Sustained Intra- and Inter-jurisdictional Transmission of Tuberculosis within a Mobile, Multi-ethnic Social Network: Lessons for Tuberculosis Elimination

BACKGROUND: A context-specific, spatial-temporal understanding of a chain of tuberculosis (TB) transmission can inform TB elimination strategy. METHODS: Clinical, public health and molecular epidemiologic data were used to: 1) identify and describe a complex cluster of TB cases in Alberta, 2) elucid...

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Bibliographic Details
Published in:Canadian Journal of Public Health
Main Authors: Aspler, Anne, Chong, Huey, Kunimoto, Dennis, Chui, Linda, Der, Evelina, Boffa, Jody, Long, Richard
Format: Text
Language:English
Published: Springer International Publishing 2010
Subjects:
Quantitative Research
Northwest Territories
Online Access:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973929/
http://www.ncbi.nlm.nih.gov/pubmed/20737810
https://doi.org/10.1007/BF03404391
Description
Summary:BACKGROUND: A context-specific, spatial-temporal understanding of a chain of tuberculosis (TB) transmission can inform TB elimination strategy. METHODS: Clinical, public health and molecular epidemiologic data were used to: 1) identify and describe a complex cluster of TB cases in Alberta, 2) elucidate transmission sequences, and 3) assess case-patient mobility. Socio-economic indicators in loci of transmission and the province at large were described. Factors seen to be fostering or hampering TB elimination were identified. RESULTS: Over a 15-year period, 18 TB cases in Alberta and multiple cases in the Northwest Territories were determined to be due to the same strain. One patient was diagnosed at death; all others completed directly-observed therapy (DOT). Case-level analysis revealed that patients were highly mobile with transmission of the strain over 26,569 km(2), an average of 2.8 different places of residence per patient during treatment, and contacts of sputum smear-positive cases spanning 9 of 17 regional health authorities. The majority of the contacts (57%) were attached to a single infectious case living in a homeless shelter. The three loci of transmission in Alberta were separated geographically but similar in terms of median incomes, rates of unemployment, levels of post-secondary education, and rates of population mobility (p<0.0001). CONCLUSION: Upon review of the experience, central oversight, intra- and inter-jurisdictional coordination and DOT were seen as fostering, and the absence of ‘real-time’ DNA fingerprinting, social network analysis, engineering controls in shelters and better determinants of health in loci of transmission were seen as hampering TB elimination.

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