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Comparative Study
. 2015 Nov 1;182(9):799-807.
doi: 10.1093/aje/kwv121. Epub 2015 Oct 13.

A field-validated approach using surveillance and genotyping data to estimate tuberculosis attributable to recent transmission in the United States

Anne Marie France, Juliana Grant, J Steve Kammerer, Thomas R Navin
Comparative Study

A field-validated approach using surveillance and genotyping data to estimate tuberculosis attributable to recent transmission in the United States

Anne Marie France et al. Am J Epidemiol. .

Abstract

Tuberculosis genotyping data are frequently used to estimate the proportion of tuberculosis cases in a population that are attributable to recent transmission (RT). Multiple factors influence genotype-based estimates of RT and limit the comparison of estimates over time and across geographic units. Additionally, methods used for these estimates have not been validated against field-based epidemiologic assessments of RT. Here we describe a novel genotype-based approach to estimation of RT based on the identification of plausible-source cases, which facilitates systematic comparisons over time and across geographic areas. We compared this and other genotype-based RT estimation approaches with the gold standard of field-based assessment of RT based on epidemiologic investigation in Arkansas, Maryland, and Massachusetts during 1996-2000. We calculated the sensitivity and specificity of each approach for epidemiologic evidence of RT and calculated the accuracy of each approach across a range of hypothetical RT prevalence rates plausible for the United States. The sensitivity, specificity, and accuracy of genotype-based RT estimates varied by approach. At an RT prevalence of 10%, accuracy ranged from 88.5% for state-based clustering to 94.4% with our novel approach. Our novel, field-validated approach allows for systematic assessments over time and across public health jurisdictions of varying geographic size, with an established level of accuracy.

Keywords: disease transmission; genotyping; molecular epidemiology; recent transmission; tuberculosis.

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Conflict of interest statement

Conflict of interest: none declared.

Figures

Figure 1
Figure 1
Estimated percentage of tuberculosis (TB) cases attributable to recent transmission as determined using state-based clustering, county-based clustering, and SaTScan-based (35) clustering, Arkansas, Maryland, and Massachusetts, January 1, 1998–September 30, 2000.
Figure 2
Figure 2
Estimated percentage of tuberculosis (TB) cases attributable to recent transmission as determined using the novel plausible-source case approach, with distance thresholds ranging from 0 to 500 miles (800 km), Arkansas, Maryland, and Massachusetts, January 1, 1998–September 30, 2000. 1 mile = 1.6 km.
See this image and copyright information in PMC

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