Journal
CLINICAL INFECTIOUS DISEASES
Volume 59, Issue 8, Pages 1123-1129Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciu506
Keywords
communicable disease control; epidemiology; transmission; tuberculosis
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Funding
- B. Frank and Kathleen Polk Assistant Professorship in Epidemiology at the Johns Hopkins Bloomberg School of Public Health
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The global tuberculosis control community has committed itself to ambitious 10-year targets. To meet these targets, biomedical advances alone will be insufficient; a more targeted public health tuberculosis strategy is also needed. We highlight the role of tuberculosis transmission catalysts, defined as variabilities in human behavior, bacillary properties, and host physiology that fuel the propagation of active tuberculosis at the local level. These catalysts can be categorized as factors that increase contact rates, infectiousness, or host susceptibility. Different catalysts predominate in different epidemiological and sociopolitical settings, and public health approaches are likely to succeed only if they are tailored to target the major catalysts driving transmission in the corresponding community. We argue that global tuberculosis policy should move from a country-level focus to a strategy that prioritizes collection of data on key transmission catalysts at the local level followed by deployment of catalyst-targeted interventions, supported by strengthened health systems.
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