Tuberculosis in teens: a geospatial approach to predict community transmission

Harvard Medical School, Boston MA

Investigators

Linked publications & trials

Abstract

PROJECT SUMMARY/ABSTRACT Tuberculosis (TB) is a preventable infectious disease, yet one million children fall sick with TB every year. Children with TB are a uniquely vulnerable population because they are challenging to diagnose and, once infected, they progress more quickly than adults to TB disease and death. Thus, children with TB are sentinel events? cautioning of recent exposure to an infectious, untreated person and signaling contact tracing to commence. Identifying infectious individuals in a community is the first step required to break the cycle of TB transmission. My overall goal is to use spatial analysis methods to identify targeted case-finding interventions that can increase case detection of children with TB in high TB transmission areas. My study will make children the cornerstone of TB surveillance. This is novel because children have been largely neglected in TB epidemiology research and interventions designed to target children at high TB risk are largely underutilized. In Aim 1, I will describe the geographic heterogeneity and clustering of pediatric TB and associated risk factors to identify individual- and population-level drivers and dynamics of the spatial variation of child TB cases. This will inform areas to target with case finding. In Aim 2, I will explore the geographic heterogeneity of within-household genotype concordance of TB strains from children and adults to identify paths of TB transmission across the community and to inform the types of case-finding strategies that may be most effective in each community. Then, in Aim 3 I will determine the geographic heterogeneity of household- and community-based risk of TB transmission to children to better understand how risk-levels vary over small spatial scales. This will guide how quickly interventions should be deployed and the resources required. Finally, in Aim 4 I will estimate and compare the impact of a set of targeted case-finding strategies to increase detection of children with TB through a simulation study, calibrated to the epidemic curve, the local spatiotemporal clustering pattern of child TB cases, and the geographic variability of TB risk in children. I will assess a set of case-finding strategies? including household contact screening, screening within two levels of the census tract (block, neighborhood), and a ring strategy where screening occurs in an increasing radius from the child TB case? to quantify the increase in the yield of TB cases detected and reduction in the total number of TB cases. The portfolio of mentored research and training proposed for this K01 award will enable me to complete advanced training in infectious disease epidemiology and develop expertise in the application of spatial analysis techniques and the study of transmission dynamics. This award will enable me to take the next critical step toward my goal of becoming an independent and influential scientist, including my submission of a research grant (R01) proposal to test novel, targeted interventions in vulnerable populations including children. I have defined a detailed career development plan and assembled a highly experienced team of mentors, led by Prof. Mercedes Becerra, a globally renowned expert in pediatric TB epidemiology.