Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Infection.

Horton, Katherine C; Schwalb Calderon, Alvaro; Emery, Jon C; Dale, Katie D; Ugarte Gil, Cesar Augusto; Houben, Rein M G J

dc.contributor.author	Schwalb Calderon, Alvaro
dc.contributor.author	Emery, Jon C
dc.contributor.author	Dale, Katie D
dc.contributor.author	Horton, Katherine C
dc.contributor.author	Ugarte Gil, Cesar Augusto
dc.contributor.author	Houben, Rein M G J
dc.date.accessioned	2023-03-23T15:49:33Z
dc.date.available	2023-03-23T15:49:33Z
dc.date.issued	2023
dc.identifier.uri	https://hdl.handle.net/20.500.12866/13273
dc.description.abstract	A key metric in tuberculosis epidemiology is the annual risk of infection (ARI), which is usually derived from tuberculin skin test (TST) and interferon-gamma release assay (IGRA) prevalence surveys in children. Deriving the ARI assumes that immunoreactivity is persistent over time; however, reversion of immunoreactivity has long been documented. Here we use a deterministic, compartmental model of Mycobacterium tuberculosis (Mtb) infection to explore the impact of reversion on ARI estimation using age-specific reversion probabilities for TST and IGRA. Using empirical data of TST reversion (22.2%/year for 0-19yo), the true ARI is 2-5 times higher than estimated from immunoreactivity studies in 8-12 year-olds. Applying empirical reversion probabilities for IGRA (9.9%/year for 12-18yo) showed a 1.5-2-fold underestimation. ARIs are increasingly underestimated in older populations, due to the cumulative impact of reversion on population reactivity over time. Declines in annual risk did not largely affect the results. Ignoring reversion leads to a stark underestimation of the true ARI in populations and our interpretation of Mtb transmission intensity. Future surveys should adjust for reversion probabilities and its cumulative effect with increasing age to provide a more accurate reflection of the burden and dynamics of Mtb infection.	en_US
dc.language.iso	eng
dc.publisher	Oxford University Press
dc.relation.ispartofseries	American Journal of Epidemiology
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	Tuberculin skin test	en_US
dc.subject	Interferon-gamma release assay	en_US
dc.subject	Mtb transmission	en_US
dc.subject	TST/IGRA surveys	en_US
dc.subject.mesh	Prueba de Tuberculina
dc.subject.mesh	Ensayos de Liberación de Interferón gamma
dc.subject.mesh	Mycobacterium tuberculosis
dc.subject.mesh	Encuestas y Cuestionarios
dc.title	Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Infection.	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1093/aje/kwad028
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.03.09
dc.relation.issn	1476-6256