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. 2016 Jan;20(1):5-10.
doi: 10.5588/ijtld.15.0494.

Plan Beta for tuberculosis: it's time to think seriously about poorly ventilated congregate settings

T A Yates  1 , F Tanser  2 , I Abubakar  3
Affiliations

Plan Beta for tuberculosis: it's time to think seriously about poorly ventilated congregate settings

T A Yates et al. Int J Tuberc Lung Dis. 2016 Jan.

Abstract
in English, French, Undetermined language

Globally, the rates of decline in tuberculosis (TB) incidence are disappointing, but in line with model predictions regarding the likely impact of the DOTS strategy. Here, we review evidence from basic epidemiology, molecular epidemiology and modelling, all of which suggest that, in high-burden settings, the majority of Mycobacterium tuberculosis transmission may occur in indoor congregate settings. We argue that mass environmental modifications in these places might have a significant impact on TB control and suggest a research agenda that might inform interventions of this nature. The necessary technology exists and, critically, implementation would not be dependent on health care workers who are in short supply in the communities worst affected by TB.

Le déclin de l'incidence de la tuberculose (TB) dans le monde est décevant mais en accord avec les prédictions modélisées relativesà l'impact probable de la stratégie DOTS. Nous revoyons ici les preuvesémanant de l'épidémiologie de base, de l'épidémiologie moléculaire et de la modélisation qui suggèrent toutes que, dans un contexte durement frappé, la majorité de la transmission de Mycobacterium tuberculosis survient dans des lieux fermés de rassemblement de population. Nous argumentons en faveur de modifications de masse de l'environnement dans ces endroits qui pourraient avoir un impact significatif sur la lutte contre la TB et suggérons un programme de recherche qui pourrait renseigner des interventions de cette nature. Les techniques nécessaires existent et, chose cruciale, leur mise en œuvre ne serait pas dépendante des travailleurs de santé qui sont en nombre réduit dans les communautés les plus affectées par la TB.

En general, las disminuciones en la incidencia de la tuberculosis (TB) son desalentadoras, pero corresponden a las predicciones de los modelos sobre la posible repercusión de la estrategia DOTS. En el presente artículo se examinan los datos existentes en materia de epidemiología fundamental, epidemiología molecular y de estudios de modelización y todos indican que en los entornos con una alta carga de morbilidad, la mayor parte de la transmisión de Mycobacterium tuberculosis ocurre en ambientes colectivos interiores. Se trata de demostrar que las modificaciones ambientales en los entornos colectivos podrían tener una repercusión considerable en el control de la TB y se propone un programa de investigación que podría fundamentar las intervenciones de este tipo. La tecnología necesaria existe y su aplicación no estaría a cargo de los profesionales de salud, cuya escasez es notoria en las comunidades más afectadas por la TB.

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