Universidad Peruana Cayetano Heredia

Investigating spillover of multidrug-resistant tuberculosis from a prison: a spatial and molecular epidemiological analysis

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dc.contributor.author Warren, Joshua L.
dc.contributor.author Grandjean, Louis
dc.contributor.author Moore, David Alexander James
dc.contributor.author Lithgow, Anna
dc.contributor.author Coronel, Jorge
dc.contributor.author Sheen Cortavarria, Patricia
dc.contributor.author Zelner, Jonathan L.
dc.contributor.author Andrews, Jason R.
dc.contributor.author Cohen, Ted
dc.date.accessioned 2018-11-30T17:17:14Z
dc.date.available 2018-11-30T17:17:14Z
dc.date.issued 2018
dc.identifier.uri https://hdl.handle.net/20.500.12866/4106
dc.description.abstract BACKGROUND: Congregate settings may serve as institutional amplifiers of tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB). We analyze spatial, epidemiological, and pathogen genetic data prospectively collected from neighborhoods surrounding a prison in Lima, Peru, where inmates experience a high risk of MDR-TB, to investigate the risk of spillover into the surrounding community. METHODS: Using hierarchical Bayesian statistical modeling, we address three questions regarding the MDR-TB risk: (i) Does the excess risk observed among prisoners also extend outside the prison? (ii) If so, what is the magnitude, shape, and spatial range of this spillover effect? (iii) Is there evidence of additional transmission across the region? RESULTS: The region of spillover risk extends for 5.47 km outside of the prison (95% credible interval: 1.38, 9.63 km). Within this spillover region, we find that nine of the 467 non-inmate patients (35 with MDR-TB) have MDR-TB strains that are genetic matches to strains collected from current inmates with MDR-TB, compared to seven out of 1080 patients (89 with MDR-TB) outside the spillover region (p values: 0.022 and 0.008). We also identify eight spatially aggregated genetic clusters of MDR-TB, four within the spillover region, consistent with local transmission among individuals living close to the prison. CONCLUSIONS: We demonstrate a clear prison spillover effect in this population, which suggests that interventions in the prison may have benefits that extend to the surrounding community. en_US
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartofseries BMC Medicine
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Adolescent en_US
dc.subject Adult en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Young Adult en_US
dc.subject Aged en_US
dc.subject Antibiotic resistance en_US
dc.subject Bayesian statistics en_US
dc.subject Middle Aged en_US
dc.subject Prisons en_US
dc.subject Spatial analysis en_US
dc.subject Spatial Analysis en_US
dc.subject Spillover analysis en_US
dc.subject Transmission en_US
dc.subject Tuberculosis, Multidrug-Resistant en_US
dc.title Investigating spillover of multidrug-resistant tuberculosis from a prison: a spatial and molecular epidemiological analysis en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1186/s12916-018-1111-x
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00
dc.relation.issn 1741-7015


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