Spatio-temporal analysis of tuberculous infection risk among clients of a homeless shelter during an outbreak
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.
Document Type: Research Article
Affiliations: 1: Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, Canada 2: Department of Microbiology & Immunology, University of British Columbia, Vancouver, Canada 3: Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, Canada 4: British Columbia Public Health Microbiology and Reference Laboratory, Vancouver, British Columbia, Canada 5: Department of Mathematics, Imperial College London, London, UK 6: 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 7: Interior Health Authority, Kelowna, British Columbia, Canada
Publication date: September 1, 2015
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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