Spatio-temporal analysis of tuberculous infection risk among clients of a homeless shelter during an outbreak.

Autor:	Crisan A; Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, Canada., Wong HY; Department of Microbiology & Immunology, University of British Columbia, Vancouver, Canada., Johnston JC; Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, Canada., Tang P; British Columbia Public Health Microbiology and Reference Laboratory, Vancouver, British Columbia, Canada., Colijn C; Department of Mathematics, Imperial College London, London, UK., Otterstatter M; Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada., Hiscoe L; Interior Health Authority, Kelowna, British Columbia, Canada., Parker R; Interior Health Authority, Kelowna, British Columbia, Canada., Pollock SL; Interior Health Authority, Kelowna, British Columbia, Canada., Gardy JL; Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada.
Jazyk:	angličtina
Zdroj:	The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease [Int J Tuberc Lung Dis] 2015 Sep; Vol. 19 (9), pp. 1033-8, i-iii.
DOI:	10.5588/ijtld.14.0957
Abstrakt:	Setting: British Columbia (BC) has a low incidence of tuberculosis (TB), with the burden of endogenously acquired disease concentrated among vulnerable populations, including the homeless. In May 2008, a TB outbreak began in a BC homeless shelter, with a single index case seeding multiple secondary cases within the shelter. Objective: To use nightly shelter records to quantify the risk of latent tuberculous infection (LTBI) among shelter clients as a function of their sleeping distance from and duration of exposure to the index case. Design: Distance and duration of exposure were visualised and assessed using logistic regression with LTBI status as outcome. We used a novel machine learning approach to establish exposure thresholds that optimally separated infected and non-infected individuals. Results: Of 161 exposed shelter clients, 58 had a recorded outcome of infected (n = 39) or non-infected (n = 19). Only duration of exposure to the index was associated with increased odds of infection (OR 1.26); stays of ⩾ 5 nights put shelter clients at higher odds of infection (OR 4.97). Conclusion: The unique data set and analytical approach suggested that, in a shelter environment, long-term clients are at highest risk of LTBI and should be prioritised for screening during an outbreak investigation.
Databáze:	MEDLINE
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