Investigating spillover of multidrug-resistant tuberculosis from a prison: a spatial and molecular epidemiological analysis
Open Access
- 3 August 2018
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Medicine
- Vol. 16 (1), 122
- https://doi.org/10.1186/s12916-018-1111-x
Abstract
Background: Congregate settings may serve as institutional amplifiers of tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB). We analyze spatial, epidemiological, and pathogen genetic data prospectively collected from neighborhoods surrounding a prison in Lima, Peru, where inmates experience a high risk of MDR-TB, to investigate the risk of spillover into the surrounding community. Methods: Using hierarchical Bayesian statistical modeling, we address three questions regarding the MDR-TB risk: (i) Does the excess risk observed among prisoners also extend outside the prison? (ii) If so, what is the magnitude, shape, and spatial range of this spillover effect? (iii) Is there evidence of additional transmission across the region? Results: The region of spillover risk extends for 5.47 km outside of the prison (95% credible interval: 1.38, 9.63 km). Within this spillover region, we find that nine of the 467 non-inmate patients (35 with MDR-TB) have MDR-TB strains that are genetic matches to strains collected from current inmates with MDR-TB, compared to seven out of 1080 patients (89 with MDR-TB) outside the spillover region (p values: 0.022 and 0.008). We also identify eight spatially aggregated genetic clusters of MDR-TB, four within the spillover region, consistent with local transmission among individuals living close to the prison. Conclusions: We demonstrate a clear prison spillover effect in this population, which suggests that interventions in the prison may have benefits that extend to the surrounding community.Keywords
Funding Information
- National Center for Advancing Translational Sciences (UL1 TR001863 and KL2 TR001862)
- National Institutes of Health (R01 AI112438, R01 AI130058, U54 GM088558)
- National Institute for Health Research
- Academy of Medical Sciences
- Wellcome Trust (201470/Z/16/Z)
This publication has 30 references indexed in Scilit:
- Whole Genome Sequencing versus Traditional Genotyping for Investigation of a Mycobacterium tuberculosis Outbreak: A Longitudinal Molecular Epidemiological StudyPLoS Medicine, 2013
- Assessing spatial heterogeneity of multidrug-resistant tuberculosis in a high-burden countryEuropean Respiratory Journal, 2012
- Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens and Patient Outcomes: An Individual Patient Data Meta-analysis of 9,153 PatientsPLoS Medicine, 2012
- Unifying the spatial epidemiology and molecular evolution of emerging epidemicsProceedings of the National Academy of Sciences of the United States of America, 2012
- Addressing Institutional Amplifiers in the Dynamics and Control of Tuberculosis EpidemicsThe American Journal of Tropical Medicine and Hygiene, 2011
- Tuberculosis Incidence in Prisons: A Systematic ReviewPLoS Medicine, 2010
- Mass incarceration can explain population increases in TB and multidrug-resistant TB in European and central Asian countriesProceedings of the National Academy of Sciences of the United States of America, 2008
- Proposal for Standardization of Optimized Mycobacterial Interspersed Repetitive Unit-Variable-Number Tandem Repeat Typing ofMycobacterium tuberculosisJournal of Clinical Microbiology, 2006
- Increased Incidence of the Outbreak Strain of Mycobacterium tuberculosis in the Surrounding Community after an Outbreak in a JailSouthern Medical Journal, 2003
- Model choice: a minimum posterior predictive loss approachBiometrika, 1998