Estimating Tuberculosis Transmission Risks in a Primary Care Clinic in South Africa: Modeling of Environmental and Clinical Data.

Carbon Dioxide / analysis Female Humans Male Mycobacterium tuberculosis / genetics Primary Health Care South Africa / epidemiology Tuberculosis / diagnosis Young Adult
Mycobacterium tuberculosis biosampling carbon dioxide cough humidity infection control intervention primary care clinic transmission tuberculosis

Journal

The Journal of infectious diseases
ISSN: 1537-6613
Titre abrégé: J Infect Dis
Pays: United States
ID NLM: 0413675

Informations de publication

Date de publication:
04 05 2022
Historique:
received: 17 07 2021
accepted: 09 11 2021
pubmed: 19 1 2022
medline: 10 5 2022
entrez: 18 1 2022
Statut: ppublish

Résumé

Congregate settings, such as healthcare clinics, may play an essential role in Mycobacterium tuberculosis (Mtb) transmission. Using patient and environmental data, we studied transmission at a primary care clinic in South Africa. We collected patient movements, cough frequency, and clinical data, and measured indoor carbon dioxide (CO2) levels, relative humidity, and Mtb genomes in the air. We used negative binomial regression model to investigate associations. We analyzed 978 unique patients who contributed 14 795 data points. The median patient age was 33 (interquartile range [IQR], 26-41) years, and 757 (77.4%) were female. Overall, median CO2 levels were 564 (IQR 495-646) parts per million and were highest in the morning. Median number of coughs per day was 466 (IQR, 368-503), and overall median Mtb DNA copies/μL/day was 4.2 (IQR, 1.2-9.5). We found an increased presence of Mtb DNA in the air of 32% (95% credible interval, 7%-63%) per 100 additional young adults (aged 15-29 years) and 1% (0-2%) more Mtb DNA per 10% increase of relative humidity. Estimated cumulative transmission risks for patients attending the clinic monthly for at least 1 hour range between 9% and 29%. We identified young adults and relative humidity as potentially important factors for transmission risks in healthcare clinics. Our approach should be used to detect transmission and evaluate infection control interventions.

Sections du résumé

BACKGROUND
Congregate settings, such as healthcare clinics, may play an essential role in Mycobacterium tuberculosis (Mtb) transmission. Using patient and environmental data, we studied transmission at a primary care clinic in South Africa.
METHODS
We collected patient movements, cough frequency, and clinical data, and measured indoor carbon dioxide (CO2) levels, relative humidity, and Mtb genomes in the air. We used negative binomial regression model to investigate associations.
RESULTS
We analyzed 978 unique patients who contributed 14 795 data points. The median patient age was 33 (interquartile range [IQR], 26-41) years, and 757 (77.4%) were female. Overall, median CO2 levels were 564 (IQR 495-646) parts per million and were highest in the morning. Median number of coughs per day was 466 (IQR, 368-503), and overall median Mtb DNA copies/μL/day was 4.2 (IQR, 1.2-9.5). We found an increased presence of Mtb DNA in the air of 32% (95% credible interval, 7%-63%) per 100 additional young adults (aged 15-29 years) and 1% (0-2%) more Mtb DNA per 10% increase of relative humidity. Estimated cumulative transmission risks for patients attending the clinic monthly for at least 1 hour range between 9% and 29%.
CONCLUSIONS
We identified young adults and relative humidity as potentially important factors for transmission risks in healthcare clinics. Our approach should be used to detect transmission and evaluate infection control interventions.

Identifiants

DOI: 10.1093/infdis/jiab534 PMID: 35039860 PMC: PMC9071349
pubmed: 35039860
pii: 6510424
doi: 10.1093/infdis/jiab534
pmc: PMC9071349
doi:

Substances chimiques

Carbon Dioxide 142M471B3J

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1642-1652

Subventions

Organisme : NIAID NIH HHS
ID : U01 AI069924
Pays : United States

Informations de copyright

© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Références

J Acquir Immune Defic Syndr. 2011 Mar 1;56(3):263-9
pubmed: 21317585
Clin Infect Dis. 2021 Oct 5;73(7):e1790-e1794
pubmed: 33506256
Int J Tuberc Lung Dis. 2012;16(3):297-305
pubmed: 22136695
PLoS One. 2011;6(10):e25098
pubmed: 22016763
Nature. 2020 Jun;582(7813):557-560
pubmed: 32340022
PLoS Med. 2008 Sep 30;5(9):e188
pubmed: 18798687
J Med Internet Res. 2017 Dec 19;19(12):e347
pubmed: 29258059
Lancet Respir Med. 2017 Apr;5(4):269-281
pubmed: 28109869
PLoS One. 2016 Jan 25;11(1):e0146658
pubmed: 26807816
Tuberculosis (Edinb). 2021 Jan;126:102038
pubmed: 33316737
Bull Int Union Tuberc. 1975;50(1):107-21
pubmed: 1218286
Eur Respir J. 2008 May;31(5):1013-8
pubmed: 18184683
Am J Epidemiol. 2001 Nov 15;154(10):934-43
pubmed: 11700248
BMC Infect Dis. 2011 Jun 01;11:156
pubmed: 21631918
Lancet Infect Dis. 2013 Feb;13(2):137-46
pubmed: 23158499
J Infect Dis. 2014 Aug 15;210(4):597-603
pubmed: 24610874
PLoS One. 2014 May 07;9(5):e96334
pubmed: 24804707
PLoS One. 2010 Dec 29;5(12):e15735
pubmed: 21209951
Eur Respir J. 2018 Feb 21;51(2):
pubmed: 29467206
Am J Respir Crit Care Med. 2007 Jan 1;175(1):87-93
pubmed: 16973982
Gates Open Res. 2017 Nov 7;1:11
pubmed: 29355225
Int J Tuberc Lung Dis. 2019 Apr 1;23(4):465-473
pubmed: 31064626
J Infect. 2017 Sep;75(3):191-197
pubmed: 28676410
J Int AIDS Soc. 2017 May 16;20(Suppl 3):21528
pubmed: 28530039
PLoS One. 2014 Sep 02;9(9):e106622
pubmed: 25181526
N Engl J Med. 2017 Jan 19;376(3):243-253
pubmed: 28099825
Lancet. 2004 Jan 17;363(9404):212-4
pubmed: 14738796
Ann Intern Med. 1992 Aug 1;117(3):191-6
pubmed: 1352093
J Infect Dis. 2020 Nov 9;222(11):1798-1806
pubmed: 32905595
MMWR Morb Mortal Wkly Rep. 1991 Aug 30;40(34):585-91
pubmed: 1870559
Indoor Air. 2003 Sep;13(3):237-45
pubmed: 12950586
BMC Public Health. 2003 Jan 13;3:5
pubmed: 12525263
JAMA. 2020 Apr 28;323(16):1610-1612
pubmed: 32129805
AIDS. 2018 Oct 23;32(16):2417-2421
pubmed: 30234604
Lancet. 2007 Oct 27;370(9597):1500-7
pubmed: 17964351
PLoS One. 2017 Dec 29;12(12):e0190260
pubmed: 29287088
Int J Tuberc Lung Dis. 2016 Sep;20(9):1155-61
pubmed: 27510239
Physiol Meas. 2018 Apr 26;39(4):045005
pubmed: 29543189
BMJ Open. 2020 Aug 26;10(8):e036214
pubmed: 32847906
J Infect Dis. 2015 Jan 1;211(1):53-61
pubmed: 25053739
J Infect Dis. 2017 Nov 3;216(suppl_6):S654-S661
pubmed: 29112743
Am J Epidemiol. 2013 Mar 15;177(6):556-61
pubmed: 23423215
PLoS One. 2015 Jul 16;10(7):e0132840
pubmed: 26181760

Auteurs

Kathrin Zürcher (K)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

Julien Riou (J)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

Carl Morrow (C)

Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, University of Cape Town, Cape Town, South Africa.

Marie Ballif (M)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

Anastasia Koch (A)

South African Medical Research Council/National Health Laboratory Service/University of Cape Town Molecular Mycobacteriology Research Unit and Department of Science and Innovation/National Research Foundation Centre of Excellence for Biomedical TB Research, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Simon Bertschinger (S)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Institute for Medical Informatics, Bern University of Applied Sciences, Bern, Switzerland.

Digby F Warner (DF)

Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
South African Medical Research Council/National Health Laboratory Service/University of Cape Town Molecular Mycobacteriology Research Unit and Department of Science and Innovation/National Research Foundation Centre of Excellence for Biomedical TB Research, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Keren Middelkoop (K)

Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, University of Cape Town, Cape Town, South Africa.

Robin Wood (R)

Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, University of Cape Town, Cape Town, South Africa.

Matthias Egger (M)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.

Lukas Fenner (L)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

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Classifications MeSH

questionsmedicales.fr › Produits chimiques inorganiques › Composés de l'oxygène › Oxydes › Dioxyde de carbone › Estimating Tuberculosis Transmission Risks in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Estimating Tuberculosis Transmission Risks in...
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questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Estimating Tuberculosis Transmission Risks in...
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