Mycobacterium tuberculosis Transmission in High-Incidence Settings—New Paradigms and Insights
Abstract
:1. Introduction
2. Historical Insights
2.1. Principles of Aerosol Transmission
2.2. Spread amongst Close Contacts
2.3. Host-Related Factors in Transmission
2.4. Transmission of Drug-Resistant Tuberculosis
2.5. Unusual Routes of Transmission
3. New Paradigms of Airborne Transmission
3.1. Continuum of Droplet-Aerosol Spread
3.2. Transmission from Asymptomatic Individuals & Subclinical Tuberculosis
3.3. Individual-Level Transmission Heterogeneity and ‘Super-Spreaders’
3.4. New Aerosol Transmission Insights from the COVID-19 Experience
4. New Paradigms and Tools from Tuberculosis Research
4.1. Reducing Community Transmission
4.2. Measuring Aerosol Transmission
4.3. Reducing Drug-Resistant Tuberculosis Spread
4.4. Genomic Transmission Tracking
Author Contributions
Funding
Conflicts of Interest
References
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Unanswered Questions | Insight from SARS-CoV-2 Research |
---|---|
Are asymptomatic and/or subclinical tuberculosis cases infectious? Furthermore, if so, how infectious are they compared to those with clinically apparent disease and what is the combined contribution to epidemic spread? | Yes; people with asymptomatic SARS-CoV-2 infection shown to be infectious, albeit less infectious than symptomatic cases. However, symptomatic cases contribute a large proportion of population-level transmission |
Are there strain related variability in transmission? | Yes; major differences demonstrated in different Variants of Concern (VoCs) |
Is there a transmission fitness cost to tuberculosis drug-resistance? | No; little research on drug-resistance, less relevant. Some level of ‘vaccine escape’ associated with VoCs |
In which community locations does transmission most commonly occur? | Yes; the vast majority of transmission shown to occur in crowded indoor settings with poor ventilation, including households, pubs and clubs, public transportation (e.g., buses and trains), hospitals, and elderly care settings. |
What are the key variables associated with transmission heterogeneity, to close contacts and at population-level? | Yes; wide transmission heterogeneity was demonstrated, with consideration that asymptomatic spread makes a major contribution to population-level spread. |
How frequently does superspreading occur and what factors are associated with superspreading? | Yes, a variety of factors have been described-mainly related to the infectiousness of the source case, their participation in large congregate settings and general mobility within the population. |
To what extent do potential institutional amplifiers (e.g., prisons, mines, hospitals, churches, schools, etc.) contribute to community-wide tuberculosis transmission? | Not well characterized, but less relevant with extensive population spread. |
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Coleman, M.; Martinez, L.; Theron, G.; Wood, R.; Marais, B. Mycobacterium tuberculosis Transmission in High-Incidence Settings—New Paradigms and Insights. Pathogens 2022, 11, 1228. https://doi.org/10.3390/pathogens11111228
Coleman M, Martinez L, Theron G, Wood R, Marais B. Mycobacterium tuberculosis Transmission in High-Incidence Settings—New Paradigms and Insights. Pathogens. 2022; 11(11):1228. https://doi.org/10.3390/pathogens11111228
Chicago/Turabian StyleColeman, Mikaela, Leonardo Martinez, Grant Theron, Robin Wood, and Ben Marais. 2022. "Mycobacterium tuberculosis Transmission in High-Incidence Settings—New Paradigms and Insights" Pathogens 11, no. 11: 1228. https://doi.org/10.3390/pathogens11111228