Changes in Tuberculin Skin Test Positivity Over 20 Years in Periurban Shantytowns in Lima, Peru

Martínez, Leonardo; Arman, Alyssa; Haveman, Nathan; Lundgren, Ashley; Cabrera, Lilia; Evans, Carlton A.; Pelly, Tom F.; Saito, Mayuko; Callacondo, David; Oberhelman, Richard A.; Collazo, Gisela; Carnero, Andrés M.; Gilman, Robert H.

doi:10.4269/ajtmh.13-0005

Cited by 26 publications

(40 citation statements)

References 36 publications

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“…Hence, the number of cases initially latently infected was sampled from a normal distribution with mean 0.5 and standard deviation of 0.1. Informed by the TB prevalence in Lima, it was assumed that initially, 98% of these latent infections were with DS-TB strains, 2% with MDR-TB strains in all households [2]. This proportion was varied in scenario analysis.…”

Section: Detailed Overview Of Simulationmentioning

confidence: 99%

“…213 of these had an initial MDR-TB case, 487 an initial DS-TB case. Tuberculin skin test (TST) prevalence surveys across Lima have found 52% (95% CI: 48-57%) to be infected with Mtb [2]. Hence, the number of cases initially latently infected was sampled from a normal distribution with mean 0.5 and standard deviation of 0.1.…”

Section: Detailed Overview Of Simulationmentioning

confidence: 99%

“…Multidrugresistant tuberculosis (MDR-TB) treatment regimens are significantly longer, cause serious side effects and are very expensive (3). Whilst currently 5% of all TB cases globally are estimated to be MDR-TB (2), predicting the future burden of DS-and MDR-TB is essential for TB control programmes.…”

Section: Introductionmentioning

confidence: 99%

“…Treatment of tuberculosis (TB) disease is not simple and drug-susceptible tuberculosis (DS-TB) requires a multiple drug regimen taken for at least 6 months (2). Multidrugresistant tuberculosis (MDR-TB) treatment regimens are significantly longer, cause serious side effects and are very expensive (3).…”

Section: Introductionmentioning

confidence: 99%

“…The latter definition is important for epidemiological predictions of burden, whilst the first provides the potential underlying biological cause. The epidemiological fitness of a Mtb strain can be split into an ability to (1) cause secondary infections (transmission) and (2) cause subsequent active disease (progression). For example, resistant Mtb may be transmitted equally as well, but subsequent disease rates in those infected may be lower or less severe.…”

Section: Introductionmentioning

confidence: 99%

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The relative fitness of drug resistantMycobacterium tuberculosis: a modelling study of household transmission in Peru

Knight

Zimic²,

Funk

et al. 2017

Preprint

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The relative fitness of drug resistant versus susceptible bacteria in an environment dictates resistance prevalence. Estimates for the relative fitness of resistant Mycobacterium tuberculosis (Mtb) strains are highly heterogeneous, many are derived from in-vitro experiments and few studies have estimated relative fitness in the field. Measuring fitness in the field allows us to determine how the environment (including factors such as host genetics, TB treatment regimen etc.) influences the ability for bacteria to survive, be transmitted and cause secondary cases of disease.We designed a household structured, stochastic mathematical model to estimate the fitness costs associated with multi-drug resistance (MDR) carriage in Mtb strains in Lima, Peru over a 3-year period. By fitting the model to data from a large prospective cohort study of TB disease in household contacts we estimated the fitness, relative to susceptible strains with a fitness of 1, of MDR-Mtb strains to be 0.33 (95% credible interval: 0.17-0.54) or 0.39 (0.26-0.58), if only transmission or progression to disease, respectively, was affected by MDR. The relative fitness of MDR-Mtb increased to 0.57 (0.43-0.73) when the fitness cost was modelled to influence both transmission and progression to disease equally.We found the average relative fitness of MDR-Mtb circulating within households in Lima, Peru between 2010-2013 to be significantly lower than susceptible-Mtb circulating at the same time and location. If these fitness levels do not change, then existing TB control programmes are likely to keep MDR-TB prevalence at the current levels in Lima, Peru. Significance StatementThe relative fitness of drug resistant strains is a key determinant of resistance prevalence. We used a new quantitative framework to directly estimate the average relative fitness cost of multi-drug resistant (MDR-) Mycobacterium tuberculosis (Mtb) strains from a household study in Lima, Peru. This showed that the relative fitness of MDR-Mtb was substantially lower than that of drug-susceptible Mtb strains circulating at the same time and location, suggesting that with current control methods MDR-TB diseases levels may be held stable in Lima, Peru.

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Section: Detailed Overview Of Simulationmentioning

confidence: 99%

Section: Detailed Overview Of Simulationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The relative fitness of drug resistantMycobacterium tuberculosis: a modelling study of household transmission in Peru

Knight

Zimic²,

Funk

et al. 2017

Preprint

Self Cite

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Tuberculosis-related knowledge is associated with patient outcomes in shantytown residents; results from a cohort study, Peru

Westerlund

Tovar

Lönnermark

et al. 2015

Journal of Infection

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Incidence and prevalence of tuberculosis in incarcerated populations: a systematic review and meta-analysis

Cords

Martínez

Warren

et al. 2021

The Lancet Public Health

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Summary Background Prisons are recognised as high-risk environments for tuberculosis, but there has been little systematic investigation of the global and regional incidence and prevalence of tuberculosis, and its determinants, in prisons. We did a systematic review and meta-analysis to assess the incidence and prevalence of tuberculosis in incarcerated populations by geographical region. Methods In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Knowledge, and the LILACS electronic database from Jan 1, 1980, to Nov 15, 2020, for cross-sectional and cohort studies reporting the incidence of Mycobacterium tuberculosis infection, incidence of tuberculosis, or prevalence of tuberculosis among incarcerated individuals in all geographical regions. We extracted data from individual studies, and calculated pooled estimates of incidence and prevalence through hierarchical Bayesian meta-regression modelling. We also did subgroup analyses by region. Incidence rate ratios between prisons and the general population were calculated by dividing the incidence of tuberculosis in prisons by WHO estimates of the national population-level incidence. Findings We identified 159 relevant studies; 11 investigated the incidence of M tuberculosis infection (n=16 318), 51 investigated the incidence of tuberculosis (n=1 858 323), and 106 investigated the prevalence of tuberculosis (n=6 727 513) in incarcerated populations. The overall pooled incidence of M tuberculosis infection among prisoners was 15·0 (95% credible interval [CrI] 3·8–41·6) per 100 person-years. The incidence of tuberculosis (per 100 000 person-years) among prisoners was highest in studies from the WHO African (2190 [95% CrI 810–4840] cases) and South-East Asia (1550 [240–5300] cases) regions and in South America (970 [460–1860] cases), and lowest in North America (30 [20–50] cases) and the WHO Eastern Mediterranean region (270 [50–880] cases). The prevalence of tuberculosis was greater than 1000 per 100 000 prisoners in all global regions except for North America and the Western Pacific, and highest in the WHO South-East Asia region (1810 [95% CrI 670–4000] cases per 100 000 prisoners). The incidence rate ratio between prisons and the general population was much higher in South America (26·9; 95% CrI 17·1–40·1) than in other regions, but was nevertheless higher than ten in the WHO African (12·6; 6·2–22·3), Eastern Mediterranean (15·6; 6·5–32·5), and South-East Asia (11·7; 4·1–27·1) regions. Interpretation Globally, people in prison are at high risk of contracting M tuberculosis infection and developing tuberculosis, with consistent disparities between prisons and the general population across regions. Tuberculosis control programmes should prioritise preventive interventions among incarcerated populations. ...

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Changes in Tuberculin Skin Test Positivity Over 20 Years in Periurban Shantytowns in Lima, Peru

Cited by 26 publications

References 36 publications

The relative fitness of drug resistantMycobacterium tuberculosis: a modelling study of household transmission in Peru

The relative fitness of drug resistantMycobacterium tuberculosis: a modelling study of household transmission in Peru

Tuberculosis-related knowledge is associated with patient outcomes in shantytown residents; results from a cohort study, Peru

Incidence and prevalence of tuberculosis in incarcerated populations: a systematic review and meta-analysis

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