Revisiting the Natural History of Pulmonary Tuberculosis: A Bayesian Estimation of Natural Recovery and Mortality Rates

Ragonnet, Romain; Flegg, Jennifer A.; Brilleman, Samuel L.; Tiemersma, Edine; Melsew, Yayehirad Alemu; McBryde, Emma S.; Trauer, James M

doi:10.1093/cid/ciaa602

Cited by 26 publications

(43 citation statements)

References 14 publications

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“…Whilst the parameters were estimated by fitting to the data and a two year infectious disease duration, our model matched empirical estimates of cumulative 10-year mortality for all infectious TB of around 40%. 18,21 We also extracted duration of symptoms before treatment. Systematic reviews of self-reported sypmtoom duration usually cite between one and three months of symptoms prior to treatment, whereas we found a median of four months.…”

Section: Discussionmentioning

confidence: 99%

The natural history of TB disease-a synthesis of data to quantify progression and regression across the spectrum

Richards

Sossen

Emery

et al. 2021

Preprint

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Background: Prevalence surveys have found a substantial burden of subclinical (asymptomatic but infectious) TB, from which individuals can progress, regress or even persist in a chronic disease state. We aimed to quantify these pathways across the spectrum of TB disease. Methods: We created deterministic framework of TB disease with progression and regression between three states of pulmonary TB disease: minimal (non-infectious), subclinical, and clinical (symptomatic and infectious) disease. We estimated ranges for each parameter by considering all data from a systematic review in a Bayesian framework, enabling quantitative estimation of TB disease pathways. Findings: Twenty-four studies contributed data from 6030 individuals. Results suggested that, after five years, 24.7%(95% uncertainty interval, UI, 21.3%-28.6%) of individuals with prevalent subclinical disease at baseline had either progressed to clinical disease or died from TB, whereas 16.1%(95%UI, 13.8%-18.5%) had recovered after regressing to minimal disease. Over the course of five years 30% (95%UI, 27.2%-32.6%) of the subclinial cohort never developed symptoms. For those with clinical disease at baseline, 39%(95%UI, 35.8%-41.9%) and 10.3%(95%UI, 8.5%-12.4%) had died or recovered from TB, with the remainder in, or undulating between, the three disease states. The ten-year mortality of people with untreated prevalent infectious disease was 38%. Interpretation: Our results show that for people with subclinical disease, classic clinical disease is neither inevitable nor an irreversible outcome. As such, reliance on symptom- based screening means a large proportion of people with infectious disease may never be detected. Funding: TB Modelling and Analysis Consortium and European Research Council

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Section: Discussionmentioning

confidence: 99%

The natural history of TB disease-a synthesis of data to quantify progression and regression across the spectrum

Richards

Sossen

Emery

et al. 2021

Preprint

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“…We used programmatic data to inform the simulated detection and treatment processes and previously published estimates to inform the natural history of TB, 17 as well as the rates of progression from latent to active TB. 16 Model parameters were fitted to local data on population size, TB prevalence, LTBI prevalence and TB notifications using an adaptive Metropolis algorithm.…”

Section: Methodsmentioning

confidence: 99%

“…Our previously published estimates were used to inform the natural history of TB (14), and the progression rates from latent to active TB (13). We fitted model parameters using local data on population size, TB prevalence, LTBI prevalence and TB notifications while considering uncertainty around the most critical model parameters (Table 2).…”

Section: Tuberculosis Modelmentioning

confidence: 99%

Long-term effects of mass screening for latent and active tuberculosis in the Marshall Islands

Ragonnet

Largen

et al. 2021

Preprint

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Background: Ambitious population-based screening programs for latent and active tuberculosis (TB) were implemented in the Republic of the Marshall Islands (RMI) in 2017 and 2018. Methods: We used a transmission dynamic model of TB informed by local data to capture the historical dynamics of the RMI epidemic. We then used the model to project the future epidemic trajectory following the active screening interventions, as well as considering a counterfactual scenario with no intervention. We also simulated future scenarios including periodic interventions similar to those previously implemented, to assess their ability to reach the End TB Strategy targets and TB pre-elimination in RMI. Findings: The screening activities conducted in 2017 and 2018 were estimated to have reduced TB incidence and mortality by more than one third in 2020, and are predicted to achieve the End TB Strategy milestone of 50% incidence reduction by 2025 compared to 2015. Screening interventions had a considerably greater impact when latent TB screening and treatment was included, compared to active case finding alone. Such combined programs implemented at the national level could achieve TB pre-elimination around 2035 if repeated every two years, and around 2045 if repeated every five years. Interpretation: Our model suggests that it would be possible to achieve TB pre-elimination by 2035 in RMI through periodic repetition of the same interventions as those already implemented in the country. It also highlights the importance of including latent infection testing in active screening activities. Funding: Australian National Health and Medical Research Council and World Health Organization.

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“…In this regard, we have introduced the protection factor p, which determines the percentage of active cases that show a smear negative course. The annual spontaneous cure ( '( and ') ) and dying (μTB,SP and μTB,SN) rates depend on the SP or SN nature of the disease and is given by Ragonnet et al 33 .…”

Section: 1-tbspectr Modelmentioning

confidence: 99%

“…Recent data based on a precise determination of mortality and curation in the natural history of TB in the pre-chemotherapy era oblige us to modify this model. In this work, the authors have been able to better distinguish the prognostic of sputum positive (SP) and sputum negative (SN) patients, as a sign of TB severity 33 . This data shows a dramatic difference between both forms and allows us to better explore the trade-offs that made this coevolution possible.…”

Section: -Introductionmentioning

confidence: 99%

The Origin and Maintenance of Tuberculosis is Explained by Its Subclinical Course, the Neolithic Revolution Being the Trigger for Its Devastating Deadly Drift

Cardona¹,

Català²,

Prats³

2021

Preprint

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The origin of Mycobacterium tuberculosis infection has recently been dated to the Middle Paleolithic; around 70,000 years before the common era (BCE). At that time Homo sapiens was just another primate living in reduced groups in balance with nature, with discrete growth and a very low-density geographic occupation. Therefore, it is difficult to understand the origin of a highly virulent obligate human pathogen. We have designed a new SEIR model (TBSpectr) that considers tuberculosis (TB) clinical spectrum, by including a protection factor (p). The model fits current accepted growth rates for Middle Paleolithic (0.003%/year) and Neolithic (0,1%/year). The data obtained links the origin of M. tuberculosis ancient lineages in the Middle Paleolithic to the induction of mild TB forms (Sputum negative), thanks to a high p factor that was further enhanced by evolution towards modern lineages. The poor health status linked to the unequal society existing after the Neolithic revolution increased the incidence of more severe forms of TB (Sputum positive). This data supports the origin of TB as a well-tolerated highly persistent infection which could coevolve towards mutualism, shows the difficulty of eradicating it and highlights the imperative of providing better health conditions to humans to avoid its severity.

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Revisiting the Natural History of Pulmonary Tuberculosis: A Bayesian Estimation of Natural Recovery and Mortality Rates

Cited by 26 publications

References 14 publications

The natural history of TB disease-a synthesis of data to quantify progression and regression across the spectrum

The natural history of TB disease-a synthesis of data to quantify progression and regression across the spectrum

Long-term effects of mass screening for latent and active tuberculosis in the Marshall Islands

The Origin and Maintenance of Tuberculosis is Explained by Its Subclinical Course, the Neolithic Revolution Being the Trigger for Its Devastating Deadly Drift

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