Journal Article

Recent Transmission of Tuberculosis — United States, 2011–2014

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

2016

Overview

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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adolescent / Adult / Aged / AIDS / Alcohol / American Indians / Analysis / Bacterial Typing Techniques / Biology and Life Sciences / Black or African American / Black People / Child / Child, Preschool / Communicable Disease Control / Confidence intervals / Diagnostic systems / Diagnostic tests / Disease control / Disease prevention / Disease transmission / Distribution / Emigration and Immigration / Epidemics / Epidemiology / Female / Foreign birth / Genotype / Genotype & phenotype / Health aspects / Health surveillance / Homeless people / Homelessness / Humans / Ill-Housed Persons / Indians, North American / Indigenous peoples / Infant / Infant, Newborn / Infectious diseases / Male / Medical diagnosis / Medicine and Health Sciences / Methods / Middle Aged / Mycobacterium / Mycobacterium tuberculosis - genetics / Pacific Islander people / People and places / Prevalence / Public health / Race / Regression analysis / Risk Factors / Statistical analysis / Tuberculosis / Tuberculosis - epidemiology / Tuberculosis - ethnology / Tuberculosis - transmission / Underserved populations / United States - epidemiology / Young Adult