Transmissibility of tuberculosis among students and non-students: an occupational-specific mathematical modelling

Abstract

Background Recently, despite the steady decline in the tuberculosis (TB) epidemic globally, school TB outbreaks have been frequently reported in China. This study aimed to quantify the transmissibility of Mycobacterium tuberculosis (MTB) among students and non-students using a mathematical model to determine characteristics of TB transmission. Methods We constructed a dataset of reported TB cases from four regions (Jilin Province, Xiamen City, Chuxiong Prefecture, and Wuhan City) in China from 2005 to 2019. We classified the population and the reported cases under student and non-student groups, and developed two mathematical models [nonseasonal model (Model A) and seasonal model (Model B)] based on the natural history and transmission features of TB. The effective reproduction number (Reff) of TB between groups were calculated using the collected data. Results During the study period, data on 456,423 TB cases were collected from four regions: students accounted for 6.1% of cases. The goodness-of-fit analysis showed that Model A had a better fitting effect (P < 0.001). The average Reff of TB estimated from Model A was 1.68 [interquartile range (IQR): 1.20–1.96] in Chuxiong Prefecture, 1.67 (IQR: 1.40–1.93) in Xiamen City, 1.75 (IQR: 1.37–2.02) in Jilin Province, and 1.79 (IQR: 1.56–2.02) in Wuhan City. The average Reff of TB in the non-student population was 23.30 times (1.65/0.07) higher than that in the student population. Conclusions The transmissibility of MTB remains high in the non-student population of the areas studied, which is still dominant in the spread of TB. TB transmissibility from the non-student-to-student-population had a strong influence on students. Specific interventions, such as TB screening, should be applied rigorously to control and to prevent TB transmission among students. Graphical Abstract

The Role of Proline-Proline-Glutamic Acid (PPE) Proteins in Mycobacterium tuberculosis Virulence: Mechanistic Insights and Therapeutic Implications

“…Despite a reduction in TB-related mortalities following the implementation of short-course directly observed treatment, it remains a leading cause of death globally [6], with approximately 25% of the global population being infected [7]. Equally important, colleges and universities are at-risk populations [8] with prior research reporting TB outbreaks among students in Italy, China, and Northwest Ethiopia, often resulting from repeated exposure to untreated TB cases [9][10][11][12]. Research attributes the high TB prevalence in higher educational institutions to inadequate understanding and awareness about this disease [13,14].…”

LTBI-negative close contacts of tuberculosis are more likely to develop the disease: enlightenment and lessons from a cluster outbreak

“…University students, the new generation of migrant workers, young freelancers, and prisoners are characterized by collective living, low income, poor living environment, heavy workload, etc. Recently, a study performed in four cities in China quantified the transmissibility of M. tuberculosis among students and non-students and found that TB transmissibility from the non-student to student population strongly influenced students ( 9 ). It can be concluded that these particular environmental and host conditions provide fertile ground for the outbreak and epidemic of TB in these populations ( 9–11 ).…”

“…Recently, a study performed in four cities in China quantified the transmissibility of M. tuberculosis among students and non-students and found that TB transmissibility from the non-student to student population strongly influenced students (9). It can be concluded that these particular environmental and host conditions provide fertile ground for the outbreak and epidemic of TB in these populations (9)(10)(11).…”

Prevalence of Pulmonary Tuberculosis and Associated Factors among Patients Admitted to the Amissa Bongo University Hospital Center in Franceville, Gabon

“…In HIV-positive patients, active tuberculosis is due to the reactivation of endogenous latent disease and reinfection with a new strain [5]. Epidemiological studies have shown that co-infection with HIV can increase the risk of reactivation of latent tuberculosis by a factor of 20, and is the strongest known risk factor for the progression of M. tuberculosis infection to active disease [6]. Furthermore, the WHO has indicated that tuberculosis, along with HIV, is the most deadly infectious disease in the world, with both diseases estimated to be responsible for approximately 1.5 million deaths in 2022 [4].…”