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.
Keywords: exposure; indoor air; infectiousness; transmission
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: 01 September 2015
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