Gomes, M. Gabriela M., Rodrigues, Paula, Hilker, Frank M., Mantilla-Beniers, Natalia B., Muehlen, Marion, Paulo, Ana Cristina and Medley, Graham. (2007) Implications of partial immunity on the prospects for tuberculosis control by post-exposure interventions. Journal of Theoretical Biology, Vol.248 (No.4). pp. 608-617. ISSN 0022-5193

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Abstract

One-third of the world population (approximately 2 billion individuals) is currently infected with Mycobacterium tuberculosis, the vast majority harboring a latent infection. As the risk of reactivation is around 10% in a lifetime, it follows that 200 million of these will eventually develop active pulmonary disease. Only therapeutic or post-exposure interventions can tame this vast reservoir of infection. Treatment of latent infections can reduce the risk of reactivation, and there is accumulating evidence that combination with postexposure vaccines can reduce the risk of reinfection. Here we develop mathematical models to explore the potential of these postexposure interventions to control tuberculosis on a global scale. Intensive programs targeting recent infections appear generally effective, but the benefit is potentially greater in intermediate prevalence scenarios. Extending these strategies to longer-term persistent infections appears more beneficial where prevalence is low. Finally, we consider that susceptibility to reinfection is altered by therapy, and explore its epidemiological consequences. When we assume that therapy reduces susceptibility to subsequent reinfection, catastrophic dynamics are observed. Thus, a bipolar outcome is obtained, where either small or large reductions in prevalence levels result, depending on the rate of detection and treatment of latent infections. By contrast, increased susceptibility after therapy may induce an increase in disease prevalence and does not lead to catastrophic dynamics. These potential outcomes are silent unless a widespread intervention is implemented.

Item Type:	Journal Article
Subjects:	Q Science > QH Natural history > QH301 Biology
Divisions:	Faculty of Science > Life Sciences (2010- ) > Biological Sciences ( -2010)
Journal or Publication Title:	Journal of Theoretical Biology
Publisher:	Elsevier
ISSN:	0022-5193
Date:	21 October 2007
Volume:	Vol.248
Number:	No.4
Number of Pages:	10
Page Range:	pp. 608-617
Identification Number:	10.1016/j.jtbi.2007.06.005
Status:	Peer Reviewed
Publication Status:	Published
URI:	http://wrap.warwick.ac.uk/id/eprint/31258

Data sourced from Thomson Reuters' Web of Knowledge

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