Munang, Melinda Lea (2019) Persistence of tuberculosis inferred from case and contact networks in Birmingham, UK. PhD thesis, University of Warwick.

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Abstract

Tuberculosis (TB) is a public health priority in urban cities of high income countries such as the UK, where the local incidence can be several times that of the national incidence. A large dataset of 63,620 individuals registered at a single centre in Birmingham, UK captured all TB treatment episodes (active disease and latent infection) and contained individual level detail on contacts of TB cases from 1980 to 2011. Exploratory analysis of the pseudonymised research dataset revealed clusters of individuals presenting as cases and contacts through time. Repeated cases originated from the pool of known individuals treated for active or latent TB with a probability of 1.5% at five years and 2.7% at ten years, but routine recording of latent TB treatment episodes is not widespread to estimate the future burden of retreatment TB. When repeated contacts were examined, their probability of being diagnosed as a case was twice that of non-repeated contacts (3.9% versus 1.6% for active disease and 10.7% versus 3.7% for latent infection) at one year. Contact repetition should be recognised but consistent recording of patient identity is lacking. In further evaluation of the role of contact structure in case detection, only the eigenvector centrality (connections to other highly scoring individuals) was associated with at least one case detection in the local network. Because networks were viewed from a static approach and network metrics may reflect effect rather than cause of the contact tracing process, further interpretation was difficult. However network visualisation identified a large cluster of 3,148 individuals, who entered the dataset at all times in the study period, that were linked through a superspreading event. Evaluating transmission was limited by a small sample of patients with mycobacterial repetitive unit-variable number tandem repeats (MIRUVNTR) typing but data available suggested that the superspreading event was nested within a risk network rather than a transmission network.

Item Type:	Thesis or Dissertation (PhD)
Subjects:	R Medicine > RA Public aspects of medicine
Library of Congress Subject Headings (LCSH):	Tuberculosis -- Transmission, Tuberculosis -- Epidemiology, Public health -- Great Britain
Official Date:	June 2019
Dates:	Date Event June 2019 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	School of Life Sciences
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Hollingsworth, Deirdre ; Medley, Graham
Format of File:	pdf
Extent:	182 leaves : illustrations, charts
Language:	eng

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