Tuberculosis attributed to transmission within healthcare facilities, Botswana—The Kopanyo Study

Abstract

Objective: Healthcare facilities are a well-known high-risk environment for transmission of M. tuberculosis, the etiologic agent of tuberculosis (TB) disease. However, the link between M. tuberculosis transmission in healthcare facilities and its role in the general TB epidemic is unknown. We estimated the proportion of overall TB transmission in the general population attributable to healthcare facilities. Methods: We combined data from a prospective, population-based molecular epidemiologic study with a universal electronic medical record (EMR) covering all healthcare facilities in Botswana to identify biologically plausible transmission events occurring at the healthcare facility. Patients with M. tuberculosis isolates of the same genotype visiting the same facility concurrently were considered an overlapping event. We then used TB diagnosis and treatment data to categorize overlapping events into biologically plausible definitions. We calculated the proportion of overall TB cases in the cohort that could be attributable to healthcare facilities. Results: In total, 1,881 participants had TB genotypic and EMR data suitable for analysis, resulting in 46,853 clinical encounters at 338 healthcare facilities. We identified 326 unique overlapping events involving 370 individual patients; 91 (5%) had biologic plausibility for transmission occurring at a healthcare facility. A sensitivity analysis estimated that 3%–8% of transmission may be attributable to healthcare facilities. Conclusions: Although effective interventions are critical in reducing individual risk for healthcare workers and patients at healthcare facilities, our findings suggest that development of targeted interventions aimed at community transmission may have a larger impact in reducing TB.

Limited Nosocomial Transmission of Drug-Resistant Tuberculosis, Moldova

“…Nosocomial transmission of MTBC infection in high-burden settings has been reported previously ( 5 – 7 ). We prospectively aimed to detect transmission events of MDR/RR strains of MTBC at the TB referral center in Moldova, a country of high MDR/RR TB incidence.…”

Time to change the way we think about tuberculosis infection prevention and control in health facilities: insights from recent research

“… 5 A recently published molecular epidemiological study from Botswana concluded, similarly, that 3–8% of Mtb transmission resulting in TB disease might be attributable to contact in healthcare facilities. 6 …”

“…5 A recently published molecular epidemiological study from Botswana concluded, similarly, that 3-8% of Mtb transmission resulting in TB disease might be attributable to contact in healthcare facilities. 6 Cost-effectiveness analyses suggest that all of the TB-IPC interventions modeled, including combinations of these interventions, are highly cost-effective. 54 We used the current opportunity cost-based threshold for South Africa, estimated at US$3,200 per disability-adjusted life-year (DALY) averted.…”

“…Transmission of Mycobacterium tuberculosis ( Mtb ) within healthcare facilities presents a substantial risk to health workers and patients in communities experiencing a high burden of tuberculosis disease (TB). 1 – 6 …”

“…Transmission of Mycobacterium tuberculosis (Mtb) within healthcare facilities presents a substantial risk to health workers and patients in communities experiencing a high burden of tuberculosis disease (TB). [1][2][3][4][5][6] We recently concluded an interdisciplinary program of research with a focus on TB infection prevention and control (TB-IPC) in primary healthcare clinics in KwaZulu-Natal and Western Cape provinces, South Africa. 7,8 These findings are discussed in light of recently published studies on TB-IPC, from other research teams, that also focus on primary healthcare clinics in countries with a high TB burden.…”