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. 2016 Apr 15;11(4):e0153728.
doi: 10.1371/journal.pone.0153728. eCollection 2016.

Recent Transmission of Tuberculosis - United States, 2011-2014

Courtney M Yuen  1 , J Steve Kammerer  1 , Kala Marks  1 , Thomas R Navin  1 , Anne Marie France  1
Affiliations

Recent Transmission of Tuberculosis - United States, 2011-2014

Courtney M Yuen et al. PLoS One. .

Abstract

Tuberculosis is an infectious disease that may result from recent transmission or from an infection acquired many years in the past; there is no diagnostic test to distinguish the two causes. Cases resulting from recent transmission are particularly concerning from a public health standpoint. To describe recent tuberculosis transmission in the United States, we used a field-validated plausible source-case method to estimate cases likely resulting from recent transmission during January 2011-September 2014. We classified cases as resulting from either limited or extensive recent transmission based on transmission cluster size. We used logistic regression to analyze patient characteristics associated with recent transmission. Of 26,586 genotyped cases, 14% were attributable to recent transmission, 39% of which were attributable to extensive recent transmission. The burden of cases attributed to recent transmission was geographically heterogeneous and poorly predicted by tuberculosis incidence. Extensive recent transmission was positively associated with American Indian/Alaska Native (adjusted prevalence ratio [aPR] = 3.6 (95% confidence interval [CI] 2.9-4.4), Native Hawaiian/Pacific Islander (aPR = 3.2, 95% CI 2.3-4.5), and black (aPR = 3.0, 95% CI 2.6-3.5) race, and homelessness (aPR = 2.3, 95% CI 2.0-2.5). Extensive recent transmission was negatively associated with foreign birth (aPR = 0.2, 95% CI 0.2-0.2). Tuberculosis control efforts should prioritize reducing transmission among higher-risk populations.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Proportion of genotyped cases attributed to recent transmission in each county compared to proportion of genotyped cases attributed to recent transmission in state where county is located—January 2011–September 2014.
Each point represents one county. Only counties with ≥15 genotyped cases during the analysis period (i.e., an average of one case per quarter) are shown. Points would be expected to cluster around the dashed black line if every county within a given state had the same proportion of cases attributable to recent transmission as the entire state.
Fig 2
Fig 2. Map of states by proportion of cases attributed to limited recent transmission—January 2011–September 2014.
Fig 3
Fig 3. Map of states by proportion of cases attributed to extensive recent transmission—January 2011–September 2014.
See this image and copyright information in PMC

References

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    1. France AM, Grant J, Kammerer JS, Navin TR. A Field-Validated Approach Using Surveillance and Genotyping Data to Estimate Tuberculosis Attributable to Recent Transmission in the United States. Am J Epidemiol. 2015;182: 799–807. 10.1093/aje/kwv121 - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention. Reported Tuberculosis in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2015.

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