ArticleThe Journal of infectious diseases2013
Nosocomial transmission of extensively drug-resistant tuberculosis in a rural hospital in South Africa.
Article in The Journal of infectious diseases, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 81 papers, 4 of them syntheses that pooled it.
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Who cites it
81 citing papers in PubMed, 4 syntheses or guidelines pooled it, 140 citations in OpenAlex.
- Molecular epidemiology of drug resistant Mycobacterium tuberculosis in Africa: a systematic review.BMC infectious diseases · 2020Pooled it
- Preventing the spread of multidrug-resistant tuberculosis and protecting contacts of infectious cases.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2017Pooled it
- Tuberculosis transmission from healthcare workers to patients and co-workers: a systematic literature review and meta-analysis.PloS one · 2015Pooled it
- Spatial and temporal analyses to investigate infectious disease transmission within healthcare settings.The Journal of hospital infection · 2014Pooled it
- Trial
- Nosocomial tuberculosis: the blind spot in global tuberculosis prevention and care.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2026Article
- Qualitative system dynamics modelling to support the design and implementation of tuberculosis infection prevention and control measures in South African primary healthcare facilities.Health policy and planning · 2024Article
- Community-based active-case finding for tuberculosis: navigating a complex minefield.BMC global and public health · 2024Review
- Accuracy of digital chest x-ray analysis with artificial intelligence software as a triage and screening tool in hospitalized patients being evaluated for tuberculosis in Lima, Peru.PLOS global public health · 2024Article
- Implementing Innovative Approaches to Improve Health Care Delivery Systems for Integrating Communicable and Non-Communicable Diseases Using Tuberculosis and Diabetes as a Model in Tanzania.International journal of environmental research and public health · 2023Article
- Limited Nosocomial Transmission of Drug-Resistant Tuberculosis, Moldova.Emerging infectious diseases · 2023Article
- Epidemiology, pathogenesis, clinical presentation and management of TB in patients with HIV and diabetes.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2023Article
- The Association Between Social Network Characteristics and Tuberculosis Infection Among Adults in 9 Rural Ugandan Communities.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Transmissibility of tuberculosis among students and non-students: an occupational-specific mathematical modelling.Infectious diseases of poverty · 2022Article
- Tuberculosis attributed to transmission within healthcare facilities, Botswana-The Kopanyo Study.Infection control and hospital epidemiology · 2022Article
- Review
- Attitudes of Healthcare Workers about Prevention and Control of Nosocomial Multidrug-Resistant Tuberculosis Infection in Two Top-Ranked Tuberculosis Specialized Public Hospitals of Ethiopia.The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale · 2022Article
- Transmission visualizations of healthcare infection clusters: A scoping review.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2022Article
- Estimating waiting times, patient flow, and waiting room occupancy density as part of tuberculosis infection prevention and control research in South African primary health care clinics.PLOS global public health · 2022Article
- Occupational Risk of AirborneInternational journal of environmental research and public health · 2021Article
21 more citing papers are in PubMed but not listed here.
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Authors and funding
13 authors at 7 institutions in 2 countries.
Funding
Abstract
backgroundExtensively drug-resistant tuberculosis (XDR-tuberculosis) is a global public health threat, but few data exist elucidating factors driving this epidemic. The initial XDR-tuberculosis report from South Africa suggested transmission is an important factor, but detailed epidemiologic and molecular analyses were not available for further characterization.
methodsWe performed a retrospective, observational study among XDR-tuberculosis patients to identify hospital-associated epidemiologic links. We used spoligotyping, IS6110-based restriction fragment-length polymorphism analysis, and sequencing of resistance-determining regions to identify clusters. Social network analysis was used to construct transmission networks among genotypically clustered patients.
resultsAmong 148 XDR-tuberculosis patients, 98% were infected with human immunodeficiency virus (HIV), and 59% had smear-positive tuberculosis. Nearly all (93%) were hospitalized while infectious with XDR-tuberculosis (median duration, 15 days; interquartile range: 10-25 days). Genotyping identified a predominant cluster comprising 96% of isolates. Epidemiologic links were identified for 82% of patients; social network analysis demonstrated multiple generations of transmission across a highly interconnected network.
conclusionsThe XDR-tuberculosis epidemic in Tugela Ferry, South Africa, has been highly clonal. However, the epidemic is not the result of a point-source outbreak; rather, a high degree of interconnectedness allowed multiple generations of nosocomial transmission. Similar to the outbreaks of multidrug-resistant tuberculosis in the 1990s, poor infection control, delayed diagnosis, and a high HIV prevalence facilitated transmission. Important lessons from those outbreaks must be applied to stem further expansion of this epidemic.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.