Determinants of cluster distribution in the molecular epidemiology of tuberculosis
Determinants of cluster distribution in the molecular epidemiology of tuberculosis
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DOI：
10.1073/pnas.022618299
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发表时间：
2002-02-05
影响因子：
11.1
通讯作者：
Murray, M
中科院分区：
文献类型：
--
作者：
Murray, M
最近发展的分子技术彻底改变了结核病的流行病学。多项研究已使用这些工具来检查不同社区中结核分枝杆菌分离株的种群结构。这些环境中结核分枝杆菌分离株簇的分布可能不同地反映了社会混合模式或生物体特定克隆的差异适应度。我们开发了基于个体的结核病传播微观模拟，以探索集群分布的社会和人口决定因素，并观察传播动态对分子流行病学研究经验数据的影响。我们的结果表明，即使假设生物体的所有菌株都具有同等的传播性，多个宿主相关因素也会导致簇分布的广泛变化。这些宿主特征包括化疗、疫苗接种和化学预防等干预措施、艾滋病毒患病率、人口年龄结构以及潜伏性结核感染的患病率。我们考虑这些结果对结核分枝杆菌聚类研究的解释以及微观模拟模型在传染病流行病学中更普遍的应用的影响。
Recently developed molecular techniques have revolutionized the epidemiology of tuberculosis. Multiple studies have used these tools to examine the population structure of Mycobacterium tuberculosis isolates in different communities. The distributions of clusters of M. tuberculosis isolates in these settings may variously reflect social mixing patterns or the differential fitness of specific clones of the organism. We developed an individual-based microsimulation of tuberculosis transmission to explore social and demographic determinants of cluster distribution and to observe the effect of transmission dynamics on the empiric data from molecular epidemiologic studies. Our results demonstrate that multiple host-related factors contribute to wide variation in cluster distributions even when all strains of the organism are assumed to be equally transmissible. These host characteristics include interventions such as chemotherapy, vaccination and chemoprophylaxis, HIV prevalence, the age structure of the population, and the prevalence of latent tuberculosis infection. We consider the implications of these results for the interpretation of cluster studies of M. tuberculosis as well as the more general application of microsimulation models to infectious disease epidemiology.