The Prevalence of Latent Tuberculosis Infection in the United States

BackgroundThe existing estimate of the global burden of latent TB infection (LTBI) as “one-third” of the world population is nearly 20 y old. Given the importance of controlling LTBI as part of the End TB Strategy for eliminating TB by 2050, changes in demography and scientific understanding, and progress in TB control, it is important to re-assess the global burden of LTBI.Methods and FindingsWe constructed trends in annual risk in infection (ARI) for countries between 1934 and 2014 using a combination of direct estimates of ARI from LTBI surveys (131 surveys from 1950 to 2011) and indirect estimates of ARI calculated from World Health Organisation (WHO) estimates of smear positive TB prevalence from 1990 to 2014. Gaussian process regression was used to generate ARIs for country-years without data and to represent uncertainty. Estimated ARI time-series were applied to the demography in each country to calculate the number and proportions of individuals infected, recently infected (infected within 2 y), and recently infected with isoniazid (INH)-resistant strains. Resulting estimates were aggregated by WHO region. We estimated the contribution of existing infections to TB incidence in 2035 and 2050.In 2014, the global burden of LTBI was 23.0% (95% uncertainty interval [UI]: 20.4%–26.4%), amounting to approximately 1.7 billion people. WHO South-East Asia, Western-Pacific, and Africa regions had the highest prevalence and accounted for around 80% of those with LTBI. Prevalence of recent infection was 0.8% (95% UI: 0.7%–0.9%) of the global population, amounting to 55.5 (95% UI: 48.2–63.8) million individuals currently at high risk of TB disease, of which 10.9% (95% UI:10.2%–11.8%) was isoniazid-resistant. Current LTBI alone, assuming no additional infections from 2015 onwards, would be expected to generate TB incidences in the region of 16.5 per 100,000 per year in 2035 and 8.3 per 100,000 per year in 2050.Limitations included the quantity and methodological heterogeneity of direct ARI data, and limited evidence to inform on potential clearance of LTBI.ConclusionsWe 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.

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“…Our results also matched a recent survey-based estimate of 13 million latent infections for the United States [25]. …”

Section: Discussionsupporting

confidence: 86%

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

2016

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“…Failure to complete LTBI treatment increases the risk of development of drug-resistant disease, if activation occurs. 9,10 Active tuberculosis as a consequence of LTBI should be an area of community and public health concern. Failure to access and complete LTBI treatment may be related to the many challenges refugees have in accessing affordable health insurance, provider reticence in accepting Medicaid, access to care at times that do not interfere with employment, and health literacy regarding treatment of a disease that is not currently causing symptoms.…”

Section: The Refugee As a Community Membermentioning

confidence: 99%

Infection prevention and control and the refugee population: Experiences from the University of Louisville Global Health Center

Carrico

Goss

Wiemken

et al. 2017

American Journal of Infection Control

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“…Using the NHANES (National Health and Nutrition Examination Survey) 2011-2012, Mancuso and colleagues (pp. 501-509) estimated the prevalence of tuberculosis infection to be 4.4% when measured using the traditional tuberculin skin test, and 4.8% when using QuantiFeron-Gold In-Tube (QFT) as the diagnostic test (5).…”

Section: Why Prevention Mattersmentioning

confidence: 99%

The Replacement Principle of Tuberculosis. Why Prevention Matters

Whalen¹

2016

Am J Respir Crit Care Med

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The Prevalence of Latent Tuberculosis Infection in the United States

Cited by 88 publications

References 27 publications

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

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

Infection prevention and control and the refugee population: Experiences from the University of Louisville Global Health Center

The Replacement Principle of Tuberculosis. Why Prevention Matters

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