-born persons should focus on finding and treating latent tuberculosis infection prior to or shortly after arrival to the United States and on reducing the burden of LTBI through improvements in global TB control.

  10. Estimation of the dynamics and rate of transmission of classical swine fever (hog cholera) in wild pigs.

    PubMed Central

    Hone, J.; Pech, R.; Yip, P.

    1992-01-01

    Infectious diseases establish in a population of wildlife hosts when the number of secondary infections is greater than or equal to one. To estimate whether establishment will occur requires extensive experience or a mathematical model of disease dynamics and estimates of the parameters of the disease model. The latter approach is explored here. Methods for estimating key model parameters, the transmission coefficient (beta) and the basic reproductive rate (RDRS), are described using classical swine fever (hog cholera) in wild pigs as an example. The tentative results indicate that an acute infection of classical swine fever will establish in a small population of wild pigs. Data required for estimation of disease transmission rates are reviewed and sources of bias and alternative methods discussed. A comprehensive evaluation of the biases and efficiencies of the methods is needed. PMID:1582476

  11. Capacity estimates for optical transmission based on the nonlinear Fourier transform

    PubMed Central

    Derevyanko, Stanislav A.; Prilepsky, Jaroslaw E.; Turitsyn, Sergei K.

    2016-01-01

    What is the maximum rate at which information can be transmitted error-free in fibre–optic communication systems? For linear channels, this was established in classic works of Nyquist and Shannon. However, despite the immense practical importance of fibre–optic communications providing for >99% of global data traffic, the channel capacity of optical links remains unknown due to the complexity introduced by fibre nonlinearity. Recently, there has been a flurry of studies examining an expected cap that nonlinearity puts on the information-carrying capacity of fibre–optic systems. Mastering the nonlinear channels requires paradigm shift from current modulation, coding and transmission techniques originally developed for linear communication systems. Here we demonstrate that using the integrability of the master model and the nonlinear Fourier transform, the lower bound on the capacity per symbol can be estimated as 10.7 bits per symbol with 500 GHz bandwidth over 2,000 km. PMID:27611059

  12. Estimation of the noise contributions from blank, transmission and emission scans in PET

    SciTech Connect

    Holm, S.; Jensen, M.; Toft, P.

    1996-08-01

    This work determines the relative importance of noise from blank (B), transmission (T) and emission (E) scans in PET using a GE Advance scanner on a 20 cm cylinder, a brain phantom, and a torso-like ellipse (18/35 cm) with examples of human scans (brain O-15 water and F-18 FDG, heart FDG). Phantom E scans were acquired in both 2D and 3D modes as decay series with C-11 or F-18 over 3--6 decades of Noise Equivalent Counts (NEC). B and T scans were made using two pin sources ({approx} 500 MBq total) over 64-32768 sec. In humans only a limited subset was available. In homogeneous phantoms normalized variance (var) was estimated from pixel distributions in single images. In other objects, including the human studies, calculations were performed on differences of paired images. In all cases a fit was made to a simple noise model. The cylinder data show expected relations of T to B noise proving the adequacy of B scan times {le} 20 min for most purposes. For the brain phantom, a contour plot is provided for var (E,T). In a typical 3D O-15 water study with 0.5 M counts per central slice, a 10 min T-scan adds less than 10% to the total noise level. An example shows how to split a total scan time between E and T scans, in order to minimize the variance.

  13. Estimating medium- and long-term trends in malaria transmission by using serological markers of malaria exposure.

    PubMed

    Drakeley, C J; Corran, P H; Coleman, P G; Tongren, J E; McDonald, S L R; Carneiro, I; Malima, R; Lusingu, J; Manjurano, A; Nkya, W M M; Lemnge, M M; Cox, J; Reyburn, H; Riley, E M

    2005-04-05

    The implementation and evaluation of malaria control programs would be greatly facilitated by new tools for the rapid assessment of malaria transmission intensity. Because acquisition and maintenance of antimalarial antibodies depend on exposure to malaria infection, such antibodies might be used as proxy measures of transmission intensity. We have compared the prevalence of IgG antibodies with three Plasmodium falciparum asexual stage antigens in individuals of all ages living at varying altitudes encompassing a range of transmission intensities from hyper- to hypoendemic in northeastern Tanzania, with alternative measures of transmission intensity. The prevalence of antibodies to merozoite surface protein-1(19) was significantly more closely correlated with altitude than either point-prevalence malaria parasitemia or single measures of hemoglobin concentration. Analysis of age-specific seroprevalence rates enabled differentiation of recent (seasonal) changes in transmission intensity from longer-term transmission trends and, using a mathematical model of the annual rate of seroconversion, estimation of the longevity of the antibody response. Thus, serological tools allow us to detect variations in malaria transmission over time. Such tools will be invaluable for monitoring trends in malaria endemicity and the effectiveness of malaria control programs.

  14. Eradication of bovine tuberculosis at a herd-level in Madrid, Spain: study of within-herd transmission dynamics over a 12 year period.

    PubMed

    Alvarez, Julio; Perez, Andres M; Bezos, Javier; Casal, Carmen; Romero, Beatriz; Rodriguez-Campos, Sabrina; Saez-Llorente, Jose L; Diaz, Rosa; Carpintero, Jesus; de Juan, Lucia; Domínguez, Lucas

    2012-06-29

    Eradication of bovine tuberculosis (bTB) through the application of test-and-cull programs is a declared goal of developed countries in which the disease is still endemic. Here, longitudinal data from more than 1,700 cattle herds tested during a 12 year-period in the eradication program in the region of Madrid, Spain, were analyzed to quantify the within-herd transmission coefficient (β) depending on the herd-type (beef/dairy/bullfighting). In addition, the probability to recover the officially bTB free (OTF) status in infected herds depending on the type of herd and the diagnostic strategy implemented was assessed using Cox proportional hazard models. Overall, dairy herds showed higher β (median 4.7) than beef or bullfighting herds (2.3 and 2.2 respectively). Introduction of interferon-gamma (IFN-γ) as an ancillary test produced an apparent increase in the β coefficient regardless of production type, likely due to an increase in diagnostic sensitivity. Time to recover OTF status was also significantly lower in dairy herds, and length of bTB episodes was significantly reduced when the IFN-γ was implemented to manage the outbreak. Our results suggest that bTB spreads more rapidly in dairy herds compared to other herd types, a likely cause being management and demographic-related factors. However, outbreaks in dairy herds can be controlled more rapidly than in typically extensive herd types. Finally, IFN-γ proved its usefulness to rapidly eradicate bTB at a herd-level.

  15. Eradication of bovine tuberculosis at a herd-level in Madrid, Spain: study of within-herd transmission dynamics over a 12 year period

    PubMed Central

    2012-01-01

    Background Eradication of bovine tuberculosis (bTB) through the application of test-and-cull programs is a declared goal of developed countries in which the disease is still endemic. Here, longitudinal data from more than 1,700 cattle herds tested during a 12 year-period in the eradication program in the region of Madrid, Spain, were analyzed to quantify the within-herd transmission coefficient (β) depending on the herd-type (beef/dairy/bullfighting). In addition, the probability to recover the officially bTB free (OTF) status in infected herds depending on the type of herd and the diagnostic strategy implemented was assessed using Cox proportional hazard models. Results Overall, dairy herds showed higher β (median 4.7) than beef or bullfighting herds (2.3 and 2.2 respectively). Introduction of interferon-gamma (IFN-γ) as an ancillary test produced an apparent increase in the β coefficient regardless of production type, likely due to an increase in diagnostic sensitivity. Time to recover OTF status was also significantly lower in dairy herds, and length of bTB episodes was significantly reduced when the IFN-γ was implemented to manage the outbreak. Conclusions Our results suggest that bTB spreads more rapidly in dairy herds compared to other herd types, a likely cause being management and demographic-related factors. However, outbreaks in dairy herds can be controlled more rapidly than in typically extensive herd types. Finally, IFN-γ proved its usefulness to rapidly eradicate bTB at a herd-level. PMID:22748007

  16. Estimates of Outbreak Risk from New Introductions of Ebola with Immediate and Delayed Transmission Control

    PubMed Central

    Gundlapalli, Adi V.; Khader, Karim; Pettey, Warren B.P.; Rubin, Michael A.; Adler, Frederick R.; Samore, Matthew H.

    2015-01-01

    While the ongoing Ebola outbreak continues in the West Africa countries of Guinea, Sierra Leone, and Liberia, health officials elsewhere prepare for new introductions of Ebola from infected evacuees or travelers. We analyzed transmission data from patients (i.e., evacuees, international travelers, and those with locally acquired illness) in countries other than the 3 with continuing Ebola epidemics and quantitatively assessed the outbreak risk from new introductions by using different assumptions for transmission control (i.e., immediate and delayed). Results showed that, even in countries that can quickly limit expected number of transmissions per case to <1, the probability that a single introduction will lead to a substantial number of transmissions is not negligible, particularly if transmission variability is high. Identifying incoming infected travelers before symptom onset can decrease worst-case outbreak sizes more than reducing transmissions from patients with locally acquired cases, but performing both actions can have a synergistic effect. PMID:26196264

  17. Factors Associated with Differences between Conventional Contact Tracing and Molecular Epidemiology in Study of Tuberculosis Transmission and Analysis in the City of Barcelona, Spain ▿

    PubMed Central

    Borrell, Sònia; Español, Montserrat; Orcau, Àngels; Tudó, Griselda; March, Francesca; Caylà, Joan A.; Jansà, Josep Maria; Alcaide, Fernando; Martín-Casabona, Núria; Salvadó, Margarita; Martínez, José Antonio; Vidal, Rafael; Sánchez, Francesca; Altet, Neus; Coll, Pere; González-Martín, Juliàn

    2009-01-01

    The aim of this study was to analyze the factors associated with conventional contact tracing (CCT) and molecular epidemiology (ME) methods in assessing tuberculosis (TB) transmission, comparing the populations studied and the epidemiological links established by both methods. Data were obtained from TB case and CCT registries, and ME was performed using IS6110-based restriction fragment length polymorphism (RFLP) analysis and mycobacterial interspersed repetitive unit 12 (MIRU12) typing as a secondary typing method. During two years (2003 and 2004), 892 cases of TB were reported, of which 687 (77%) were confirmed by culture. RFLP analysis was performed with 463 (67.4%) of the 687 isolated strains, and MIRU12 types in 75 strains were evaluated; 280 strains (60.5%) had a unique RFLP pattern, and 183 (39.5%) shared patterns, grouping into 65 clusters. CCT of 613 (68.7%) of 892 cases detected 44 clusters involving 101 patients. The results of both CCT and ME methods yielded 96 clusters involving 255 patients. The household link was the one most frequently identified by CCT (corresponding to 80.7% of the cases clustered by this method), whereas nonhousehold and unknown links were associated with 94.1% of the strains clustered by ME. When both methods were used in 351 cases (39.3%), they showed the same results in 214 cases (61%). Of the remainder, 106 (30.2%) were clustered only by ME, 19 (5.5%) were clustered only by CCT, and 12 (3.4%) were clustered by both methods but into different clusters. Patients with factors potentially associated with social problems were less frequently studied by CCT (P = 0.002), whereas patients of <15 years of age, most with negative cultures, were less frequently studied by ME (P = 0.005). Significant differences in the populations studied by ME versus CCT were observed, possibly explaining the scarce correlation found between the results of these methods. Moreover, ME allowed the detection of nonhousehold contact relationships, whereas

  18. Reducing pediatric HIV infection: estimating mother-to-child transmission rates in a program setting in Zambia.

    PubMed

    Torpey, Kwasi; Kasonde, Prisca; Kabaso, Mushota; Weaver, Mark A; Bryan, Gail; Mukonka, Victor; Bweupe, Maximillian; Zimba, Chilunje; Mwale, Felicitas; Colebunders, Robert

    2010-08-01

    Vertical transmission of HIV remains the main source of pediatric HIV infection in Africa with transmission rates as high as 25%-45% without intervention. Even though effective interventions to reduce vertical transmission of HIV are now available and remarkable progress has been made in scaling up prevention of mother-to-child transmission (PMTCT) services, the effectiveness of PMTCT interventions is unknown in Zambia. In this study, we estimate HIV vertical transmission rates at different age bands among perinatally exposed children. The study analyzed program data of DNA polymerase chain reaction results and selected client information on dried blood spot samples from perinatally exposed children aged 0-12 months sent to the polymerase chain reaction laboratory from 5 provinces between September 2007 and January 2009. Samples of 8237 babies between 0 and 12 months were analyzed, with 84% of the mothers having ever breastfed their children. The observed transmission rate was 6.5% (5.1%, 7.8%) among infants aged 0-6 weeks when both mother and infant received interventions compared with 20.9% (12.3%, 29.5%) where no intervention was given to either mother or baby. Observed HIV transmission with single-dose nevirapine (sdNVP) was 8.5% (5.9%, 11.0%) among infants aged 0-6 weeks, whereas zidovudine with sdNVP (zidovudine + NVP) and highly active antiretroviral therapy were associated with observed transmission rates of 6.8% (4.5%, 9.1%) and 5.0% (3.0%, 7.0%), respectively; whereas these estimates were not significantly different from one another, they were all significantly lower than no intervention for which the estimated rate was 20.9%. Regardless of the intervention, the observed transmission rates were higher among infants aged 6-12 months. PMTCT interventions, including sdNVP, are working in program settings. However, postnatal transmission especially after 6 months through suboptimal feeding practises remains an important challenge to further reduce pediatric

  19. [Focus on the role of ventilation and ultraviolet rays in preventing nosocomial transmission of tuberculosis in health care facilities. Groupe de travail sur la prévention de la transmission nosocomiale de la tuberculose (Direction Générale de la Santé)].

    PubMed

    Desenclos, J C; Abiteboul, D; Bouvet, E; Brucker, G; Demeulemester, R; Haury, B; Huré, P; Leprince, A; Macrez, A; Mayaud, C

    1995-01-01

    Recent episodes of nosocomial tuberculosis, sometimes due to multiresistant strains, in HIV infected patients in the USA has led to the need for new prevention measures against the transmission of Mycobacterium tuberculosis in health care facilities. Tuberculosis is transmitted in Pflügge droplets generated when contagious persons cough. After drying, the droplets become aerosolized solid particles which are rapidly dispersed by air flow within the patient's room. People exposed to the same air are thus at high risk of being contaminated. If the air pressure in the patient's room is higher than the rest of the facility, the air coming form the room may contaminate personnel and other patients elsewhere in the facility. Infecting particles can be eliminated rapidly if the room air is ventilated outdoors. If the ventilation is strong enough so that air constantly circulates from the corridor into the room, infecting particles can no longer diffuse to the rest of the ward. It is also possible to use ultraviolet C light to disinfect the air, either within the room or within the ventilation system. These two basically simple systems are the fundamental environmental and prevention measures needed to limit tuberculosis spread in health care facilities. These methods are however technically complex, costly and require constant evaluation and maintenance by specialized personnel. In addition the potential side effects of ultraviolet waves could considerably reduce their application. These environmental methods, which are complementary methods, only have a meaning if the elementary measures for preventing the transmission of tuberculosis are correctly applied.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. [Estimating the prevalence of tuberculosis infection among healthcare workers in our hospital by repeat QFT-G testing].

    PubMed

    Okumura, Masao; Satoh, Atsuko; Yoshiyama, Takashi; Yanai, Hideki; Rhi, Rina; Kudoh, Shoji; Ogata, Hideo

    2013-04-01

    The QuantiFERON-TB (QFT) blood test is the major tool for the diagnosis of Mycobacterium tuberculosis (TB) infection among healthcare workers (HCWs). We used QFT tests to estimate the prevalence of TB infection among HCWs in our hospital. Between 2003 and 2010, a total of 733 HCWs were enrolled in this study, and the prevalence of TB infection was analyzed according to the HCWs' jobs and work place. Among the 152 men and 581 women who were evaluated, 3 female HCWs had a history of TB. Fifty-eight HCWs (8 men and 50 women with a mean age of 56.3 years and 48.4 years, respectively) demonstrated positive QFT tests. The positive rate was 7.9% for all staff members throughout the study period. The QFT test was positive for 1 HCW who was treated for TB in 1998, and negative and inconclusive for 2 other HCWs treated for TB in 2002. The positive rate for QFT was 16.0% in the TB ward (12/75, 95% confidence interval [CI]: 7.7-24.3%), 9.9% in the other wards (22/222, 95% CI: 7.9-11.9), and 1.1% in the outpatient department (1/91, 95% CI: 0-2.2). According to the job category, the QFT positive rates were as follows: doctors, 4.3% (3/70, 95% CI: 1.9-6.7); nurses, 10.3 (4/35, 95% CI: 6.0-16.8). The positive rate among doctors working in the TB ward was 10.0%, and that for nurses was 24.3%. This indicates that the prevalence of infection among HCWs in the TB ward was significantly higher than that in other work places. A comparison of the results from 2003 through 2007 revealed that for a total of 307 workers, 90.6% and 5.2% remained negative and positive, respectively, while 1.6% converted from negative to positive, and 2.6% from positive to negative. The positive rate among HCWs in the TB ward was higher than that in other wards. This is especially remarkable for doctors and nurses working in the TB ward.

  1. Tuberculosis incidence in prisons: a systematic review.

    PubMed

    Baussano, Iacopo; Williams, Brian G; Nunn, Paul; Beggiato, Marta; Fedeli, Ugo; Scano, Fabio

    2010-12-21

    Transmission of tuberculosis (TB) in prisons has been reported worldwide to be much higher than that reported for the corresponding general population. A systematic review has been performed to assess the risk of incident latent tuberculosis infection (LTBI) and TB disease in prisons, as compared to the incidence in the corresponding local general population, and to estimate the fraction of TB in the general population attributable (PAF%) to transmission within prisons. Primary peer-reviewed studies have been searched to assess the incidence of LTBI and/or TB within prisons published until June 2010; both inmates and prison staff were considered. Studies, which were independently screened by two reviewers, were eligible for inclusion if they reported the incidence of LTBI and TB disease in prisons. Available data were collected from 23 studies out of 582 potentially relevant unique citations. Five studies from the US and one from Brazil were available to assess the incidence of LTBI in prisons, while 19 studies were available to assess the incidence of TB. The median estimated annual incidence rate ratio (IRR) for LTBI and TB were 26.4 (interquartile range [IQR]: 13.0-61.8) and 23.0 (IQR: 11.7-36.1), respectively. The median estimated fraction (PAF%) of tuberculosis in the general population attributable to the exposure in prisons for TB was 8.5% (IQR: 1.9%-17.9%) and 6.3% (IQR: 2.7%-17.2%) in high- and middle/low-income countries, respectively. The very high IRR and the substantial population attributable fraction show that much better TB control in prisons could potentially protect prisoners and staff from within-prison spread of TB and would significantly reduce the national burden of TB. Future studies should measure the impact of the conditions in prisons on TB transmission and assess the population attributable risk of prison-to-community spread. Please see later in the article for the Editors' Summary.

  2. Analysis of well hydrographs in a karst aquifer: Estimates of specific yields and continuum transmissivities

    SciTech Connect

    Shevenell, L.A.

    1994-11-01

    Hydrograph analysis techniques have been well developed for hydrographs obtained from streams and springs, where data are cast in terms of total discharge. The data obtained from well hydrographs provide water level versus time; hence, a method of hydrograph analysis is required for situations in which only water level data are available. It is hypothesized here that three segments on a recession curve from wells in a karst aquifer represent drainage from three types of storage: conduit (C), fracture (F), and matrix (M). Hydrographs from several wells in a karst aquifer at the U.S. Department of Energy Oak Ridge Y-12 Plant are used to estimate the specific yields (S{sub y}) associated with each portion of the aquifer (C, F, M), as well as continuum transmissivities (T). Data from three short injection tests at one well indicate continuum T at this well bore is {approximately} 5m{sup 2}/d, and tests at numerous other wells in the aquifer yield results between 1 and 7 M{sup 2}/d. The T estimated with well hydrographs from two storm events indicates a T of 9.8 m{sup 2}2/d. Well developed conduit systems in which water levels in wells show a flashy response typically show S{sub y} values of 1{times}10{sup -4}, 1{times}10{sup -3}, and 3{times}10{sup -3}, for C, F, and M. Less well developed conduit areas show more nearly equal S{sub y} values (8.6{times}10{sup -4}, 1.3{times}10{sup -3}, 3{times}10{sup -3}). Areas with no evidence for the presence of conduits have only one, or in some cases two, slopes on the recession curve. In these cases, water level responses are slow. Recession curves with a single slope represent drainage from only the lower T matrix. Those with two slopes have an additional, more rapid response, segment on the recession curve, which represents drainage from the higher T, lower S{sub y}, fractures in the system.

  3. Cutaneous Tuberculosis

    PubMed Central

    Frankel, Amylynne; Penrose, Carolin

    2009-01-01

    Cutaneous tuberculosis occurs rarely, despite a high and increasing prevalence of tuberculosis worldwide. Mycobacterium tuberculosis, Mycobacterrium bovis, and the Bacille Calmette-Guérin vaccine can cause tuberculosis involving the skin. Cutaneous tuberculosis can be acquired exogenously or endogenously and present as a multitude of differing clinical morphologies. Diagnosis of these lesions can be difficult, as they resemble many other dermatological conditions that are often primarily considered. Further, microbiological confirmation is poor, despite scientific advances, such as the more frequent use of polymerase chain reaction. The authors report a case that illustrates the challenges faced by dermatologists when considering a diagnosis of cutaneous tuberculosis. PMID:20725570

  4. Controlling the seedbeds of tuberculosis: diagnosis and treatment of tuberculosis infection.

    PubMed

    Rangaka, Molebogeng X; Cavalcante, Solange C; Marais, Ben J; Thim, Sok; Martinson, Neil A; Swaminathan, Soumya; Chaisson, Richard E

    2015-12-05

    The billions of people with latent tuberculosis infection serve as the seedbeds for future cases of active tuberculosis. Virtually all episodes of tuberculosis disease are preceded by a period of asymptomatic Mycobacterium tuberculosis infection; therefore, identifying infected individuals most likely to progress to disease and treating such subclinical infections to prevent future disease provides a crucial opportunity to interrupt tuberculosis transmission and reduce the global burden of tuberculosis disease. Programmes focusing on single strategies rather than comprehensive programmes that deliver an integrated arsenal for tuberculosis control might continue to struggle. Tuberculosis preventive therapy is a poorly used method that is essential for controlling the reservoirs of disease that drive the epidemic. Comprehensive control strategies that combine preventive therapy for the most high-risk populations and communities with improved case-finding and treatment, control of transmission, and health systems strengthening could ultimately lead to worldwide tuberculosis elimination. In this Series paper we outline challenges to implementation of preventive therapy and provide pragmatic suggestions for overcoming them. We further advocate for tuberculosis preventive therapy as the core of a renewed worldwide focus to implement a comprehensive epidemic control strategy that would reduce new tuberculosis cases to elimination targets. This strategy would be underpinned by accelerated research to further understand the biology of subclinical tuberculosis infections, develop novel diagnostics and drug regimens specifically for subclinical tuberculosis infection, strengthen health systems and community engagement, and enhance sustainable large scale implementation of preventive therapy programmes.

  5. Controlling the Seedbeds of Tuberculosis: Diagnosis and Treatment of Tuberculosis Infection

    PubMed Central

    Rangaka, Molebogeng X.; Cavalcante, Solange C.; Marais, Ben J.; Thim, Sok; Martinson, Neil A.; Swaminathan, Soumya; Chaisson, Richard E.

    2015-01-01

    The billions of people with latent tuberculosis infection serve as the seedbeds for future cases of active tuberculosis. Virtually all episodes of tuberculosis disease are preceded by a period of asymptomatic Mycobacterium tuberculosis infection; therefore, identifying infected individuals most likely to progress to disease and treating such subclinical infections to prevent future disease provides a critical opportunity to interrupt tuberculosis transmission and reduce the global burden of tuberculosis disease. Programs focusing on single strategies rather than comprehensive programs that deliver an integrated arsenal for tuberculosis control may continue to struggle. Tuberculosis preventive therapy is a poorly utilized tool that is essential for controlling the reservoirs of disease that drive the current epidemic. Comprehensive control strategies that combine preventive therapy for the most high-risk populations and communities with improved case-finding and treatment, control of transmission and health systems strengthening could ultimately lead to worldwide tuberculosis elimination. This paper outlines challenges to implementation of preventive therapy and provides pragmatic suggestions for overcoming them. It further advocates for tuberculosis preventive therapy as the core of a renewed global focus to implement a comprehensive epidemic control strategy that would reduce new tuberculosis cases to elimination targets. This strategy would be underpinned by accelerated research to further understand the biology of subclinical tuberculosis infections, develop novel diagnostics, and drug regimens specifically for subclinical tuberculosis infection, strengthen health systems, community engagement, and enhance sustainable large scale implementation of preventive therapy programs. PMID:26515679

  6. The history of tuberculosis.

    PubMed

    Daniel, Thomas M

    2006-11-01

    Tuberculosis has claimed its victims throughout much of known human history. It reached epidemic proportions in Europe and North America during the 18th and 19th centuries, earning the sobriquet, "Captain Among these Men of Death." Then it began to decline. Understanding of the pathogenesis of tuberculosis began with the work of Théophile Laennec at the beginning of the 19th century and was further advanced by the demonstration of the transmissibility of Mycobacterium tuberculosis infection by Jean-Antoine Villemin in 1865 and the identification of the tubercle bacillus as the etiologic agent by Robert Koch in 1882. Clemens von Pirquet developed the tuberculin skin test in 1907 and 3 years later used it to demonstrate latent tuberculous infection in asymptomatic children. In the late 19th and early 20th centuries sanatoria developed for the treatment of patients with tuberculosis. The rest provided there was supplemented with pulmonary collapse procedures designed to rest infected parts of lungs and to close cavities. Public Health measures to combat the spread of tuberculosis emerged following the discovery of its bacterial cause. BCG vaccination was widely employed following World War I. The modern era of tuberculosis treatment and control was heralded by the discovery of streptomycin in 1944 and isoniazid in 1952.

  7. Lives saved by Global Fund-supported HIV/AIDS, tuberculosis and malaria programs: estimation approach and results between 2003 and end-2007

    PubMed Central

    2010-01-01

    Background Since 2003, the Global Fund has supported the scale-up of HIV/AIDS, tuberculosis and malaria control in low- and middle-income countries. This paper presents and discusses a methodology for estimating the lives saved through selected service deliveries reported to the Global Fund. Methods Global Fund-supported programs reported, by end-2007, 1.4 million HIV-infected persons on antiretroviral treatment (ARV), 3.3 million new smear-positive tuberculosis cases detected in DOTS (directly observed TB treatment, short course) programs, and 46 million insecticide-treated mosquito nets (ITNs) delivered. We estimated the corresponding lives saved using adaptations of existing epidemiological estimation models. Results By end-2007, an estimated 681,000 lives (95% uncertainty range 619,000-774,000) were saved and 1,097,000 (993,000-1,249,000) life-years gained by ARV. DOTS treatment would have saved 1.63 million lives (1.09 - 2.17 million) when compared against no treatment, or 408,000 lives (265,000-551,000) when compared against non-DOTS treatment. ITN distributions in countries with stable endemic falciparum malaria were estimated to have achieved protection from malaria for 26 million of child-years at risk cumulatively, resulting in 130,000 (27,000-232,000) under-5 deaths prevented. Conclusions These results illustrate the scale of mortality effects that supported programs may have achieved in recent years, despite margins of uncertainty and covering only selected intervention components. Evidence-based evaluation of disease impact of the programs supported by the Global Fund with international and in-country partners must be strengthened using population-level data on intervention coverage and demographic outcomes, information on quality of services, and trends in disease burdens recorded in national health information systems. PMID:20433714

  8. Limitations to estimating bacterial cross-species transmission using genetic and genomic markers: inferences from simulation modeling

    PubMed Central

    Benavides, Julio A; Cross, Paul C; Luikart, Gordon; Creel, Scott

    2014-01-01

    Cross-species transmission (CST) of bacterial pathogens has major implications for human health, livestock, and wildlife management because it determines whether control actions in one species may have subsequent effects on other potential host species. The study of bacterial transmission has benefitted from methods measuring two types of genetic variation: variable number of tandem repeats (VNTRs) and single nucleotide polymorphisms (SNPs). However, it is unclear whether these data can distinguish between different epidemiological scenarios. We used a simulation model with two host species and known transmission rates (within and between species) to evaluate the utility of these markers for inferring CST. We found that CST estimates are biased for a wide range of parameters when based on VNTRs and a most parsimonious reconstructed phylogeny. However, estimations of CST rates lower than 5% can be achieved with relatively low bias using as low as 250 SNPs. CST estimates are sensitive to several parameters, including the number of mutations accumulated since introduction, stochasticity, the genetic difference of strains introduced, and the sampling effort. Our results suggest that, even with whole-genome sequences, unbiased estimates of CST will be difficult when sampling is limited, mutation rates are low, or for pathogens that were recently introduced. PMID:25469159

  9. Limitations to estimating bacterial cross-species transmission using genetic and genomic markers: inferences from simulation modeling.

    PubMed

    Benavides, Julio A; Cross, Paul C; Luikart, Gordon; Creel, Scott

    2014-08-01

    Cross-species transmission (CST) of bacterial pathogens has major implications for human health, livestock, and wildlife management because it determines whether control actions in one species may have subsequent effects on other potential host species. The study of bacterial transmission has benefitted from methods measuring two types of genetic variation: variable number of tandem repeats (VNTRs) and single nucleotide polymorphisms (SNPs). However, it is unclear whether these data can distinguish between different epidemiological scenarios. We used a simulation model with two host species and known transmission rates (within and between species) to evaluate the utility of these markers for inferring CST. We found that CST estimates are biased for a wide range of parameters when based on VNTRs and a most parsimonious reconstructed phylogeny. However, estimations of CST rates lower than 5% can be achieved with relatively low bias using as low as 250 SNPs. CST estimates are sensitive to several parameters, including the number of mutations accumulated since introduction, stochasticity, the genetic difference of strains introduced, and the sampling effort. Our results suggest that, even with whole-genome sequences, unbiased estimates of CST will be difficult when sampling is limited, mutation rates are low, or for pathogens that were recently introduced.

  10. Sources of error in the estimation of mosquito infection rates used to assess risk of arbovirus transmission.

    PubMed

    Bustamante, Dulce M; Lord, Cynthia C

    2010-06-01

    Infection rate is an estimate of the prevalence of arbovirus infection in a mosquito population. It is assumed that when infection rate increases, the risk of arbovirus transmission to humans and animals also increases. We examined some of the factors that can invalidate this assumption. First, we used a model to illustrate how the proportion of mosquitoes capable of virus transmission, or infectious, is not a constant fraction of the number of infected mosquitoes. Thus, infection rate is not always a straightforward indicator of risk. Second, we used a model that simulated the process of mosquito sampling, pooling, and virus testing and found that mosquito infection rates commonly underestimate the prevalence of arbovirus infection in a mosquito population. Infection rate should always be used in conjunction with other surveillance indicators (mosquito population size, age structure, weather) and historical baseline data when assessing the risk of arbovirus transmission.

  11. Sources of Error in the Estimation of Mosquito Infection Rates Used to Assess Risk of Arbovirus Transmission

    PubMed Central

    Bustamante, Dulce M.; Lord, Cynthia C.

    2010-01-01

    Infection rate is an estimate of the prevalence of arbovirus infection in a mosquito population. It is assumed that when infection rate increases, the risk of arbovirus transmission to humans and animals also increases. We examined some of the factors that can invalidate this assumption. First, we used a model to illustrate how the proportion of mosquitoes capable of virus transmission, or infectious, is not a constant fraction of the number of infected mosquitoes. Thus, infection rate is not always a straightforward indicator of risk. Second, we used a model that simulated the process of mosquito sampling, pooling, and virus testing and found that mosquito infection rates commonly underestimate the prevalence of arbovirus infection in a mosquito population. Infection rate should always be used in conjunction with other surveillance indicators (mosquito population size, age structure, weather) and historical baseline data when assessing the risk of arbovirus transmission. PMID:20519620

  12. Contribution of Company Affiliation and Social Contacts to Risk Estimates of Between-Farm Transmission of Avian Influenza

    PubMed Central

    Leibler, Jessica H.; Carone, Marco; Silbergeld, Ellen K.

    2010-01-01

    Background Models of between-farm transmission of pathogens have identified service vehicles and social groups as risk factors mediating the spread of infection. Because of high levels of economic organization in much of the poultry industry, we examined the importance of company affiliation, as distinct from social contacts, in a model of the potential spread of avian influenza among broiler poultry farms in a poultry-dense region in the United States. The contribution of company affiliation to risk of between-farm disease transmission has not been previously studied. Methodology/Principal Findings We obtained data on the nature and frequency of business and social contacts through a national survey of broiler poultry growers in the United States. Daily rates of contact were estimated using Monte Carlo analysis. Stochastic modeling techniques were used to estimate the exposure risk posed by a single infectious farm to other farms in the region and relative risk of exposure for farms under different scenarios. The mean daily rate of vehicular contact was 0.82 vehicles/day. The magnitude of exposure risk ranged from <1% to 25% under varying parameters. Risk of between-farm transmission was largely driven by company affiliation, with farms in the same company group as the index farm facing as much as a 5-fold increase in risk compared to farms contracted with different companies. Employment of part-time workers contributed to significant increases in risk in most scenarios, notably for farms who hired day-laborers. Social visits were significantly less important in determining risk. Conclusions/Significance Biosecurity interventions should be based on information on industry structure and company affiliation, and include part-time workers as potentially unrecognized sources of viral transmission. Modeling efforts to understand pathogen transmission in the context of industrial food animal production should consider company affiliation in addition to geospatial

  13. Contribution of company affiliation and social contacts to risk estimates of between-farm transmission of avian influenza.

    PubMed

    Leibler, Jessica H; Carone, Marco; Silbergeld, Ellen K

    2010-03-25

    Models of between-farm transmission of pathogens have identified service vehicles and social groups as risk factors mediating the spread of infection. Because of high levels of economic organization in much of the poultry industry, we examined the importance of company affiliation, as distinct from social contacts, in a model of the potential spread of avian influenza among broiler poultry farms in a poultry-dense region in the United States. The contribution of company affiliation to risk of between-farm disease transmission has not been previously studied. We obtained data on the nature and frequency of business and social contacts through a national survey of broiler poultry growers in the United States. Daily rates of contact were estimated using Monte Carlo analysis. Stochastic modeling techniques were used to estimate the exposure risk posed by a single infectious farm to other farms in the region and relative risk of exposure for farms under different scenarios. The mean daily rate of vehicular contact was 0.82 vehicles/day. The magnitude of exposure risk ranged from <1% to 25% under varying parameters. Risk of between-farm transmission was largely driven by company affiliation, with farms in the same company group as the index farm facing as much as a 5-fold increase in risk compared to farms contracted with different companies. Employment of part-time workers contributed to significant increases in risk in most scenarios, notably for farms who hired day-laborers. Social visits were significantly less important in determining risk. Biosecurity interventions should be based on information on industry structure and company affiliation, and include part-time workers as potentially unrecognized sources of viral transmission. Modeling efforts to understand pathogen transmission in the context of industrial food animal production should consider company affiliation in addition to geospatial factors and pathogen characteristics. Restriction of social contacts

  14. How much is tuberculosis screening worth? Estimating the value of active case finding for tuberculosis in South Africa, China, and India.

    PubMed

    Azman, Andrew S; Golub, Jonathan E; Dowdy, David W

    2014-10-30

    Current approaches are unlikely to achieve the aggressive global tuberculosis (TB) control targets set for 2035 and beyond. Active case finding (ACF) may be an important tool for augmenting existing strategies, but the cost-effectiveness of ACF remains uncertain. Program evaluators can often measure the cost of ACF per TB case detected, but how this accessible measure translates into traditional metrics of cost-effectiveness, such as the cost per disability-adjusted life year (DALY), remains unclear. We constructed dynamic models of TB in India, China, and South Africa to explore the medium-term impact and cost-effectiveness of generic ACF activities, conceptualized separately as discrete (2-year) campaigns and as continuous activities integrated into ongoing TB control programs. Our primary outcome was the cost per DALY, measured in relationship to the cost per TB case actively detected and started on treatment. Discrete campaigns costing up to $1,200 (95% uncertainty range [UR] 850-2,043) per case actively detected and started on treatment in India, $3,800 (95% UR 2,706-6,392) in China, and $9,400 (95% UR 6,957-13,221) in South Africa were all highly cost-effective (cost per DALY averted less than per capita gross domestic product). Prolonged integration was even more effective and cost-effective. Short-term assessments of ACF dramatically underestimated potential longer term gains; for example, an assessment of an ACF program at 2 years might find a non-significant 11% reduction in prevalence, but a 10-year evaluation of that same intervention would show a 33% reduction. ACF can be a powerful and highly cost-effective tool in the fight against TB. Given that short-term assessments may dramatically underestimate medium-term effectiveness, current willingness to pay may be too low. ACF should receive strong consideration as a basic tool for TB control in most high-burden settings, even when it may cost over $1,000 to detect and initiate treatment for each extra

  15. The importance of implementation strategy in scaling up Xpert MTB/RIF for diagnosis of tuberculosis in the Indian health-care system: a transmission model.

    PubMed

    Salje, Henrik; Andrews, Jason R; Deo, Sarang; Satyanarayana, Srinath; Sun, Amanda Y; Pai, Madhukar; Dowdy, David W

    2014-07-01

    India has announced a goal of universal access to quality tuberculosis (TB) diagnosis and treatment. A number of novel diagnostics could help meet this important goal. The rollout of one such diagnostic, Xpert MTB/RIF (Xpert) is being considered, but if Xpert is used mainly for people with HIV or high risk of multidrug-resistant TB (MDR-TB) in the public sector, population-level impact may be limited. We developed a model of TB transmission, care-seeking behavior, and diagnostic/treatment practices in India and explored the impact of six different rollout strategies. Providing Xpert to 40% of public-sector patients with HIV or prior TB treatment (similar to current national strategy) reduced TB incidence by 0.2% (95% uncertainty range [UR]: -1.4%, 1.7%) and MDR-TB incidence by 2.4% (95% UR: -5.2%, 9.1%) relative to existing practice but required 2,500 additional MDR-TB treatments and 60 four-module GeneXpert systems at maximum capacity. Further including 20% of unselected symptomatic individuals in the public sector required 700 systems and reduced incidence by 2.1% (95% UR: 0.5%, 3.9%); a similar approach involving qualified private providers (providers who have received at least some training in allopathic or non-allopathic medicine) reduced incidence by 6.0% (95% UR: 3.9%, 7.9%) with similar resource outlay, but only if high treatment success was assured. Engaging 20% of all private-sector providers (qualified and informal [providers with no formal medical training]) had the greatest impact (14.1% reduction, 95% UR: 10.6%, 16.9%), but required >2,200 systems and reliable treatment referral. Improving referrals from informal providers for smear-based diagnosis in the public sector (without Xpert rollout) had substantially greater impact (6.3% reduction) than Xpert scale-up within the public sector. These findings are subject to substantial uncertainty regarding private-sector treatment patterns, patient care-seeking behavior, symptoms, and infectiousness over

  16. The Importance of Implementation Strategy in Scaling Up Xpert MTB/RIF for Diagnosis of Tuberculosis in the Indian Health-Care System: A Transmission Model

    PubMed Central

    Salje, Henrik; Andrews, Jason R.; Deo, Sarang; Satyanarayana, Srinath; Sun, Amanda Y.; Pai, Madhukar; Dowdy, David W.

    2014-01-01

    Background India has announced a goal of universal access to quality tuberculosis (TB) diagnosis and treatment. A number of novel diagnostics could help meet this important goal. The rollout of one such diagnostic, Xpert MTB/RIF (Xpert) is being considered, but if Xpert is used mainly for people with HIV or high risk of multidrug-resistant TB (MDR-TB) in the public sector, population-level impact may be limited. Methods and Findings We developed a model of TB transmission, care-seeking behavior, and diagnostic/treatment practices in India and explored the impact of six different rollout strategies. Providing Xpert to 40% of public-sector patients with HIV or prior TB treatment (similar to current national strategy) reduced TB incidence by 0.2% (95% uncertainty range [UR]: −1.4%, 1.7%) and MDR-TB incidence by 2.4% (95% UR: −5.2%, 9.1%) relative to existing practice but required 2,500 additional MDR-TB treatments and 60 four-module GeneXpert systems at maximum capacity. Further including 20% of unselected symptomatic individuals in the public sector required 700 systems and reduced incidence by 2.1% (95% UR: 0.5%, 3.9%); a similar approach involving qualified private providers (providers who have received at least some training in allopathic or non-allopathic medicine) reduced incidence by 6.0% (95% UR: 3.9%, 7.9%) with similar resource outlay, but only if high treatment success was assured. Engaging 20% of all private-sector providers (qualified and informal [providers with no formal medical training]) had the greatest impact (14.1% reduction, 95% UR: 10.6%, 16.9%), but required >2,200 systems and reliable treatment referral. Improving referrals from informal providers for smear-based diagnosis in the public sector (without Xpert rollout) had substantially greater impact (6.3% reduction) than Xpert scale-up within the public sector. These findings are subject to substantial uncertainty regarding private-sector treatment patterns, patient care-seeking behavior

  17. Effects of contact network structure on epidemic transmission trees: implications for data required to estimate network structure.

    PubMed

    Carnegie, Nicole Bohme

    2017-02-13

    Understanding the dynamics of disease spread is key to developing effective interventions to control or prevent an epidemic. The structure of the network of contacts over which the disease spreads has been shown to have a strong influence on the outcome of the epidemic, but an open question remains as to whether it is possible to estimate contact network features from data collected in an epidemic. The approach taken in this paper is to examine the distributions of epidemic outcomes arising from epidemics on networks with particular structural features to assess whether that structure could be measured from epidemic data and what other constraints might be needed to make the problem identifiable. To this end, we vary the network size, mean degree, and transmissibility of the pathogen, as well as the network feature of interest: clustering, degree assortativity, or attribute-based preferential mixing. We record several standard measures of the size and spread of the epidemic, as well as measures that describe the shape of the transmission tree in order to ascertain whether there are detectable signals in the final data from the outbreak. The results suggest that there is potential to estimate contact network features from transmission trees or pure epidemic data, particularly for diseases with high transmissibility or for which the relevant contact network is of low mean degree. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  18. Estimating Plasmodium falciparum transmission rates in low-endemic settings using a combination of community prevalence and health facility data.

    PubMed

    Yukich, Joshua; Briët, Olivier; Bretscher, Michael T; Bennett, Adam; Lemma, Seblewengel; Berhane, Yemane; Eisele, Thomas P; Keating, Joseph; Smith, Thomas

    2012-01-01

    As some malaria control programs shift focus from disease control to transmission reduction, there is a need for transmission data to monitor progress. At lower levels of transmission, it becomes increasingly more difficult to measure precisely, for example through entomological studies. Many programs conduct regular cross sectional parasite prevalence surveys, and have access to malaria treatment data routinely collected by ministries of health, often in health management information systems. However, by themselves, these data are poor measures of transmission. In this paper, we propose an approach for combining annual parasite incidence and treatment data with cross-sectional parasite prevalence and treatment seeking survey data to estimate the incidence of new infections in the human population, also known as the force of infection. The approach is based on extension of a reversible catalytic model. The accuracy of the estimates from this model appears to be highly dependent on levels of detectability and treatment in the community, indicating the importance of information on private sector treatment seeking and access to effective and appropriate treatment.

  19. Estimation of Parameters Influencing Waterborne Transmission of Infectious Hematopoietic Necrosis Virus (IHNV) in Atlantic Salmon (Salmo salar)

    PubMed Central

    Garver, Kyle A; Mahony, Amelia A. M.; Stucchi, Dario; Richard, Jon; Van Woensel, Cecile; Foreman, Mike

    2013-01-01

    Understanding how pathogenic organisms spread in the environment is crucial for the management of disease, yet knowledge of propagule dispersal and transmission in aquatic environments is limited. We conducted empirical studies using the aquatic virus, infectious hematopoietic necrosis virus (IHNV), to quantify infectious dose, shedding capacity, and virus destruction rates in order to better understand the transmission of IHN virus among Atlantic salmon marine net-pen aquaculture. Transmission of virus and subsequent mortality in Atlantic salmon post-smolts was initiated with as low as 10 plaque forming units (pfu) ml−1. Virus shedding from IHNV infected Atlantic salmon was detected before the onset of visible signs of disease with peak shed rates averaging 3.2×107 pfu fish−1 hour−1 one to two days prior to mortality. Once shed into the marine environment, the abundance of free IHNV is modulated by sunlight (UV A and B) and the growth of natural biota present in the seawater. Virus decayed very slowly in sterilized seawater while rates as high as k =  4.37 d−1 were observed in natural seawater. Decay rates were further accelerated when exposed to sunlight with virus infectivity reduced by six orders of magnitude within 3 hours of full sunlight exposure. Coupling the IHNV transmission parameter estimates determined here with physical water circulation models, will increase the understanding of IHNV dispersal and provide accurate geospatial predictions of risk for IHNV transmission from marine salmon sites. PMID:24340016

  20. Estimation of parameters influencing waterborne transmission of infectious hematopoietic necrosis virus (IHNV) in Atlantic salmon (Salmo salar).

    PubMed

    Garver, Kyle A; Mahony, Amelia A M; Stucchi, Dario; Richard, Jon; Van Woensel, Cecile; Foreman, Mike

    2013-01-01

    Understanding how pathogenic organisms spread in the environment is crucial for the management of disease, yet knowledge of propagule dispersal and transmission in aquatic environments is limited. We conducted empirical studies using the aquatic virus, infectious hematopoietic necrosis virus (IHNV), to quantify infectious dose, shedding capacity, and virus destruction rates in order to better understand the transmission of IHN virus among Atlantic salmon marine net-pen aquaculture. Transmission of virus and subsequent mortality in Atlantic salmon post-smolts was initiated with as low as 10 plaque forming units (pfu) ml(-1). Virus shedding from IHNV infected Atlantic salmon was detected before the onset of visible signs of disease with peak shed rates averaging 3.2 × 10(7) pfu fish(-1) hour(-1) one to two days prior to mortality. Once shed into the marine environment, the abundance of free IHNV is modulated by sunlight (UV A and B) and the growth of natural biota present in the seawater. Virus decayed very slowly in sterilized seawater while rates as high as k =  4.37 d(-1) were observed in natural seawater. Decay rates were further accelerated when exposed to sunlight with virus infectivity reduced by six orders of magnitude within 3 hours of full sunlight exposure. Coupling the IHNV transmission parameter estimates determined here with physical water circulation models, will increase the understanding of IHNV dispersal and provide accurate geospatial predictions of risk for IHNV transmission from marine salmon sites.

  1. Bovine tuberculosis

    USDA-ARS?s Scientific Manuscript database

    Tuberculosis (TB) in animals and humans may result from exposure to bacilli within the Mycobacterium tuberculosis complex (i.e., M. tuberculosis, M. bovis, M. africanum, M. pinnipedii, M. microti, M. caprae, or M. canetti) . Mycobacterium bovis is the species most often isolated from tuberculous cat...

  2. Bovine Tuberculosis

    USDA-ARS?s Scientific Manuscript database

    Tuberculosis (TB) in animals and humans may result from exposure to bacilli within the Mycobacterium tuberculosis complex (i.e., M. tuberculosis, M. bovis, M. africanum, M. pinnipedii, M. microti, M. caprae, or M. canetti). Mycobacterium bovis is the species most often isolated from tuberculous catt...

  3. Estimating transmissivity in the Edwards Aquifer using upscaling, geostatistics, and Bayesian updating

    NASA Astrophysics Data System (ADS)

    Painter, S. L.; Jiang, Y.; Woodbury, A. D.

    2002-12-01

    The Edwards Aquifer, a highly heterogeneous karst aquifer located in south central Texas, is the sole source of drinking water for more than one million people. Hydraulic conductivity (K) measurements in the Edwards Aquifer are sparse, highly variable (log-K variance of 6.4), and are mostly from single-well drawdown tests that are appropriate for the spatial scale of a few meters. To support ongoing efforts to develop a groundwater management (MODFLOW) model of the San Antonio segment of the Edwards Aquifer, a multistep procedure was developed to assign hydraulic parameters to the 402 m x 402 m computational cells intended for the management model. The approach used a combination of nonparametric geostatistical analysis, stochastic simulation, numerical upscaling, and automatic model calibration based on Bayesian updating [1,2]. Indicator correlograms reveal a nested spatial structure in the well-test K of the confined zone, with practical correlation ranges of 3,600 and 15,000 meters and a large nugget effect. The fitted geostatistical model was used in unconditional stochastic simulations by the sequential indicator simulation method. The resulting realizations of K, defined at the scale of the well tests, were then numerically upscaled to the block scale. A new geostatistical model was fitted to the upscaled values. The upscaled model was then used to cokrige the block-scale K based on the well-test K. The resulting K map was then converted to transmissivity (T) using deterministically mapped aquifer thickness. When tested in a forward groundwater model, the upscaled T reproduced hydraulic heads better than a simple kriging of the well-test values (mean error of -3.9 meter and mean-absolute-error of 12 meters, as compared with -13 and 17 meters for the simple kriging). As the final step in the study, the upscaled T map was used as the prior distribution in an inverse procedure based on Bayesian updating [1,2]. When input to the forward groundwater model, the

  4. Implication of the RD(Rio) Mycobacterium tuberculosis sublineage in multidrug resistant tuberculosis in Portugal.

    PubMed

    David, Susana; Duarte, Elsa L; Leite, Clarice Queico Fugimura; Ribeiro, João-Nuno; Maio, José-Nuno; Paixão, Eleonora; Portugal, Clara; Sancho, Luísa; Germano de Sousa, José

    2012-10-01

    Multidrug and extensively drug resistant Mycobacterium tuberculosis are a threat to tuberculosis control programs. Genotyping methods, such as spoligotyping and MIRU-VNTR typing (Mycobacterial Interspersed Repetitive Units), are useful in monitoring potentially epidemic strains and estimating strain phylogenetic lineages and/or genotypic families. M. tuberculosis Latin American Mediterranean (LAM) family is a major worldwide contributor to tuberculosis (TB). LAM specific molecular markers, Ag85C(103) single nucleotide polymorphism (SNP) and RD(Rio) long-sequence polymorphism (LSP), were used to characterize spoligotype signatures from 859 patient isolates from Portugal. LAM strains were found responsible for 57.7% of all tuberculosis cases. Strains with the RD(Rio) deletion (referred to as RD(Rio)) were estimated to represent 1/3 of all the strains and over 60% of the multidrug resistant (MDR) strains. The major spoligotype signature SIT20 belonging to the LAM1 RD(Rio) sublineage, represented close to 1/5th of all the strains, over 20% of which were MDR. Analysis of published datasets according to stipulated 12loci MIRU-VNTR RD(Rio) signatures revealed that 96.3% (129/134) of MDR and extensively drug resistant (XDR) clusters were RD(Rio). This is the first report associating the LAM RD(Rio) sublineage with MDR. These results are an important contribution to the monitoring of these strains with heightened transmission for future endeavors to arrest MDR-TB and XDR-TB. Copyright © 2012 Elsevier B.V. All rights reserved.

  5. Estimating the phenology of elk brucellosis transmission with hierarchical models of cause-specific and baseline hazards

    USGS Publications Warehouse

    Cross, Paul C.; Maichak, Eric J.; Rogerson, Jared D.; Irvine, Kathryn M.; Jones, Jennifer D; Heisey, Dennis M.; Edwards, William H.; Scurlock, Brandon M.

    2015-01-01

    Understanding the seasonal timing of disease transmission can lead to more effective control strategies, but the seasonality of transmission is often unknown for pathogens transmitted directly. We inserted vaginal implant transmitters (VITs) in 575 elk (Cervus elaphus canadensis) from 2006 to 2014 to assess when reproductive failures (i.e., abortions or still births) occur, which is the primary transmission route of Brucella abortus, the causative agent of brucellosis in the Greater Yellowstone Ecosystem. Using a survival analysis framework, we developed a Bayesian hierarchical model that simultaneously estimated the total baseline hazard of a reproductive event as well as its 2 mutually exclusive parts (abortions or live births). Approximately, 16% (95% CI = 0.10, 0.23) of the pregnant seropositive elk had reproductive failures, whereas 2% (95% CI = 0.01, 0.04) of the seronegative elk had probable abortions. Reproductive failures could have occurred as early as 13 February and as late as 10 July, peaking from March through May. Model results suggest that less than 5% of likely abortions occurred after 6 June each year and abortions were approximately 5 times more likely in March, April, or May compared to February or June. In western Wyoming, supplemental feeding of elk begins in December and ends during the peak of elk abortions and brucellosis transmission (i.e., Mar and Apr). Years with more snow may enhance elk-to-elk transmission on supplemental feeding areas because elk are artificially aggregated for the majority of the transmission season. Elk-to-cattle transmission will depend on the transmission period relative to the end of the supplemental feeding season, elk seroprevalence, population size, and the amount of commingling. Our statistical approach allowed us to estimate the probability density function of different event types over time, which may be applicable to other cause-specific survival analyses. It is often challenging to assess the

  6. Nonlinear pattern of pulmonary tuberculosis among migrants at entry in Kuwait: 1997–2006

    PubMed Central

    Akhtar, Saeed; Mohammad, Hameed GHH

    2008-01-01

    Background There is a paucity of published data on the pattern of pulmonary tuberculosis among migrant workers entering Middle Eastern countries particularly Kuwait. The objectives of this study were to use routine health surveillance data i) to estimate the prevalence of pulmonary tuberculosis among migrant workers at entry in Kuwait and ii) to determine the occurrence of any time trends in the proportions of pulmonary tuberculosis positive workers over the study period. Methods The monthly aggregates of daily number of migrants tested and the number of pulmonary tuberculosis cases detected during routine health examinations of migrant workers from tuberculosis high-prevalence countries were used to generate the monthly series of proportions (per 100,000) of pulmonary tuberculosis cases over 120 months between January 1, 1997 and December 31, 2006 and analysed using time series methods. Results The overall prevalence (per 100,000) of documented pulmonary tuberculosis cases among screened migrants was 198 (4608/2328582). Year-specific prevalence (per 100,000) of tuberculosis cases consistently declined from 456 (95% CI: 424 – 490) in 1997 to 124 (95% CI: 110 – 140) in 2002 before showing a steady increase up to 183 (95% CI: 169–197) in 2006. The second-order polynomial regression model revealed significant (P < 0.001) initial decline, followed by a significant (P < 0.001) increasing trend thereafter in monthly proportions of tuberculosis cases among migrant workers. Conclusion The proportions of documented tuberculosis cases among migrant workers showed a significant nonlinear pattern, with an initial decline followed by a significant increasing trend towards the end of the study period. These findings underscore the need to maintain the current policy of migrants' screening for tuberculosis at entry. The public health authorities in Kuwait and perhaps other countries in the region may consider complementing the current screening protocol with interferon

  7. Mycobacterium tuberculosis Genotypes Determined by Spoligotyping to Be Circulating in Colombia between 1999 and 2012 and Their Possible Associations with Transmission and Susceptibility to First-Line Drugs

    PubMed Central

    Puerto, Gloria; Erazo, Lina; Wintaco, Maira; Castro, Claudia; Ribón, Wellman; Guerrero, Martha Inírida

    2015-01-01

    Introduction Tuberculosis (TB) remains a primary public health problem worldwide. The number of multidrug-resistant tuberculosis (MDR TB) cases has increased in recent years in Colombia. Knowledge of M. tuberculosis genotypes defined by spoligotyping can help determine the circulation of genotypes that must be controlled to prevent the spread of TB. Objective To describe the genotypes of M. tuberculosis using spoligotyping in resistant and drug-sensitive isolates and their possible associations with susceptibility to first-line drugs. Methods An analytical observational study was conducted that included 741 isolates of M. tuberculosis from patients. The isolates originated from 31 departments and were obtained by systematic surveillance between 1999 and 2012. Results In total 61.94% of the isolates were resistant to 1 or more drugs, and 147 isolates were MDR. In total, 170 genotypes were found in the population structure of Colombian M. tuberculosis isolates. The isolates were mainly represented by four families: LAM (39.9%), Haarlem (19%), Orphan (17%) and T (9%). The SIT42 (LAM 9) was the most common genotype and contained 24.7% of the isolates, followed by the genotypes SIT62 (Haarlem1), SIT53 (T1), and SIT50 (H3). A high clustering of isolates was evident with 79.8% of the isolates classified into 32 groups. The Beijing family was associated with resistant isolates, whereas the Haarlem and T families were associated with sensitive isolates. The Haarlem family was also associated with grouped isolates (p = 0.031). Conclusions A high proportion (approximately 80%) of isolates was found in clusters; these clusters were not associated with resistance to first-line drugs. The Beijing family was associated with drug resistance, whereas the T and Haarlem families were associated with susceptibility in the Colombian isolates studied. PMID:26066494

  8. Estimating the risk of dengue transmission from Dutch blood donors travelling to Suriname and the Dutch Caribbean.

    PubMed

    Oei, W; Lieshout-Krikke, R W; Kretzschmar, M E; Zaaijer, H L; Coutinho, R A; Eersel, M; Jubithana, B; Halabi, Y; Gerstenbluth, I; Maduro, E; Tromp, M; Janssen, M P

    2016-05-01

    The risk of dengue transmitted by travellers is known. Methods to estimate the transmission by transfusion (TT) risk from blood donors travelling to risk areas are available, for instance, the European Up-Front Risk Assessment Tool (EUFRAT). This study aimed to validate the estimated risk from travelling donors obtained from EUFRAT. Surveillance data on notified dengue cases in Suriname and the Dutch Caribbean islands (Aruba, Curaçao, St. Maarten, Bonaire, St. Eustatius and Saba) in 2001-2011 was used to calculate local incidence rates. Information on travel and donation behaviour of Dutch donors was collected. With the EUFRAT model, the TT risks from Dutch travelling donors were calculated. Model estimates were compared with the number of infections in Dutch travellers found by laboratory tests in the Netherlands. The expected cumulative number of donors becoming infected during travels to Suriname and the Dutch Caribbean from 2001 to 2011 was estimated at 5 (95% CI, 2-11) and 86 (45-179), respectively. The infection risk inferred from the laboratory-based study was 19 (9-61) and 28 (14-92). Given the independence of the data sources, these estimates are remarkably close. The model estimated that 0·02 (0·001-0·06) and 0·40 (0·01-1·4) recipients would have been infected by these travelling donors. The EUFRAT model provided an estimate close to actual observed number of dengue infections. The dengue TT risk among Dutch travelling donors can be estimated using basic transmission, travel and donation information. The TT risk from Dutch donors travelling to Suriname and the Dutch Caribbean is small. © 2016 International Society of Blood Transfusion.

  9. Higher Rate of Tuberculosis in Second Generation Migrants Compared to Native Residents in a Metropolitan Setting in Western Europe

    PubMed Central

    Marx, Florian M.; Fiebig, Lena; Hauer, Barbara; Brodhun, Bonita; Glaser-Paschke, Gisela; Haas, Walter

    2015-01-01

    Background In Western Europe, migrants constitute an important risk group for tuberculosis, but little is known about successive generations of migrants. We aimed to characterize migration among tuberculosis cases in Berlin and to estimate annual rates of tuberculosis in two subsequent migrant generations. We hypothesized that second generation migrants born in Germany are at higher risk of tuberculosis compared to native (non-migrant) residents. Methods A prospective cross-sectional study was conducted. All tuberculosis cases reported to health authorities in Berlin between 11/2010 and 10/2011 were eligible. Interviews were conducted using a structured questionnaire including demographic data, migration history of patients and their parents, and language use. Tuberculosis rates were estimated using 2011 census data. Results Of 314 tuberculosis cases reported, 154 (49.0%) participated. Of these, 81 (52.6%) were first-, 14 (9.1%) were second generation migrants, and 59 (38.3%) were native residents. The tuberculosis rate per 100,000 individuals was 28.3 (95CI: 24.0–32.6) in first-, 10.2 (95%CI: 6.1–16.6) in second generation migrants, and 4.6 (95%CI: 3.7–5.6) in native residents. When combining information from the standard notification variables country of birth and citizenship, the sensitivity to detect second generation migration was 28.6%. Conclusions There is a higher rate of tuberculosis among second generation migrants compared to native residents in Berlin. This may be explained by presumably frequent contact and transmission within migrant populations. Second generation migration is insufficiently captured by the surveillance variables country of birth and citizenship. Surveillance systems in Western Europe should allow for quantifying the tuberculosis burden in this important risk group. PMID:26061733

  10. [Tuberculosis and immigration].

    PubMed

    Salas-Coronas, Joaquín; Rogado-González, M Cruz; Lozano-Serrano, Ana Belén; Cabezas-Fernández, M Teresa

    2016-04-01

    The incidence of tuberculosis worldwide is declining. However, in Western countries this decline is slower due to the impact of immigration. Tuberculosis in the immigrant population is related to health status in the country of origin and with overcrowding and poverty conditions in the host country. Immigrants with tuberculosis are younger, have a higher prevalence of extrapulmonary forms, greater proportion of drug resistance and higher treatment default rates than those of natives. New molecular techniques not only reduce diagnostic delay time but also allow the rapid identification of resistances and improve knowledge of transmission patterns. It is necessary to implement measures to improve treatment compliance in this population group like facilitating access to health card, the use of fixed-dose combination drugs, the participation of cultural mediators and community health workers and gratuity of drugs.

  11. Surveillance of bovine tuberculosis and risk estimation of a future reservoir formation in wildlife in Switzerland and Liechtenstein.

    PubMed

    Schöning, Janne Marie; Cerny, Nadine; Prohaska, Sarah; Wittenbrink, Max M; Smith, Noel H; Bloemberg, Guido; Pewsner, Mirjam; Schiller, Irene; Origgi, Francesco C; Ryser-Degiorgis, Marie-Pierre

    2013-01-01

    Bovine tuberculosis (bTB) caused by Mycobacterium bovis or M. caprae has recently (re-) emerged in livestock and wildlife in all countries bordering Switzerland (CH) and the Principality of Liechtenstein (FL). Comprehensive data for Swiss and Liechtenstein wildlife are not available so far, although two native species, wild boar (Sus scrofa) and red deer (Cervus elaphus elaphus), act as bTB reservoirs elsewhere in continental Europe. Our aims were (1) to assess the occurrence of bTB in these wild ungulates in CH/FL and to reinforce scanning surveillance in all wild mammals; (2) to evaluate the risk of a future bTB reservoir formation in wild boar and red deer in CH/FL. Tissue samples collected from 2009 to 2011 from 434 hunted red deer and wild boar and from eight diseased ungulates with tuberculosis-like lesions were tested by direct real-time PCR and culture to detect mycobacteria of the Mycobacterium tuberculosis complex (MTBC). Identification of suspicious colonies was attempted by real-time PCR, genotyping and spoligotyping. Information on risk factors for bTB maintenance within wildlife populations was retrieved from the literature and the situation regarding identified factors was assessed for our study areas. Mycobacteria of the MTBC were detected in six out of 165 wild boar (3.6%; 95% CI: 1.4-7.8) but none of the 269 red deer (0%; 0-1.4). M. microti was identified in two MTBC-positive wild boar, while species identification remained unsuccessful in four cases. Main risk factors for bTB maintenance worldwide, including different causes of aggregation often resulting from intensive wildlife management, are largely absent in CH and FL. In conclusion, M. bovis and M. caprae were not detected but we report for the first time MTBC mycobacteria in Swiss wild boar. Present conditions seem unfavorable for a reservoir emergence, nevertheless increasing population numbers of wild ungulates and offal consumption may represent a risk.

  12. Tuberculosis (TB): Treatment

    MedlinePlus

    ... Education & Training Home Conditions Tuberculosis (TB) Tuberculosis: Treatment Tuberculosis: Treatment Make an Appointment Refer a Patient Ask ... or bones is treated longer. NEXT: Preventive Treatment Tuberculosis: Diagnosis Tuberculosis: History Clinical Trials For more than ...

  13. Tuberculosis (TB): Treatment

    MedlinePlus

    ... Training Home Conditions Tuberculosis (TB) Treating Tuberculosis Treating Tuberculosis Make an Appointment Refer a Patient Ask a ... bones is treated longer. NEXT: Preventive Treatment Diagnosing Tuberculosis History of TB Clinical Trials Tuberculosis (TB) Causes ...

  14. Estimating West Nile virus transmission period in Pennsylvania using an optimized degree-day model.

    PubMed

    Chen, Shi; Blanford, Justine I; Fleischer, Shelby J; Hutchinson, Michael; Saunders, Michael C; Thomas, Matthew B

    2013-07-01

    Abstract We provide calibrated degree-day models to predict potential West Nile virus (WNV) transmission periods in Pennsylvania. We begin by following the standard approach of treating the degree-days necessary for the virus to complete the extrinsic incubation period (EIP), and mosquito longevity as constants. This approach failed to adequately explain virus transmission periods based on mosquito surveillance data from 4 locations (Harrisburg, Philadelphia, Pittsburgh, and Williamsport) in Pennsylvania from 2002 to 2008. Allowing the EIP and adult longevity to vary across time and space improved model fit substantially. The calibrated models increase the ability to successfully predict the WNV transmission period in Pennsylvania to 70-80% compared to less than 30% in the uncalibrated model. Model validation showed the optimized models to be robust in 3 of the locations, although still showing errors for Philadelphia. These models and methods could provide useful tools to predict WNV transmission period from surveillance datasets, assess potential WNV risk, and make informed mosquito surveillance strategies.

  15. Estimating lightning performance of transmission line 2--Updates to analytical models

    SciTech Connect

    Whitehead, J.T.; Chisholm, W.A.; Anderson, J.G.; Clayton, R.; Elahi, H.; Eriksson, A.J.; Grzybowski, S.; Hileman, A.R.; Janischewskyj, W.; Longo, V.J.; Moser, C.H.; Mousa, A.M.; Orville, R.E.; Parrish, D.E.; Rizk, F.A.M.; Renowden, J.R.

    1993-07-01

    The IEEE Simplified Method for computing lightning performance of overhead transmission lines was first described by Anderson. Since its publication, considerable experience has been obtained in the application of the method and in the testing of various component models. This paper describes application experience, sets out the theoretical basis for modifications and provides a framework for future advancements.

  16. Estimating West Nile Virus Transmission Period in Pennsylvania Using an Optimized Degree-Day Model

    PubMed Central

    Blanford, Justine I.; Fleischer, Shelby J.; Hutchinson, Michael; Saunders, Michael C.; Thomas, Matthew B.

    2013-01-01

    Abstract We provide calibrated degree-day models to predict potential West Nile virus (WNV) transmission periods in Pennsylvania. We begin by following the standard approach of treating the degree-days necessary for the virus to complete the extrinsic incubation period (EIP), and mosquito longevity as constants. This approach failed to adequately explain virus transmission periods based on mosquito surveillance data from 4 locations (Harrisburg, Philadelphia, Pittsburgh, and Williamsport) in Pennsylvania from 2002 to 2008. Allowing the EIP and adult longevity to vary across time and space improved model fit substantially. The calibrated models increase the ability to successfully predict the WNV transmission period in Pennsylvania to 70–80% compared to less than 30% in the uncalibrated model. Model validation showed the optimized models to be robust in 3 of the locations, although still showing errors for Philadelphia. These models and methods could provide useful tools to predict WNV transmission period from surveillance datasets, assess potential WNV risk, and make informed mosquito surveillance strategies. PMID:23590317

  17. Estimation of the rate of mother to child transmission of HIV in Nigeria.

    PubMed

    Audu, R A; Salu, O B; Musa, A Z; Onyewuche, J; Funso-Adebayo, E O; Iroha, E O; Ezeaka, V C; Adetifa, I M O; Okoeguale, B; Idigbe, E O

    2006-06-01

    Definitive diagnosis of HIV infection in infants < 18 months of age who were born to HIV-infected mothers is still posing some difficulty in Nigeria and other developing countries. Within this age definitive diagnosis can only be carried out by antigen based techniques which are indeed not available in these developing countries. This has resulted in the absence of authoritative data on the rate of mother-to-child transmission in these countries. Nigeria inclusive. The present pilot study was therefore carried out to generate some information on the rate of mother to child transmission in Nigeria using the PCR technique. Plasma samples were obtained from 68 children of both sexes less than 18 months of age and who were born to HIV infected mothers. The samples were collected from two pediatric departments. in Lagos and in Benin. The presence of HIV 1 RNA in each of the samples. was determined using the Amplicor Monitor V 1.5 technique (Roche Diagnostics). Data showed that HIV-1 RNA was detected in 15 of the 68 samples tested. This gave an HIV-1 RNA detection rate of 22%. Among women who had some intervention, the rate of transmission of infection was 11% while the rate among those without intervention was 30%. The 22% transmission rate recorded in this study is close to the range of 25 to 35% that has been reported in several developed and a few developing countries. A multicenter nationwide study will still be needed to determine the national mother to child transmission rate in Nigeria.

  18. Dynamics of shigellosis epidemics: estimating individual-level transmission and reporting rates from national epidemiologic data sets.

    PubMed

    Joh, Richard I; Hoekstra, Robert M; Barzilay, Ezra J; Bowen, Anna; Mintz, Eric D; Weiss, Howard; Weitz, Joshua S

    2013-10-15

    Shigellosis, a diarrheal disease, is endemic worldwide and is responsible for approximately 15,000 laboratory-confirmed cases in the United States every year. However, patients with shigellosis often do not seek medical care. To estimate the burden of shigellosis, we extended time-series susceptible-infected-recovered models to infer epidemiologic parameters from underreported case data. We applied the time-series susceptible-infected-recovered-based inference schemes to analyze the largest surveillance data set of Shigella sonnei in the United States from 1967 to 2007 with county-level resolution. The dynamics of shigellosis transmission show strong annual and multiyear cycles, as well as seasonality. By using the schemes, we inferred individual-level parameters of shigellosis infection, including seasonal transmissibilities and basic reproductive number (R0). In addition, this study provides quantitative estimates of the reporting rate, suggesting that the shigellosis burden in the United States may be more than 10 times the number of laboratory-confirmed cases. Although the estimated reporting rate is generally under 20%, and R0 is generally under 1.5, there is a strong negative correlation between estimates of the reporting rate and R0. Such negative correlations are likely to pose identifiability problems in underreported diseases. We discuss complementary approaches that might further disentangle the true reporting rate and R0.

  19. The relationship between the Plasmodium falciparum parasite ratio in childhood and climate estimates of malaria transmission in Kenya.

    PubMed

    Omumbo, Judith A; Hay, Simon I; Guerra, Carlos A; Snow, Robert W

    2004-06-17

    Plasmodium falciparum morbid and fatal risks are considerably higher in areas supporting parasite prevalence > or =25%, when compared with low transmission areas supporting parasite prevalence below 25%. Recent descriptions of the health impacts of malaria in Africa are based upon categorical descriptions of a climate-driven fuzzy model of suitability (FCS) for stable transmission developed by the Mapping Malaria Risk in Africa collaboration (MARA). An electronic and national search was undertaken to identify community-based parasite prevalence surveys in Kenya. Data from these surveys were matched using ArcView 3.2 to extract spatially congruent estimates of the FCS values generated by the MARA model. Levels of agreement between three classes used during recent continental burden estimations of parasite prevalence (0%, >0-<25% and > or =25%) and three classes of FCS (0, >0-<0.75 and > or =0.75) were tested using the kappa (k) statistic and examined as continuous variables to define better levels of agreement. Two hundred and seventeen independent parasite prevalence surveys undertaken since 1980 were identified during the search. Overall agreement between the three classes of parasite prevalence and FCS was weak although significant (k = 0.367, p < 0.0001). The overall correlation between the FCS and the parasite ratio when considered as continuous variables was also positive (0.364, p < 0.001). The margins of error were in the stable, endemic (parasite ratio > or =25%) class with 42% of surveys represented by an FCS <0.75. Reducing the FCS value criterion to > or =0.6 improved the classification of stable, endemic parasite ratio surveys. Zero values of FCS were not adequate discriminators of zero parasite prevalence. Using the MARA model to categorically distinguish populations at differing intensities of malaria transmission in Kenya may under-represent those who are exposed to stable, endemic transmission and over-represent those at no risk. The MARA approach

  20. Mycobacterium tuberculosis Infection among Asian Elephants in Captivity

    PubMed Central

    Simpson, Gary; Zimmerman, Ralph; Shashkina, Elena; Chen, Liang; Richard, Michael; Bradford, Carol M.; Dragoo, Gwen A.; Saiers, Rhonda L.; Peloquin, Charles A.; Daley, Charles L.; Planet, Paul; Narachenia, Apurva; Mathema, Barun

    2017-01-01

    Although awareness of tuberculosis among captive elephants is increasing, antituberculosis therapy for these animals is not standardized. We describe Mycobacterium tuberculosis transmission between captive elephants based on whole genome analysis and report a successful combination treatment. Infection control protocols and careful monitoring of treatment of captive elephants with tuberculosis are warranted. PMID:28221115

  1. Transmission-less attenuation estimation from time-of-flight PET histo-images using consistency equations

    PubMed Central

    Li, Yusheng; Defrise, Michel; Metzler, Scott D; Matej, Samuel

    2015-01-01

    In positron emission tomography (PET) imaging, attenuation correction with accurate attenuation estimation is crucial for quantitative patient studies. Recent research showed that the attenuation sinogram can be determined up to a scaling constant utilizing the time-of-flight information. The TOF-PET data can be naturally and efficiently stored in a histo-image without information loss, and the radioactive tracer distribution can be efficiently reconstructed using the DIRECT approaches. In this paper, we explore transmission-less attenuation estimation from TOF-PET histo-images. We first present the TOF-PET histo-image formation and the consistency equations in the histo-image parameterization, then we derive a least-squares solution for estimating the directional derivatives of the attenuation factors from the measured emission histo-images. Finally, we present a fast solver to estimate the attenuation factors from their directional derivatives using the discrete sine transform and fast Fourier transform while considering the boundary conditions. We find that the attenuation histo-images can be uniquely determined from the TOF-PET histo-images by considering boundary conditions. Since the estimate of the attenuation directional derivatives can be inaccurate for LORs tangent to the patient boundary, external sources, e.g., a ring or annulus source, might be needed to give an accurate estimate of the attenuation gradient for such LORs. The attenuation estimation from TOF-PET emission histo-images is demonstrated using simulated 2D TOF-PET data. PMID:26267223

  2. Transmission-less attenuation estimation from time-of-flight PET histo-images using consistency equations

    NASA Astrophysics Data System (ADS)

    Li, Yusheng; Defrise, Michel; Metzler, Scott D.; Matej, Samuel

    2015-08-01

    In positron emission tomography (PET) imaging, attenuation correction with accurate attenuation estimation is crucial for quantitative patient studies. Recent research showed that the attenuation sinogram can be determined up to a scaling constant utilizing the time-of-flight information. The TOF-PET data can be naturally and efficiently stored in a histo-image without information loss, and the radioactive tracer distribution can be efficiently reconstructed using the DIRECT approaches. In this paper, we explore transmission-less attenuation estimation from TOF-PET histo-images. We first present the TOF-PET histo-image formation and the consistency equations in the histo-image parameterization, then we derive a least-squares solution for estimating the directional derivatives of the attenuation factors from the measured emission histo-images. Finally, we present a fast solver to estimate the attenuation factors from their directional derivatives using the discrete sine transform and fast Fourier transform while considering the boundary conditions. We find that the attenuation histo-images can be uniquely determined from the TOF-PET histo-images by considering boundary conditions. Since the estimate of the attenuation directional derivatives can be inaccurate for LORs tangent to the patient boundary, external sources, e.g. a ring or annulus source, might be needed to give an accurate estimate of the attenuation gradient for such LORs. The attenuation estimation from TOF-PET emission histo-images is demonstrated using simulated 2D TOF-PET data.

  3. Reconstruction of Rift Valley fever transmission dynamics in Madagascar: estimation of force of infection from seroprevalence surveys using Bayesian modelling

    PubMed Central

    Olive, Marie-Marie; Grosbois, Vladimir; Tran, Annelise; Nomenjanahary, Lalaina Arivony; Rakotoarinoro, Mihaja; Andriamandimby, Soa-Fy; Rogier, Christophe; Heraud, Jean-Michel; Chevalier, Veronique

    2017-01-01

    The force of infection (FOI) is one of the key parameters describing the dynamics of transmission of vector-borne diseases. Following the occurrence of two major outbreaks of Rift Valley fever (RVF) in Madagascar in 1990–91 and 2008–09, recent studies suggest that the pattern of RVF virus (RVFV) transmission differed among the four main eco-regions (East, Highlands, North-West and South-West). Using Bayesian hierarchical models fitted to serological data from cattle of known age collected during two surveys (2008 and 2014), we estimated RVF FOI and described its variations over time and space in Madagascar. We show that the patterns of RVFV transmission strongly differed among the eco-regions. In the North-West and Highlands regions, these patterns were synchronous with a high intensity in mid-2007/mid-2008. In the East and South-West, the peaks of transmission were later, between mid-2008 and mid-2010. In the warm and humid northwestern eco-region favorable to mosquito populations, RVFV is probably transmitted all year-long at low-level during inter-epizootic period allowing its maintenance and being regularly introduced in the Highlands through ruminant trade. The RVF surveillance of animals of the northwestern region could be used as an early warning indicator of an increased risk of RVF outbreak in Madagascar. PMID:28051125

  4. Reconstruction of Rift Valley fever transmission dynamics in Madagascar: estimation of force of infection from seroprevalence surveys using Bayesian modelling.

    PubMed

    Olive, Marie-Marie; Grosbois, Vladimir; Tran, Annelise; Nomenjanahary, Lalaina Arivony; Rakotoarinoro, Mihaja; Andriamandimby, Soa-Fy; Rogier, Christophe; Heraud, Jean-Michel; Chevalier, Veronique

    2017-01-04

    The force of infection (FOI) is one of the key parameters describing the dynamics of transmission of vector-borne diseases. Following the occurrence of two major outbreaks of Rift Valley fever (RVF) in Madagascar in 1990-91 and 2008-09, recent studies suggest that the pattern of RVF virus (RVFV) transmission differed among the four main eco-regions (East, Highlands, North-West and South-West). Using Bayesian hierarchical models fitted to serological data from cattle of known age collected during two surveys (2008 and 2014), we estimated RVF FOI and described its variations over time and space in Madagascar. We show that the patterns of RVFV transmission strongly differed among the eco-regions. In the North-West and Highlands regions, these patterns were synchronous with a high intensity in mid-2007/mid-2008. In the East and South-West, the peaks of transmission were later, between mid-2008 and mid-2010. In the warm and humid northwestern eco-region favorable to mosquito populations, RVFV is probably transmitted all year-long at low-level during inter-epizootic period allowing its maintenance and being regularly introduced in the Highlands through ruminant trade. The RVF surveillance of animals of the northwestern region could be used as an early warning indicator of an increased risk of RVF outbreak in Madagascar.

  5. Focusing the HIV response through estimating the major modes of HIV transmission: a multi-country analysis

    PubMed Central

    Gouws, Eleanor; Cuchi, Paloma

    2012-01-01

    Objective An increasing number of countries have been estimating the distribution of new adult HIV infections by modes of transmission (MOT) to help prioritise prevention efforts. We compare results from studies conducted between 2008 and 2012 and discuss their use for planning and responding to the HIV epidemic. Methods The UNAIDS recommended MOT model helps countries to estimate the proportion of new HIV infections that occur through key transmission modes including sex work, injecting drug use (IDU), men having sex with men (MSM), multiple sexual partnerships, stable relationships and medical interventions. The model typically forms part of a country-led process that includes a comprehensive review of epidemiological data. Recent revisions to the model are described. Results Modelling results from 25 countries show large variation between and within regions. In sub-Saharan Africa, new infections occur largely in the general heterosexual population because of multiple partnerships or in stable discordant relationships, while sex work contributes significantly to new infections in West Africa. IDU and sex work are the main contributors to new infections in the Middle East and North Africa, with MSM the main contributor in Latin America. Patterns vary substantially between countries in Eastern Europe and Asia in terms of the relative contribution of sex work, MSM, IDU and spousal transmission. Conclusions The MOT modelling results, comprehensive review and critical assessment of data in a country can contribute to a more strategically focused HIV response. To strengthen this type of research, improved epidemiological and behavioural data by risk population are needed. PMID:23172348

  6. Application of expectation maximization to x-ray spectrum estimation for medical accelerators from transmission data

    NASA Astrophysics Data System (ADS)

    Sidky, Emil Y.; Yu, Lifeng; Pan, Xiaochuan

    2004-05-01

    Accurate computation of dose delivered to the patient depends on knowledge of the x-ray spectrum of therapy, x-ray beams. This work applies the expectation-maximization (EM) method to the problem of reconstructing the x-ray source spectrum from transmission data of Aluminum and Lead. The proposed EM method is compared to an algebraic approach for solving the corresponding linear system of equations.

  7. Prevention, diagnosis, and treatment of tuberculosis in children and mothers: evidence for action for maternal, neonatal, and child health services.

    PubMed

    Getahun, Haileyesus; Sculier, Delphine; Sismanidis, Charalambos; Grzemska, Malgorzata; Raviglione, Mario

    2012-05-15

    Tuberculosis affected an estimated 8.8 million people and caused 1.4 million deaths globally in 2010, including a half-million women and at least 64 000 children. It also results in nearly 10 million cumulative orphans due to parental deaths. Moreover, it causes 6%-15% of all maternal mortality, which increases to 15%-34% if only indirect causes are considered. Increasingly, more women with tuberculosis are notified than men in settings with a high prevalence of human immunodeficiency virus (HIV), and maternal tuberculosis increases the vertical transmission of HIV. Tuberculosis prevention, diagnosis, and treatment services should be included as key interventions in the integrated management of pregnancy and child health. Tuberculosis screening using a simple clinical algorithm that relies on the absence of current cough, fever, weight loss, and night sweats should be used to identify eligible pregnant women living with HIV for isoniazid preventive therapy or for further investigation for tuberculosis disease as part of services for prevention of vertical HIV transmission. While implementing these simple, low-cost, effective interventions as part of maternal, neonatal, and child health services, the unmet basic and operational tuberculosis research needs of children, pregnant, and breastfeeding women should be addressed. National policy makers, program managers, and international stakeholders (eg, United Nations bodies, donors, and implementers) working on maternal, neonatal, and child health, especially in HIV-prevalent settings, should give due attention and include tuberculosis prevention, diagnosis, and treatment services as part of their core functions and address the public health impacts of tuberculosis in their programs and services.

  8. Surveillance of Bovine Tuberculosis and Risk Estimation of a Future Reservoir Formation in Wildlife in Switzerland and Liechtenstein

    PubMed Central

    Schöning, Janne Marie; Cerny, Nadine; Prohaska, Sarah; Wittenbrink, Max M.; Smith, Noel H.; Bloemberg, Guido; Pewsner, Mirjam; Schiller, Irene; Origgi, Francesco C.; Ryser-Degiorgis, Marie-Pierre

    2013-01-01

    Bovine tuberculosis (bTB) caused by Mycobacterium bovis or M. caprae has recently (re-) emerged in livestock and wildlife in all countries bordering Switzerland (CH) and the Principality of Liechtenstein (FL). Comprehensive data for Swiss and Liechtenstein wildlife are not available so far, although two native species, wild boar (Sus scrofa) and red deer (Cervus elaphus elaphus), act as bTB reservoirs elsewhere in continental Europe. Our aims were (1) to assess the occurrence of bTB in these wild ungulates in CH/FL and to reinforce scanning surveillance in all wild mammals; (2) to evaluate the risk of a future bTB reservoir formation in wild boar and red deer in CH/FL. Tissue samples collected from 2009 to 2011 from 434 hunted red deer and wild boar and from eight diseased ungulates with tuberculosis-like lesions were tested by direct real-time PCR and culture to detect mycobacteria of the Mycobacterium tuberculosis complex (MTBC). Identification of suspicious colonies was attempted by real-time PCR, genotyping and spoligotyping. Information on risk factors for bTB maintenance within wildlife populations was retrieved from the literature and the situation regarding identified factors was assessed for our study areas. Mycobacteria of the MTBC were detected in six out of 165 wild boar (3.6%; 95% CI: 1.4–7.8) but none of the 269 red deer (0%; 0–1.4). M. microti was identified in two MTBC-positive wild boar, while species identification remained unsuccessful in four cases. Main risk factors for bTB maintenance worldwide, including different causes of aggregation often resulting from intensive wildlife management, are largely absent in CH and FL. In conclusion, M. bovis and M. caprae were not detected but we report for the first time MTBC mycobacteria in Swiss wild boar. Present conditions seem unfavorable for a reservoir emergence, nevertheless increasing population numbers of wild ungulates and offal consumption may represent a risk. PMID:23349839

  9. Molecular Epidemiology of Tuberculosis: Current Insights

    PubMed Central

    Mathema, Barun; Kurepina, Natalia E.; Bifani, Pablo J.; Kreiswirth, Barry N.

    2006-01-01

    Molecular epidemiologic studies of tuberculosis (TB) have focused largely on utilizing molecular techniques to address short- and long-term epidemiologic questions, such as in outbreak investigations and in assessing the global dissemination of strains, respectively. This is done primarily by examining the extent of genetic diversity of clinical strains of Mycobacterium tuberculosis. When molecular methods are used in conjunction with classical epidemiology, their utility for TB control has been realized. For instance, molecular epidemiologic studies have added much-needed accuracy and precision in describing transmission dynamics, and they have facilitated investigation of previously unresolved issues, such as estimates of recent-versus-reactive disease and the extent of exogenous reinfection. In addition, there is mounting evidence to suggest that specific strains of M. tuberculosis belonging to discrete phylogenetic clusters (lineages) may differ in virulence, pathogenesis, and epidemiologic characteristics, all of which may significantly impact TB control and vaccine development strategies. Here, we review the current methods, concepts, and applications of molecular approaches used to better understand the epidemiology of TB. PMID:17041139

  10. A nonlinear programming approach for estimation of transmission parameters in childhood infectious disease using a continuous time model

    PubMed Central

    Word, Daniel P.; Cummings, Derek A. T.; Burke, Donald S.; Iamsirithaworn, Sopon; Laird, Carl D.

    2012-01-01

    Mathematical models can enhance our understanding of childhood infectious disease dynamics, but these models depend on appropriate parameter values that are often unknown and must be estimated from disease case data. In this paper, we develop a framework for efficient estimation of childhood infectious disease models with seasonal transmission parameters using continuous differential equations containing model and measurement noise. The problem is formulated using the simultaneous approach where all state variables are discretized, and the discretized differential equations are included as constraints, giving a large-scale algebraic nonlinear programming problem that is solved using a nonlinear primal–dual interior-point solver. The technique is demonstrated using measles case data from three different locations having different school holiday schedules, and our estimates of the seasonality of the transmission parameter show strong correlation to school term holidays. Our approach gives dramatic efficiency gains, showing a 40–400-fold reduction in solution time over other published methods. While our approach has an increased susceptibility to bias over techniques that integrate over the entire unknown state-space, a detailed simulation study shows no evidence of bias. Furthermore, the computational efficiency of our approach allows for investigation of a large model space compared with more computationally intensive approaches. PMID:22337634

  11. A nonlinear programming approach for estimation of transmission parameters in childhood infectious disease using a continuous time model.

    PubMed

    Word, Daniel P; Cummings, Derek A T; Burke, Donald S; Iamsirithaworn, Sopon; Laird, Carl D

    2012-08-07

    Mathematical models can enhance our understanding of childhood infectious disease dynamics, but these models depend on appropriate parameter values that are often unknown and must be estimated from disease case data. In this paper, we develop a framework for efficient estimation of childhood infectious disease models with seasonal transmission parameters using continuous differential equations containing model and measurement noise. The problem is formulated using the simultaneous approach where all state variables are discretized, and the discretized differential equations are included as constraints, giving a large-scale algebraic nonlinear programming problem that is solved using a nonlinear primal-dual interior-point solver. The technique is demonstrated using measles case data from three different locations having different school holiday schedules, and our estimates of the seasonality of the transmission parameter show strong correlation to school term holidays. Our approach gives dramatic efficiency gains, showing a 40-400-fold reduction in solution time over other published methods. While our approach has an increased susceptibility to bias over techniques that integrate over the entire unknown state-space, a detailed simulation study shows no evidence of bias. Furthermore, the computational efficiency of our approach allows for investigation of a large model space compared with more computationally intensive approaches.

  12. Burden of tuberculosis in Kampala, Uganda.

    PubMed Central

    Guwatudde, David; Zalwango, Sarah; Kamya, Moses R.; Debanne, Sara M.; Diaz, Mireya I.; Okwera, Alphonse; Mugerwa, Roy D.; King, Charles; Whalen, Christopher C.

    2003-01-01

    OBJECTIVE: To determine the prevalence and incidence of tuberculosis in one of Uganda's poor peri-urban areas. METHODS: Multi-stage sampling was used to select a sample of households whose members were evaluated for presence of signs and/or symptoms of active tuberculosis; history of tuberculosis treatment; and relevant demographic, socioeconomic, and household environment characteristics. Patients with suspected tuberculosis underwent standardized evaluation for active disease. FINDINGS: A sample of 263 households with 1142 individuals was evaluated. Nineteen people were classified as having had tuberculosis during the one-year reference period (May 2001-April 2002): nine (47%) cases already had been diagnosed through the health care system, while 10 cases (53%) were diagnosed through the survey. The prevalences for all forms of tuberculosis and for sputum smear-positive tuberculosis were 14.0 (95% confidence interval (CI) 7.8-20.3) and 4.4 (CI = 0.83-7.89) per thousand, respectively. The incidences for all forms of tuberculosis and for sputum smear-positive tuberculosis were 9.2 (CI = 3.97-14.4) and 3.7 (CI = 0.39-6.95) per thousand per year, respectively. CONCLUSION: The rate of tuberculosis in this peri-urban community was exceptionally high and may be underestimated by current surveillance systems. The need for interventions aimed at reducing tuberculosis transmission in this, and other similar communities with high case rates, is urgent. PMID:14758406

  13. Imposing nonlinear constraints when estimating genetic and cultural transmission under assortative mating: a simulation study using Mx and BUGS.

    PubMed

    van den Berg, Stéphanie M

    2009-01-01

    Modeling both genetic and cultural transmission in parent-offspring data in the presence of phenotypic assortment requires the imposition of nonlinear constraints. This article reports a simulation study that determined how well the structural equation modeling software package Mx and the Bayesian-oriented BUGS software package can handle such nonlinear constraints under various conditions. Results generally showed good and comparable results for Mx and BUGS, although BUGS was much slower than Mx. However, since BUGS uses Markov-chain Monte Carlo estimation it could be used for parent-offspring models with non-normal data and/or item-response theory models.

  14. [Strategical use of genotyping of Mycobacterium tuberculosis in tuberculosis control].

    PubMed

    David, Susana

    2008-01-01

    The tuberculosis situation in Portugal justifies the use of a strategy for the genotyping of Mycobacterium tuberculosis, particularly as Portugal is part of the global backdrop of human mobility, something which has a knock-on effect on the pandemic. Several international studies have placed spoligotyping and MIRU- VNTR typing as first line techniques for the molecular epidemiology of Mycobacterium tuberculosis as these techniques rely on simple technologies (PCR) and produce patterns which are easily translated into a direct interpretation numerical code. Spoligotyping has been accordingly proposed for all the isolates, while MIRU-VNTR typing should be applied to isolates with a common spoliotype. Other techniques, including IS6110-RFLP, should be reserved for use ill accordance with selected criteria. Previous studies in Portugal using spoligotyping have underlined the advantages of a strategy based on sampling consecutive patient isolates with no prior selection criteria. This allows characterisation of the M. tuberculosis population structure through monitoring the distribution of the genotypes geographically over time and within the various risk groups. On the other hand, the association of spoligotyping, MIRU-VNTF (typing and, possibly, other techniques, needs evaluating as part of bigger pictures, including identifying recent transmission situations, distinguishing between reinfection and relapse episodes and mapping the size and dynamics of disease transmission. The solution to the tuberculosis problem in Portugal implies structuring genotyping's role in tuberculosis prevention and control and its evaluation through concrete examples and results.

  15. Prevalence of tuberculosis in pigs slaughtered at two abattoirs in Ethiopia and molecular characterization of Mycobacterium tuberculosis isolated from tuberculous-like lesions in pigs.

    PubMed

    Arega, Sintayehu Mulugeta; Conraths, Franz Josef; Ameni, Gobena

    2013-05-06

    Tuberculosis (TB) is an infectious, granulomatous disease caused by acid-fast bacilli of the genus Mycobacterium. The disease affects practically all species of vertebrates. Although mammalian tuberculosis has been nearly controlled in many developed countries, it is still a serious problem in humans and domestic animals including pigs in developing countries. In Ethiopia, the prevalence of TB in pigs is not known. Therefore, this study was designed to estimate the prevalence of TB in pigs in central Ethiopia and to characterize the causative agents using molecular techniques. The estimated prevalence of TB was 5.8% (49/841). Age and origin of pigs were significantly associated (P<0.001) with the prevalence. In contrast, an association of sex, floor type and water source with the prevalence could not be shown. Culture positivity was confirmed in 30.6% (15/49) of the tuberculous-like lesions. Of the 15 isolates, 12 were acid fast positive while five of the latter were confirmed by multiplex PCR as members of the M. tuberculosis complex. Speciation of the five isolates further confirmed that they were M. tuberculosis, belonging to SIT1088 (two isolates) and SIT1195 (one isolate). The remaining two isolates belong to an identical spoligotype, the pattern of which was not found in the spoligotype database (SpolDB4). The isolation of M. tuberculosis from pigs suggests a possible risk of transmission between humans and pigs. Hence, establishing feasible control methods is required.

  16. Prevalence of tuberculosis in pigs slaughtered at two abattoirs in Ethiopia and molecular characterization of Mycobacterium tuberculosis isolated from tuberculous-like lesions in pigs

    PubMed Central

    2013-01-01

    Background Tuberculosis (TB) is an infectious, granulomatous disease caused by acid-fast bacilli of the genus Mycobacterium. The disease affects practically all species of vertebrates. Although mammalian tuberculosis has been nearly controlled in many developed countries, it is still a serious problem in humans and domestic animals including pigs in developing countries. In Ethiopia, the prevalence of TB in pigs is not known. Therefore, this study was designed to estimate the prevalence of TB in pigs in central Ethiopia and to characterize the causative agents using molecular techniques. Results The estimated prevalence of TB was 5.8% (49/841). Age and origin of pigs were significantly associated (P<0.001) with the prevalence. In contrast, an association of sex, floor type and water source with the prevalence could not be shown. Culture positivity was confirmed in 30.6% (15/49) of the tuberculous-like lesions. Of the 15 isolates, 12 were acid fast positive while five of the latter were confirmed by multiplex PCR as members of the M. tuberculosis complex. Speciation of the five isolates further confirmed that they were M. tuberculosis, belonging to SIT1088 (two isolates) and SIT1195 (one isolate). The remaining two isolates belong to an identical spoligotype, the pattern of which was not found in the spoligotype database (SpolDB4). Conclusions The isolation of M. tuberculosis from pigs suggests a possible risk of transmission between humans and pigs. Hence, establishing feasible control methods is required. PMID:23647845

  17. Estimation of Sensitivity and Specificity of Bacteriology, Histopathology and PCR for the Confirmatory Diagnosis of Bovine Tuberculosis Using Latent Class Analysis

    PubMed Central

    Brugère, Laure; Faye, Sandy; Hénault, Sylvie; Gares, Hélène; Boschiroli, Maria-Laura

    2014-01-01

    Bacteriology and histopathology are the most commonly used tests used for official confirmatory diagnosis of bovine tuberculosis (bTB) in cattle in most countries. PCR is also being used increasingly because it allows a fast diagnosis. This test could be applied as a supplement to or replacement for current bTB confirmatory diagnostic tests but its characteristics have first to be evaluated. The aim of this study was to estimate and compare sensitivities and specificities of bacteriology, histopathology and PCR under French field conditions, in the absence of a gold standard using latent class analysis. The studied population consisted of 5,211 animals from which samples were subjected to bacteriology and PCR (LSI VetMAX™ Mycobacterium tuberculosis Complex PCR Kit, Life Technologies) as their herd of origin was either suspected or confirmed infected with bTB or because bTB-like lesions were detected during slaughterhouse inspection. Samples from 697 of these animals (all with bTB-like lesions) were subjected to histopathology. Bayesian models were developed, allowing for dependence between bacteriology and PCR, while assuming independence from histopathology. The sensitivity of PCR was higher than that of bacteriology (on average 87.7% [82.5–92.3%] versus 78.1% [72.9–82.8%]) while specificity of both tests was very good (on average 97.0% for PCR [94.3–99.0%] and 99.1% for bacteriology [97.1–100.0%]). Histopathology was at least as sensitive as PCR (on average 93.6% [89.9–96.9%]) but less specific than the two other tests (on average 83.3% [78.7–87.6%]). These results suggest that PCR has the potential to replace bacteriology to confirm bTB in samples submitted from suspect cattle. PMID:24625670

  18. Malaria vectors in the Bioko Island (Equatorial Guinea): estimation of vector dynamics and transmission intensities.

    PubMed

    Cano, J; Berzosa, P J; Roche, J; Rubio, J M; Moyano, E; Guerra-Neira, A; Brochero, H; Mico, M; Edú, M; Benito, A

    2004-03-01

    The current study was performed on the Bioko Island (Equatorial Guinea) with the aim of establishing a rapid assessment technique for mapping malaria risk and measuring vector densities. Human bait collection, tent traps, light traps, indoor resting collection, and window exit traps were used to collect Anopheles gambiae s.s. and Anopheles funestus, the two anopheline species involved in malaria transmission in this island. Capture data were used to compare differences in the behavior and vectorial capacity of An. gambiae s.s. and An. funestus. Differences in the two species of mosquitoes were found in relation to the season and trapping methods used. Entomological inoculation rates (EIR) for Plasmodium falciparum were calculated using a polymerase chain reaction (PCR) test with individual anopheline mosquitoes from human bait collections in two villages during the dry and rainy seasons. P. falciparum sporozoites were detected from both dissected heads/thorax and abdomens of both species.

  19. Estimating the Basic Reproductive Number (R0) for African Swine Fever Virus (ASFV) Transmission between Pig Herds in Uganda.

    PubMed

    Barongo, Mike B; Ståhl, Karl; Bett, Bernard; Bishop, Richard P; Fèvre, Eric M; Aliro, Tony; Okoth, Edward; Masembe, Charles; Knobel, Darryn; Ssematimba, Amos

    2015-01-01

    African swine fever (ASF) is a highly contagious, lethal and economically devastating haemorrhagic disease of domestic pigs. Insights into the dynamics and scale of virus transmission can be obtained from estimates of the basic reproduction number (R0). We estimate R0 for ASF virus in small holder, free-range pig production system in Gulu, Uganda. The estimation was based on data collected from outbreaks that affected 43 villages (out of the 289 villages with an overall pig population of 26,570) between April 2010 and November 2011. A total of 211 outbreaks met the criteria for inclusion in the study. Three methods were used, specifically; (i) GIS- based identification of the nearest infectious neighbour based on the Euclidean distance between outbreaks, (ii) epidemic doubling time, and (iii) a compartmental susceptible-infectious (SI) model. For implementation of the SI model, three approaches were used namely; curve fitting (CF), a linear regression model (LRM) and the SI/N proportion. The R0 estimates from the nearest infectious neighbour and epidemic doubling time methods were 3.24 and 1.63 respectively. Estimates from the SI-based method were 1.58 for the CF approach, 1.90 for the LRM, and 1.77 for the SI/N proportion. Since all these values were above one, they predict the observed persistence of the virus in the population. We hypothesize that the observed variation in the estimates is a consequence of the data used. Higher resolution and temporally better defined data would likely reduce this variation. This is the first estimate of R0 for ASFV in a free range smallholder pig keeping system in sub-Saharan Africa and highlights the requirement for more efficient application of available disease control measures.

  20. Comparative analysis estimates the relative frequencies of co-divergence and cross-species transmission within viral families

    PubMed Central

    Geoghegan, Jemma L.

    2017-01-01

    The cross-species transmission of viruses from one host species to another is responsible for the majority of emerging infections. However, it is unclear whether some virus families have a greater propensity to jump host species than others. If related viruses have an evolutionary history of co-divergence with their hosts there should be evidence of topological similarities between the virus and host phylogenetic trees, whereas host jumping generates incongruent tree topologies. By analyzing co-phylogenetic processes in 19 virus families and their eukaryotic hosts we provide a quantitative and comparative estimate of the relative frequency of virus-host co-divergence versus cross-species transmission among virus families. Notably, our analysis reveals that cross-species transmission is a near universal feature of the viruses analyzed here, with virus-host co-divergence occurring less frequently and always on a subset of viruses. Despite the overall high topological incongruence among virus and host phylogenies, the Hepadnaviridae, Polyomaviridae, Poxviridae, Papillomaviridae and Adenoviridae, all of which possess double-stranded DNA genomes, exhibited more frequent co-divergence than the other virus families studied here. At the other extreme, the virus and host trees for all the RNA viruses studied here, particularly the Rhabdoviridae and the Picornaviridae, displayed high levels of topological incongruence, indicative of frequent host switching. Overall, we show that cross-species transmission plays a major role in virus evolution, with all the virus families studied here having the potential to jump host species, and that increased sampling will likely reveal more instances of host jumping. PMID:28178344

  1. Promising drugs against tuberculosis.

    PubMed

    de Souza, Marcus Vinícius Nora

    2006-01-01

    Tuberculosis (TB) is an important public health problem worldwide due to AIDS epidemic, the advent of multidrug resistant strains (MDR) and the lack of new drugs in the market. TB is responsible for almost 3 millions deaths each year. According to WHO (World Health Organization), which declared tuberculosis a global health emergency in 1993, tuberculosis, without a coordinated control effort, will infect an estimated 1 billion people by 2020, killing 70 million. In spite of this problem, there is a lack of development of new TB drugs. For example, it has been nearly 35 years since the introduction of a new class of compounds for the treatment of TB. Thus, there is an urgent need for new drugs to fight against this disease. Considering that, this review aims promising drug candidates that are in development against TB.

  2. Immunophoretic rapid diagnostic tests as a source of immunoglobulins for estimating malaria sero-prevalence and transmission intensity.

    PubMed

    Williams, Geoffrey S; Mweya, Clement; Stewart, Laveta; Mtove, George; Reyburn, Hugh; Cook, Jackie; Corran, Patrick H; Riley, Eleanor M; Drakeley, Chris J

    2009-07-22

    Sero-epidemiological methods are being developed as a tool for rapid assessment of malaria transmission intensity. Simple blood collection methods for use in field settings will make this more feasible. This paper describes validation of such a method, by analysing immunoglobulins from blood retained within immunophoretic rapid diagnostic tests (RDTs) for Plasmodium falciparum. RDTs are now widely used for the diagnosis of malaria and estimation of parasite rates, and this method represents a further use for these devices in malaria control. Immunoglobulins eluted from RDTs, designed to detect parasite histidine rich protein-2 (HRP-2), were analysed by indirect ELISA for IgG recognizing the P. falciparum blood stage antigens merozoite surface protein-1(19) (MSP-1(19)) and apical membrane antigen-1 (AMA-1). Optimal storage conditions for RDTs were evaluated by comparing antibody responses from RDTs stored in dry or humid conditions at 4 degrees C or at ambient temperature (with or without air-conditioning) for 7, 31 or 70 days. Antibody levels estimated using 3,700 RDT samples from attendees at health facilities in North-eastern Tanzania were compared with contemporaneously collected filter paper blood spots (FPBS) and used to estimate seroconversion rates. Storage of RDTs at 4 degrees C was optimal for immunoglobulin recovery but short-term storage at ambient temperatures did not substantially affect anti-malarial IgG levels. Results from RDTs were comparable with those from FPBSs, for both antigens. RDT-generated titres tended to be slightly higher than those generated from FPBSs, possibly due to greater recovery of immunoglobulins from RDTs compared to filter paper. Importantly, however, RDT-based seroconversion rates, and hence serological estimates of malaria transmission intensity, agreed closely with those from FPBSs. RDTs represent a practical option for collecting blood for sero-epidemiological surveys, with potential cost and logistical advantages over

  3. Immunophoretic rapid diagnostic tests as a source of immunoglobulins for estimating malaria sero-prevalence and transmission intensity

    PubMed Central

    Williams, Geoffrey S; Mweya, Clement; Stewart, Laveta; Mtove, George; Reyburn, Hugh; Cook, Jackie; Corran, Patrick H; Riley, Eleanor M; Drakeley, Chris J

    2009-01-01

    Background Sero-epidemiological methods are being developed as a tool for rapid assessment of malaria transmission intensity. Simple blood collection methods for use in field settings will make this more feasible. This paper describes validation of such a method, by analysing immunoglobulins from blood retained within immunophoretic rapid diagnostic tests (RDTs) for Plasmodium falciparum. RDTs are now widely used for the diagnosis of malaria and estimation of parasite rates, and this method represents a further use for these devices in malaria control. Methods Immunoglobulins eluted from RDTs, designed to detect parasite histidine rich protein-2 (HRP-2), were analysed by indirect ELISA for IgG recognizing the P. falciparum blood stage antigens merozoite surface protein-119 (MSP-119) and apical membrane antigen-1 (AMA-1). Optimal storage conditions for RDTs were evaluated by comparing antibody responses from RDTs stored in dry or humid conditions at 4°C or at ambient temperature (with or without air-conditioning) for 7, 31 or 70 days. Antibody levels estimated using 3,700 RDT samples from attendees at health facilities in North-eastern Tanzania were compared with contemporaneously collected filter paper blood spots (FPBS) and used to estimate seroconversion rates. Results Storage of RDTs at 4°C was optimal for immunoglobulin recovery but short-term storage at ambient temperatures did not substantially affect anti-malarial IgG levels. Results from RDTs were comparable with those from FPBSs, for both antigens. RDT-generated titres tended to be slightly higher than those generated from FPBSs, possibly due to greater recovery of immunoglobulins from RDTs compared to filter paper. Importantly, however, RDT-based seroconversion rates, and hence serological estimates of malaria transmission intensity, agreed closely with those from FPBSs. Conclusion RDTs represent a practical option for collecting blood for sero-epidemiological surveys, with potential cost and logistical

  4. Deriving an estimate for the Fried parameter in mobile optical transmission scenarios.

    PubMed

    Giggenbach, Dirk

    2011-01-10

    Measuring the Fried parameter r(0) (atmospheric optical coherence length) in optical link scenarios is crucial to estimate a receiver's telescope performance or to dimension atmospheric mitigation techniques, such as in adaptive optics. The task of measuring r(0) is aggravated in mobile scenarios, when the receiver itself is prone to mechanical vibrations (e.g., when mounted on a moving platform) or when the receiver telescope has to track a fast-moving signal source, such as, in our case, a laser transmitter on board a satellite or aircraft. We have derived a method for estimating r(0) that avoids the influence of angle-of-arrival errors by only using short-term tilt-removed focal intensity speckle patterns.

  5. Risk of tuberculosis among air passengers estimated by interferon gamma release assay: survey of contact investigations, Japan, 2012 to 2015

    PubMed Central

    Ota, Masaki; Kato, Seiya

    2017-01-01

    Although the World Health Organization recommends contact investigations around air travel-associated sputum smear-positive tuberculosis (TB) patients, evidence suggests that the information thus obtained may have overestimated the risk of TB infection because it involved some contacts born in countries with high TB burden who were likely to have been infected with TB in the past, or because tuberculin skin tests were used, which are less specific than the interferon gamma release assay (IGRA) particularly in areas where Bacillus Calmette-Guérin (BCG) vaccination coverage is high. We conducted a questionnaire survey on air travel-associated TB contact investigations in local health offices of Japan from 2012 to 2015, focusing on IGRA positivity. Among 651 air travel-associated TB contacts, average positivity was 3.8% (95% confidence interval (CI): 2.5–5.6) with a statistically significant increasing trend with older age (p < 0.0094). Positivity among 0–34 year-old contacts was 1.0% (95% CI: 0.12–3.5%), suggesting their risk of TB infection is as small as among Japanese young adults with low risk of TB infection (positivity: 0.85–0.90%). Limiting the contact investigation to fewer passengers (within two seats surrounding the index case, rather than two rows) seems reasonable in the case of aircraft with many seats per row. PMID:28367799

  6. Risk of tuberculosis among air passengers estimated by interferon gamma release assay: survey of contact investigations, Japan, 2012 to 2015.

    PubMed

    Ota, Masaki; Kato, Seiya

    2017-03-23

    Although the World Health Organization recommends contact investigations around air travel-associated sputum smear-positive tuberculosis (TB) patients, evidence suggests that the information thus obtained may have overestimated the risk of TB infection because it involved some contacts born in countries with high TB burden who were likely to have been infected with TB in the past, or because tuberculin skin tests were used, which are less specific than the interferon gamma release assay (IGRA) particularly in areas where Bacillus Calmette-Guérin (BCG) vaccination coverage is high. We conducted a questionnaire survey on air travel-associated TB contact investigations in local health offices of Japan from 2012 to 2015, focusing on IGRA positivity. Among 651 air travel-associated TB contacts, average positivity was 3.8% (95% confidence interval (CI): 2.5-5.6) with a statistically significant increasing trend with older age (p < 0.0094). Positivity among 0-34 year-old contacts was 1.0% (95% CI: 0.12-3.5%), suggesting their risk of TB infection is as small as among Japanese young adults with low risk of TB infection (positivity: 0.85-0.90%). Limiting the contact investigation to fewer passengers (within two seats surrounding the index case, rather than two rows) seems reasonable in the case of aircraft with many seats per row. This article is copyright of The Authors, 2017.

  7. Optical properties of amorphous HF-In-Zn-O thin films estimated from transmission spectra

    NASA Astrophysics Data System (ADS)

    Joon Shin, Hyun; Kang, Se-Jun; Yoon Baik, Jae; Lee, Ik-Jae; Singh, Palwinder; Thakur, Anup

    2015-05-01

    Amorphous and flat (<1 nm roughness) Hf-In-Zn-O thin films were prepared by radio frequency (rf) magnetron sputtering method at room temperature (RT) and at 300 °C substrate temperature. The crystal structure and surface morphology were investigated by high resolution X-ray diffraction (HR-XRD) and atomic force microscopy (AFM), respectively. Optical properties of these films were obtained from the UV-VIS-NIR transmission spectra, at normal incidence, over the 200-2000 nm spectral range. Swanepoel's method was used to calculate the thickness and the refractive index of the films. The dispersion of refractive index was obtained in terms of the single-oscillator Wemple-DiDomenico model. The optical absorption edge was described using the direct transition model proposed by Tauc. The film deposited at higher substrate temperature had lower optical band gap, higher refractive index, higher oscillator strength and energy of the effective dispersion oscillator. Optical characterization shows that films become more stable, relaxed and rigid at higher substrate temperature.

  8. Transmission FTIR derivative spectroscopy for estimation of furosemide in raw material and tablet dosage form

    PubMed Central

    Gallignani, Máximo; Rondón, Rebeca A.; Ovalles, José F.; Brunetto, María R.

    2014-01-01

    A Fourier transform infrared derivative spectroscopy (FTIR-DS) method has been developed for determining furosemide (FUR) in pharmaceutical solid dosage form. The method involves the extraction of FUR from tablets with N,N-dimethylformamide by sonication and direct measurement in liquid phase mode using a reduced path length cell. In general, the spectra were measured in transmission mode and the equipment was configured to collect a spectrum at 4 cm−1 resolution and a 13 s collection time (10 scans co-added). The spectra were collected between 1400 cm−1 and 450 cm−1. Derivative spectroscopy was used for data processing and quantitative measurement using the peak area of the second order spectrum of the major spectral band found at 1165 cm−1 (SO2 stretching of FUR) with baseline correction. The method fulfilled most validation requirements in the 2 mg/mL and 20 mg/mL range, with a 0.9998 coefficient of determination obtained by simple calibration model, and a general coefficient of variation <2%. The mean recovery for the proposed assay method resulted within the (100±3)% over the 80%–120% range of the target concentration. The results agree with a pharmacopoeial method and, therefore, could be considered interchangeable. PMID:26579407

  9. Transmission FTIR derivative spectroscopy for estimation of furosemide in raw material and tablet dosage form.

    PubMed

    Gallignani, Máximo; Rondón, Rebeca A; Ovalles, José F; Brunetto, María R

    2014-10-01

    A Fourier transform infrared derivative spectroscopy (FTIR-DS) method has been developed for determining furosemide (FUR) in pharmaceutical solid dosage form. The method involves the extraction of FUR from tablets with N,N-dimethylformamide by sonication and direct measurement in liquid phase mode using a reduced path length cell. In general, the spectra were measured in transmission mode and the equipment was configured to collect a spectrum at 4 cm(-1) resolution and a 13 s collection time (10 scans co-added). The spectra were collected between 1400 cm(-1) and 450 cm(-1). Derivative spectroscopy was used for data processing and quantitative measurement using the peak area of the second order spectrum of the major spectral band found at 1165 cm(-1) (SO2 stretching of FUR) with baseline correction. The method fulfilled most validation requirements in the 2 mg/mL and 20 mg/mL range, with a 0.9998 coefficient of determination obtained by simple calibration model, and a general coefficient of variation <2%. The mean recovery for the proposed assay method resulted within the (100±3)% over the 80%-120% range of the target concentration. The results agree with a pharmacopoeial method and, therefore, could be considered interchangeable.

  10. Tuberculosis in European badgers (Meles meles) and the control of infection with bacille Calmette-Guérin vaccination.

    PubMed

    Corner, L A L; Murphy, D; Costello, E; Gormley, E

    2009-10-01

    The eradication of tuberculosis (Mycobacterium bovis infection) from cattle herds may be compromised if infected wildlife species, such as European badgers (Meles meles), share the same environment and contribute to transfer of infection. Options for dealing with tuberculosis in this wild reservoir host are limited by conservation and social concerns, despite a clear implication that infected badgers are involved with the initiation of tuberculosis in cattle herds. Vaccination of badgers against M. bovis, if successfully employed, would directly facilitate the completion of bovine tuberculosis eradication in affected areas. Vaccine trials in captive badgers have established that the M. bovis bacille Calmette-Guérin (BCG) vaccine can induce a protective response that limits the distribution and severity of tuberculosis disease following experimental challenge. The protective effect of the vaccine has been demonstrated when the vaccine was delivered by subcutaneous injection, deposited on mucous membranes, and given orally in a lipid formulation. A large-scale field trial of oral BCG vaccine has been designed to measure the protection generated in wild badgers subjected to natural transmission of infection and to estimate vaccine efficacy. These parameters will be estimated by comparing the prevalence of M. bovis infection in vaccinated and nonvaccinated badgers. The results will provide a framework for the development and implementation of a national strategy to eliminate the disease in badger populations and if successful will remove this major impediment to bovine tuberculosis eradication.

  11. Equalization of nonlinear transmission impairments by maximum-likelihood-sequence estimation in digital coherent receivers.

    PubMed

    Khairuzzaman, Md; Zhang, Chao; Igarashi, Koji; Katoh, Kazuhiro; Kikuchi, Kazuro

    2010-03-01

    We describe a successful introduction of maximum-likelihood-sequence estimation (MLSE) into digital coherent receivers together with finite-impulse response (FIR) filters in order to equalize both linear and nonlinear fiber impairments. The MLSE equalizer based on the Viterbi algorithm is implemented in the offline digital signal processing (DSP) core. We transmit 20-Gbit/s quadrature phase-shift keying (QPSK) signals through a 200-km-long standard single-mode fiber. The bit-error rate performance shows that the MLSE equalizer outperforms the conventional adaptive FIR filter, especially when nonlinear impairments are predominant.

  12. Type curve and numerical solutions for estimation of Transmissivity and Storage coefficient with variable discharge condition

    NASA Astrophysics Data System (ADS)

    Zhang, Guowei

    2013-01-01

    SummaryMost of the coal mines of China are mining under the ground, so the artesian test which is one of the aquifer tests is conducted normally several hundred of meters below the earth surface. And the target aquifer is with very high hydraulic pressure, sometimes more than 3 MPa. Because of the high hydraulic pressure, it is most difficult to control the rate of flow out of the artesian well. Moreover, the velocity of flow out of the well cannot descend rapidly to zero, thus the analytical solution of Jacob and Lohman type curve for the artesian test will not be applicable. It is more reasonable if analyzing this test as a pumping test but with variable discharge. It is considered to rebuild that hydrogeological conceptual model in this paper. This conceptual model is similar with Theis model but with the variable discharge merely. And a general equation for any discharge variability is given. Its application for the linearly decreasing discharge is presented subsequently, and a type curve of this equation with linearly decreasing discharge will be given as well. Then a simple numerical model using FEFLOW will be built to simulate the linearly decreasing discharge from giving several different groups of the values of Transmissivity (T) and Storage coefficient (S). Both of them are much important hydrogeological parameters, and will be evaluated by using the type curve developed for this linear decreasing discharge well. The error between the given values of T and S in FEFLOW and the values of those calculated by matching point are much small. The solution gives really satisfactory values of these hydrogeological parameters.

  13. [Tuberculosis control].

    PubMed

    Schoch, Otto

    2011-07-01

    Tuberculosis control activities focus on identification and treatment of sputum smear positive tuberculosis patients. As soon as these patients can be treated, they not only have an optimal chance for cure, they also no longer spread Mycobacterium tuberculosis (M.tb) in the community. Screening is a systematic search for tuberculosis disease, often performed by radiological or by sputum smear examinations. On the other hand, Screening for Infection with M.tb is with immunological tests. Persons infected with M.tb have an increased risk to develop active tuberculosis in the future. Screening for infection is recommended in tuberculosis contact tracing and in several risk groups for the progression to tuberculosis disease, specifically before the start of immunosuppressive therapy with tumor necrosis factor antagonists or in transplant recipients. Several immunological tests are available. If compared to the traditional in vivo Mantoux tuberculin skin test, in vitro blood tests called Interferon Gamma Release Assays (IGRA) are more specific because the cell wall antigens used for the tests are not present in the wall of Bacille Calmitte Guerin BCG and most atypical mycobacteria. Another advantage of IGRA is the mitogen positive control, which detects unreliable tests in immunodeficiency. Persons found to be infected with M.tb are treated with prophylactic isoniacid for 9 months.

  14. Estimation, transmission, and distribution of motion information in future image communication networks

    NASA Astrophysics Data System (ADS)

    Chupeau, Bertrand

    1993-10-01

    There is no doubt that in a near future a large number of image processing techniques will be based on motion compensation, making thus very common the cascading of several 'motion compensated' devices in the same image chain. A reference scheme for the optimum use of motion compensation in future image communication networks is presented. Motion estimation is performed once only, at a very early stage of the process chain, then motion information is encoded, transmitted in a separate data channel and distributed to the cascaded motion compensated processes. The distribution scenario must take into consideration the various transformations performed on the image signal since its origination so that the motion information distributed is always consistent with the pictures to process. The problems of the representation of motion relatively to a given source image signal and of its adjustment to new frame rate environments are especially addressed.

  15. Nonlinear mitigation using carrier phase estimation and digital backward propagation in coherent QAM transmission.

    PubMed

    Lin, Chien-Yu; Asif, Rameez; Holtmannspoetter, Michael; Schmauss, Bernhard

    2012-12-10

    We investigate the performance of carrier phase estimation (CPE) and digital backward propagation (DBP) in compensating fiber nonlinearity for 224 Gbps polarization-multiplexed quadrature-amplitude-modulation coherent systems with level of 4 and 16 (PM-4-QAM and PM-16-QAM) over standard single-mode fiber (SSMF) uncompensated link. The results from numerical simulation show the individual performance of CPE and DBP as well as their mutual influence. With DBP compensation, required CPE tap number for optimal performance can be reduced by 50% for 4-QAM signal and 67% for 16-QAM signal compared to linear compensation. On the other hand, employing CPE compensation after DBP also allows to reduce DBP steps. In the mentioned PM-16-QAM system, 60% reduction in the required number of DBP steps to achieve BER=10(-3) is possible, with a step-size of 200 km, which reveals great potential to reduce the complexity for future real time implementation.

  16. Transmission map estimation of weather-degraded images using a hybrid of recurrent fuzzy cerebellar model articulation controller and weighted strategy

    NASA Astrophysics Data System (ADS)

    Wang, Jyun-Guo; Tai, Shen-Chuan; Lin, Cheng-Jian

    2016-08-01

    This study proposes a hybrid of a recurrent fuzzy cerebellar model articulation controller (RFCMAC) and a weighted strategy for solving single-image visibility in a degraded image. The proposed RFCMAC model is used to estimate the transmission map. The average value of the brightest 1% in a hazy image is calculated for atmospheric light estimation. A new adaptive weighted estimation is then used to refine the transmission map and remove the halo artifact from the sharp edges. Experimental results show that the proposed method has better dehazing capability compared to state-of-the-art techniques and is suitable for real-world applications.

  17. Estimating the Effectiveness of Isolation and Decolonization Measures in Reducing Transmission of Methicillin-resistant Staphylococcus aureus in Hospital General Wards

    PubMed Central

    Worby, Colin J.; Jeyaratnam, Dakshika; Robotham, Julie V.; Kypraios, Theodore; O'Neill, Philip D.; De Angelis, Daniela; French, Gary; Cooper, Ben S.

    2013-01-01

    Infection control for hospital pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) often takes the form of a package of interventions, including the use of patient isolation and decolonization treatment. Such interventions, though widely used, have generated controversy because of their significant resource implications and the lack of robust evidence with regard to their effectiveness at reducing transmission. The aim of this study was to estimate the effectiveness of isolation and decolonization measures in reducing MRSA transmission in hospital general wards. Prospectively collected MRSA surveillance data from 10 general wards at Guy's and St. Thomas' hospitals, London, United Kingdom, in 2006–2007 were used, comprising 14,035 patient episodes. Data were analyzed with a Markov chain Monte Carlo algorithm to model transmission dynamics. The combined effect of isolation and decolonization was estimated to reduce transmission by 64% (95% confidence interval: 37, 79). Undetected MRSA-positive patients were estimated to be the source of 75% (95% confidence interval: 67, 86) of total transmission events. Isolation measures combined with decolonization treatment were strongly associated with a reduction in MRSA transmission in hospital general wards. These findings provide support for active methods of MRSA control, but further research is needed to determine the relative importance of isolation and decolonization in preventing transmission. PMID:23592544

  18. Estimating the effectiveness of isolation and decolonization measures in reducing transmission of methicillin-resistant Staphylococcus aureus in hospital general wards.

    PubMed

    Worby, Colin J; Jeyaratnam, Dakshika; Robotham, Julie V; Kypraios, Theodore; O'Neill, Philip D; De Angelis, Daniela; French, Gary; Cooper, Ben S

    2013-06-01

    Infection control for hospital pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) often takes the form of a package of interventions, including the use of patient isolation and decolonization treatment. Such interventions, though widely used, have generated controversy because of their significant resource implications and the lack of robust evidence with regard to their effectiveness at reducing transmission. The aim of this study was to estimate the effectiveness of isolation and decolonization measures in reducing MRSA transmission in hospital general wards. Prospectively collected MRSA surveillance data from 10 general wards at Guy's and St. Thomas' hospitals, London, United Kingdom, in 2006-2007 were used, comprising 14,035 patient episodes. Data were analyzed with a Markov chain Monte Carlo algorithm to model transmission dynamics. The combined effect of isolation and decolonization was estimated to reduce transmission by 64% (95% confidence interval: 37, 79). Undetected MRSA-positive patients were estimated to be the source of 75% (95% confidence interval: 67, 86) of total transmission events. Isolation measures combined with decolonization treatment were strongly associated with a reduction in MRSA transmission in hospital general wards. These findings provide support for active methods of MRSA control, but further research is needed to determine the relative importance of isolation and decolonization in preventing transmission.

  19. Annual Risk of Tuberculosis Infection in Hellenic Air Force Recruits

    PubMed Central

    Garyfalia, Vlachou; Irini, Gerogianni; Vasilios, Skoufaras; Konstantinos, Gourgoulianis

    2013-01-01

    Background: The annual risk of Tuberculosis infection (ARTI) is a key indicator in epidemiology, of the extent of transmission in a community. There have been several suggested methods in order to evaluate the prevalence of Tuberculosis infection using tuberculin skin data. This survey estimates the ARTI in young Hellenic air force recruits. The effect of BCG vaccination has also been investigated. Materials and Methods: During the period November 2006-November 2007 tuberculin skin tests were conducted to estimate the prevalence of mycobacterium tuberculosis infection and also to determine the ARTI. Tuberculin PPD-RT 23, dose 2 IU was used in 7.492 Greek air force military recruits with a mean age of 23.57 years. All recruits were examined for previous bacill Calmette-Guérin vaccination through BCG scar. A vast number of personal, epidemiological significance, data of the participants was collected. Results: The ARTI was 0.2%, in those who were not previously BCG vaccinated; this was derived from a tuberculin skin test cut-off point of 10 mm. There were not any statistically significant differences, neither between urban and rural population concerning the positivity of the tuberculin skin test, nor among the population in recent contact with immigrants from high-incidence countries. Conclusion: The estimated ARTI among non BCG vaccinated young Greek men is 0.2%. PMID:24459536

  20. Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees.

    PubMed

    Dolan, Kate; Wirtz, Andrea L; Moazen, Babak; Ndeffo-Mbah, Martial; Galvani, Alison; Kinner, Stuart A; Courtney, Ryan; McKee, Martin; Amon, Joseph J; Maher, Lisa; Hellard, Margaret; Beyrer, Chris; Altice, Fredrick L

    2016-09-10

    The prison setting presents not only challenges, but also opportunities, for the prevention and treatment of HIV, viral hepatitis, and tuberculosis. We did a comprehensive literature search of data published between 2005 and 2015 to understand the global epidemiology of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV), and tuberculosis in prisoners. We further modelled the contribution of imprisonment and the potential impact of prevention interventions on HIV transmission in this population. Of the estimated 10·2 million people incarcerated worldwide on any given day in 2014, we estimated that 3·8% have HIV (389 000 living with HIV), 15·1% have HCV (1 546 500), 4·8% have chronic HBV (491 500), and 2·8% have active tuberculosis (286 000). The few studies on incidence suggest that intraprison transmission is generally low, except for large-scale outbreaks. Our model indicates that decreasing the incarceration rate in people who inject drugs and providing opioid agonist therapy could reduce the burden of HIV in this population. The prevalence of HIV, HCV, HBV, and tuberculosis is higher in prison populations than in the general population, mainly because of the criminalisation of drug use and the detention of people who use drugs. The most effective way of controlling these infections in prisoners and the broader community is to reduce the incarceration of people who inject drugs.

  1. Estimation of the Effective Number of Founders That Initiate an Infection after Aphid Transmission of a Multipartite Plant Virus ▿

    PubMed Central

    Betancourt, Mónica; Fereres, Alberto; Fraile, Aurora; García-Arenal, Fernando

    2008-01-01

    The fecundity of RNA viruses can be very high. Thus, it is often assumed that viruses have large populations, and RNA virus evolution has been mostly explained using purely deterministic models. However, population bottlenecks during the virus life cycle could result in effective population numbers being much smaller than reported censuses, and random genetic drift could be important in virus evolution. A step at which population bottlenecks may be severe is host-to-host transmission. We report here an estimate of the size of the population that starts a new infection when Cucumber mosaic virus (CMV) is transmitted by the aphid Aphis gossypii, based on the segregation of two CMV genotypes in plants infected by aphids that acquired the virus from plants infected by both genotypes. Results show very small effective numbers of founders, between one and two, both in experiments in which the three-partite genome of CMV was aphid transmitted and in experiments in which a fourth RNA, CMV satellite RNA, was also transmitted. These numbers are very similar to those published for Potato virus Y, which has a monopartite genome and is transmitted by aphids according to a different mechanism than CMV. Thus, the number of genomic segments seems not to be a major determinant of the effective number of founders. Also, our results suggest that the occurrence of severe bottlenecks during horizontal transmission is general for viruses nonpersistently transmitted by aphids, indicating that random genetic drift should be considered when modeling virus evolution. PMID:18842732

  2. Estimation of Plasmodium falciparum Transmission Intensity in Lilongwe, Malawi, by Microscopy, Rapid Diagnostic Testing, and Nucleic Acid Detection.

    PubMed

    Parr, Jonathan B; Belson, Connor; Patel, Jaymin C; Hoffman, Irving F; Kamthunzi, Portia; Martinson, Francis; Tegha, Gerald; Thengolose, Isaac; Drakeley, Chris; Meshnick, Steven R; Escamillia, Veronica; Emch, Michael; Juliano, Jonathan J

    2016-08-03

    Estimates of malaria transmission intensity (MTI) typically rely upon microscopy or rapid diagnostic testing (RDT). However, these methods are less sensitive than nucleic acid amplification techniques and may underestimate parasite prevalence. We compared microscopy, RDT, and polymerase chain reaction (PCR) for the diagnosis of Plasmodium falciparum parasitemia as part of an MTI study of 800 children and adults conducted in Lilongwe, Malawi. PCR detected more cases of parasitemia than microscopy or RDT. Age less than 5 years predicted parasitemia detected by PCR alone (adjusted odds ratio = 1.61, 95% confidence interval = 1.09-2.38, Wald P = 0.02). In addition, we identified one P. falciparum parasite with a false-negative RDT result due to a suspected deletion of the histidine-rich protein 2 (hrp2) gene and used a novel, ultrasensitive PCR assay to detect low-level parasitemia missed by traditional PCR. Molecular methods should be considered for use in future transmission studies as a supplement to RDT or microscopy. © The American Society of Tropical Medicine and Hygiene.

  3. Estimating transmission of avian influenza in wild birds from incomplete epizootic data: implications for surveillance and disease spreac

    USGS Publications Warehouse

    Viviane Henaux,; Jane Parmley,; Catherine Soos,; Samuel, Michael D.

    2013-01-01

    Synthesis and applications. Our study highlights the potential of integrating incomplete surveillance data with epizootic models to quantify disease transmission and immunity. This modelling approach provides an important tool to understand spatial and temporal epizootic dynamics and inform disease surveillance. Our findings suggest focusing highly pathogenic avian influenza virus (HPAIv) surveillance on postbreeding areas where mortality of immunologically naïve hatch-year birds is most likely to occur, and collecting serology to enhance HPAIv detection. Our modelling approach can integrate various types of disease data facilitating its use with data from other surveillance programs (as illustrated by the estimation of infection rate during an HPAIv outbreak in mute swansCygnus olor in Europe).

  4. Neonatal tuberculosis.

    PubMed

    Obringer, Emily; Heald-Sargent, Taylor; Hageman, Joseph R

    2015-05-01

    Tuberculosis remains a prevalent disease worldwide, with approximately 9 million cases diagnosed annually. The emergence of multidrug-resistant tuberculosis has proven to be a challenging international public health issue. In the United States, however, the incidence of tuberculosis has been decreasing since 1992. There were just over 9,500 reported cases in 2013, and almost 500 of those were in children younger than age 15 years. Foreign-born persons are a high-risk group and account for 65% of new cases annually. Other high-risk groups include ethnic minorities, HIV-infected patients, and people living in low-socioeconomic urban areas. Copyright 2015, SLACK Incorporated.

  5. Model-based estimates of the effects of efavirenz on bedaquiline pharmacokinetics and suggested dose adjustments for patients coinfected with HIV and tuberculosis.

    PubMed

    Svensson, Elin M; Aweeka, Francesca; Park, Jeong-Gun; Marzan, Florence; Dooley, Kelly E; Karlsson, Mats O

    2013-06-01

    Safe, effective concomitant treatment regimens for tuberculosis (TB) and HIV infection are urgently needed. Bedaquiline (BDQ) is a promising new anti-TB drug, and efavirenz (EFV) is a commonly used antiretroviral. Due to EFV's induction of cytochrome P450 3A4, the metabolic enzyme responsible for BDQ biotransformation, the drugs are expected to interact. Based on data from a phase I, single-dose pharmacokinetic study, a nonlinear mixed-effects model characterizing BDQ pharmacokinetics and interaction with multiple-dose EFV was developed. BDQ pharmacokinetics were best described by a 3-compartment disposition model with absorption through a dynamic transit compartment model. Metabolites M2 and M3 were described by 2-compartment models with clearance of BDQ and M2, respectively, as input. Impact of induction was described as an instantaneous change in clearance 1 week after initialization of EFV treatment and estimated for all compounds. The model predicts average steady-state concentrations of BDQ and M2 to be reduced by 52% (relative standard error [RSE], 3.7%) with chronic coadministration. A range of models with alternative structural assumptions regarding onset of induction effect and fraction metabolized resulted in similar estimates of the typical reduction and did not offer a markedly better fit to data. Simulations to investigate alternative regimens mitigating the estimated interaction effect were performed. The results suggest that simple adjustments of the standard regimen during EFV coadministration can prevent reduced exposure to BDQ without increasing exposures to M2. However, exposure to M3 would increase. Evaluation in clinical trials of adjusted regimens is necessary to ensure appropriate dosing for HIV-infected TB patients on an EFV-based regimen.

  6. [The development of tuberculosis control and tuberculosis epidemiology in East Germany].

    PubMed

    Steinbrück, P

    1983-01-01

    The fight against tuberculosis in the German Democratic Republic was performed from the very beginning as a task of the state and the society; it was developed according to the progress of economic possibilities and the epidemiological situation. The contribution of the community and of the social-economic development on tuberculosis epidemiology has proved to be decisively important factors in tuberculosis control. The specific methods applied in tuberculosis control in the course of more than 30 years have changed in their importance effectiveness and efficiency with the reduction of the tuberculosis problem and the development of new techniques. Therefore a continuous evaluation of the tuberculosis situation is necessary to recognize the most effective approach. By reducing the estimated annual infection rate to less than 0.05%, the incidence of smear positive pulmonary tuberculosis to less than 5/100,000 and the practical disappearance of tuberculosis among children tuberculosis has become an endemic localized disease among predominantly old citizens. People's mass x-ray examinations have considerably lost their value for finding tuberculosis. Early coverage and examination of persons with respiratory symptoms (21-days-coughers), of contact persons and high risk groups will determine the future activities of the chest clinics. Their integration into the system of outpatient clinics and the system of primary health care were an important step on this way. Successful treatment of each case of tuberculosis is now possible and must be attained. Early case finding + treatment considered as an united activity has become the decisively important measure in the control of tuberculosis. The endemic foci of tuberculosis in some communities have to be surveyed and eliminated with priority. Moreover, the cooperation of all physicians of public health is necessary. Only by this way tuberculosis can be eradicated in GDR in a defined time. (Aim of WHO and IUaT: 1 case of

  7. Tuberculosis Incidence in Prisons: A Systematic Review

    PubMed Central

    Baussano, Iacopo; Williams, Brian G.; Nunn, Paul; Beggiato, Marta; Fedeli, Ugo; Scano, Fabio

    2010-01-01

    Background Transmission of tuberculosis (TB) in prisons has been reported worldwide to be much higher than that reported for the corresponding general population. Methods and Findings A systematic review has been performed to assess the risk of incident latent tuberculosis infection (LTBI) and TB disease in prisons, as compared to the incidence in the corresponding local general population, and to estimate the fraction of TB in the general population attributable (PAF%) to transmission within prisons. Primary peer-reviewed studies have been searched to assess the incidence of LTBI and/or TB within prisons published until June 2010; both inmates and prison staff were considered. Studies, which were independently screened by two reviewers, were eligible for inclusion if they reported the incidence of LTBI and TB disease in prisons. Available data were collected from 23 studies out of 582 potentially relevant unique citations. Five studies from the US and one from Brazil were available to assess the incidence of LTBI in prisons, while 19 studies were available to assess the incidence of TB. The median estimated annual incidence rate ratio (IRR) for LTBI and TB were 26.4 (interquartile range [IQR]: 13.0–61.8) and 23.0 (IQR: 11.7–36.1), respectively. The median estimated fraction (PAF%) of tuberculosis in the general population attributable to the exposure in prisons for TB was 8.5% (IQR: 1.9%–17.9%) and 6.3% (IQR: 2.7%–17.2%) in high- and middle/low-income countries, respectively. Conclusions The very high IRR and the substantial population attributable fraction show that much better TB control in prisons could potentially protect prisoners and staff from within-prison spread of TB and would significantly reduce the national burden of TB. Future studies should measure the impact of the conditions in prisons on TB transmission and assess the population attributable risk of prison-to-community spread. Please see later in the article for the Editors' Summary PMID

  8. Estimating electricity storage power rating and discharge duration for utility transmission and distribution deferral :a study for the DOE energy storage program.

    SciTech Connect

    Eyer, James M. (Distributed Utility Associates, Livermore, CA); Butler, Paul Charles; Iannucci, Joseph J., Jr.

    2005-11-01

    This report describes a methodology for estimating the power and energy capacities for electricity energy storage systems that can be used to defer costly upgrades to fully overloaded, or nearly overloaded, transmission and distribution (T&D) nodes. This ''sizing'' methodology may be used to estimate the amount of storage needed so that T&D upgrades may be deferred for one year. The same methodology can also be used to estimate the characteristics of storage needed for subsequent years of deferral.

  9. Tuberculosis outbreak in a Texas prison, 1994.

    PubMed Central

    Bergmire-Sweat, D.; Barnett, B. J.; Harris, S. L.; Taylor, J. P.; Mazurek, G. H.; Reddy, V.

    1996-01-01

    In 1994 a Texas prison containing a population of mentally retarded inmates experienced a large tuberculosis outbreak. Fifteen cases of tuberculosis were identified (8 confirmed by positive cultures for Mycobacterium tuberculosis) and more than 100 inmates became infected. The culture-confirmed patients were infected with