Know your tuberculosis epidemic–Is it time to add Mycobacterium tuberculosis immunoreactivity back into global surveillance

Tuberculosis (TB) still causes 1.5 million deaths globally each year. Over recent decades, slow and uneven declines in TB incidence have resulted in a falling prevalence of TB disease, which increasingly concentrates in vulnerable populations. Falling prevalence, while welcome, poses new challenges for TB surveillance. Cross-sectional disease surveys require very large sample sizes to accurately estimate disease burden, and even more participants to detect trends over time or identify high-risk areas or populations, making them prohibitively resource-intensive. In the past, tuberculin skin surveys measuring Mycobacterium tuberculosis (Mtb) immunoreactivity were widely used to monitor TB epidemiology in high-incidence settings, but were limited by challenges with both delivering and interpreting the test. Here we argue that the shifting epidemiology of tuberculosis, and the development of new tests for Mtb infection, make it timely and important to revisit the strategy of TB surveillance based on infection or immunoreactivity. Mtb infection surveys carry their own operational challenges and fundamental questions, for example: around survey design and frequency; which groups should be included; how the prevalence of immunoreactivity in a population should be used to estimate force of infection; how individual results should be interpreted and managed; and how surveillance can be delivered efficiently and ethically. However, if these knowledge gaps are addressed, the relative feasibility and lower costs of Mtb infection surveillance offer a powerful and affordable opportunity to better “know your TB epidemic”, understand trends, identify high-risk and underserved communities, and tailor public health responses to dynamic epidemiology

Disease · Disease burden · Environmental health · Global health · Mycobacterium tuberculosis · Pathology · Population · Public health · Tuberculin · Tuberculosis · Medicine · Mycobacterium research and diagnosis · Pneumonia and Respiratory Infections · Tuberculosis Research and Epidemiology · Epidemiology · Immunology

• Insights into tuberculosis burden in Karachi, Pakistan

  Open Access•Palwasha Khan, Mohammed Shariq Paracha et al.•PLOS Global Public Health•2024

  Incluir item

• The impact of a combined TB/HIV intervention on the incidence of TB infection among adolescents and young adults in the HPTN 071 (PopART) trial communities in Zambia and South Africa

  Open Access•Kwame Shanaube, Ab Schaap et al.•PLOS Global Public Health•2023

  Incluir item

• Tuberculin skin test surveys and the Annual Risk of Tuberculous Infection in school children in Northern KwaZulu-Natal

  Open Access•Tom Yates, Siphiwe Cebekhulu et al.•PLOS Global Public Health•2024

  Incluir item

• The Global Burden of Latent Tuberculosis Infection

  Open Access•Rein Mgj Houben, Rein M G J Houben et al.•PLoS Medicine•2016

  Incluir item

• Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection

  Open Access•Ineke Spruijt, Dawit Tesfay Haile et al.•BMC Public Health•2020

  Incluir item