Mapping sites of high TB transmission risk: Integrating the shared air and social behaviour of TB cases and adolescents in a South African township
Mapping sites of high TB transmission risk: Integrating the shared air and social behaviour of TB cases and adolescents in a South African township
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DOI：
10.1016/j.scitotenv.2017.01.026
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发表时间：
2017-04-01
影响因子：
9.8
通讯作者：
Wood, Robin
中科院分区：
文献类型：
--
作者：
Patterson, Benjamin;Morrow, Carl D.;Wood, Robin
背景：结核病仍然是世界贫困地区的一个主要公共卫生问题。社区聚集场所占结核病高负担settings.Objective的传播的大部分：调查社会行为模式的个人谁开发的结核病和青少年的感染风险。为了开发一种廉价和有效的方法来定位高负担community.Design的传输热点：便携式，结合CO2/GIS监测仪和位置日记给个人从南非乡镇。这三个群体：新诊断的结核病患者、最近接受治疗的结核病患者和青少年记录了他们在中位数两天内的活动。再呼吸空气量（RAVs）在所有地理信息系统的位置计算从二氧化碳水平使用Rudnick-Milton变量的韦尔斯-莱利结核病传播模型。热点分析，以确定公共建筑物，对应于空间聚集的高RAVs.Results：分析的日记发现，青少年组花了更多的时间在聚集的设置相比，其他两个组驱动的时间花在学校/工作（新TB：1%，最近TB：8%，和青少年：23%）。青少年也更频繁地改变他们的位置（每天9.0，6.0，14.3次变化; p < 0.001）。RAV反映了组间的这种差异（44，40，127 1; p < 0.001）。与高RAV相关的公共建筑被发现是一个诊所，两所学校和一个图书馆。热点分析揭示了最激烈的集群高RAVs在社区school.Conclusion：我们的研究展示了一种新的方法来发现结核病传播的热点使用的技术，避免了需要预先选择的位置。对南非一个城镇的调查突出表明，学校存在高风险潜力，青少年的社会行为也存在高风险。因此，针对学校的减少传播战略可能在高负担环境中非常有效。(C)2017作者由Elsevier B. V.发布，这是CC BY许可下的开放获取文章。
Background: Tuberculosis remains a major public health problem in poverty-stricken areas of the world. Communal gathering places account for the majority of TB transmission in high burden settings.Objective: To investigate the social behaviour patterns of individuals who have developed TB disease and adolescents at risk of infection. To develop a cheap and effective method to locate transmission hot spots in high burden communities.Design: Portable, combined CO2/GIS monitors and location diaries were given to individuals from a South African township. The three groups: newly diagnosed TB patients, recently treated TB patients and adolescents recorded their activities over a median of two days. Rebreathed air volumes (RAVs) at all GIS locations were calculated from CO2 levels using the Rudnick-Milton variant of the Wells-Riley TB transmission model. Hot spot analysis was performed to determine the communal buildings which correspond to spatially clustered high RAVs.Results: Analysis of diaries found that the adolescent group spent greater time in congregate settings compared with the other two groups driven by time spent in school/work (new TB: 1%, recent TB: 8%, and adolescents: 23%). Adolescents also changed their location more frequently (9.0, 6.0, 14.3 changes per day; p < 0.001). The RAVs reflected this divergence between the groups (44, 40, 127 1; p < 0.001). Communal buildings associated with high RAVs were found to be a clinic, two schools and a library. Hot spot analysis revealed the most intense clustering of high RAVs at a community school.Conclusion: Our study demonstrates a new methodology to uncover TB transmission hot spots using a technique that avoids the need to pre-select locations. Investigation of a South African township highlighted the high risk potential of schools and high risk social behaviour of adolescents. Consequently the targeting of transmission reduction strategies to schools may prove highly efficacious in high burden settings. (C) 2017 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license.