Rapid impact of effective treatment on transmission of multidrug-resistant tuberculosis
OBJECTIVES: To estimate the impact of treatment on infectiousness among MDR-TB patients.
METHODS: A series of five human-to-guinea pig TB transmission studies was conducted to test various interventions for infection control. Guinea pigs in adjacent chambers were exposed to exhaust air from a hospital ward occupied by mostly sputum smear- and culture-positive MDR-TB patients. The guinea pigs then underwent tuberculin skin testing for infection. Only the control groups of guinea pigs from each study (no interventions used) provide the data for this analysis. The number of guinea pigs infected in each study is reported and correlated with Mycobacterium tuberculosis drug susceptibility relative to treatment.
RESULTS: Despite exposure to presumably infectious MDR-TB patients, infection percentages among guinea pigs ranged from 1% to 77% in the five experiments conducted. In one experiment in which guinea pigs were exposed to 27 MDR-TB patients newly started on effective treatment for 3 months, there was minimal transmission. In four other experiments with greater transmission, guinea pigs had been exposed to patients with unsuspected extensively drug-resistant tuberculosis who were not on effective treatment.
CONCLUSIONS: In this model, effective treatment appears to render MDR-TB patients rapidly non-infectious. Further prospective studies on this subject are needed.
Keywords: extensively drug-resistant tuberculosis; impact of treatment; multidrug-resistant tuberculosis; transmission
Document Type: Research Article
Affiliations: 1: Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA 2: South African Medical Research Council, Pretoria 3: University of Pretoria, Pretoria, South Africa 4: Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts 5: Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Publication date: 01 September 2014
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