Rationale: The persistent burden of tuberculosis (TB) disease emphasizes the need to identify individuals with TB for treatment and those at a high risk of incident TB for prevention. Targeting interventions toward those at high risk of developing and transmitting TB is a public health priority. Objectives: We aimed to identify characteristics of individuals involved in TB transmission in a community setting, which may guide the prioritization of targeted interventions. Methods: We collected clinical and sociodemographic data from a cohort of patients with TB in Lima, Peru. We used whole-genome sequencing data to assess the genetic distance between all possible pairs of patients; we considered pairs to be the result of a direct transmission event if they differed by three or fewer SNPs, and we assumed that the first diagnosed patient in a pair was the transmitter and the second was the recipient. We used logistic regression to examine the association between host factors and the likelihood of direct TB transmission. Measurements and Main Results: Analyzing data from 2,518 index patients with TB, we identified 1,447 direct transmission pairs. Regardless of recipient attributes, individuals less than 34 years old, males, and those with a history of incarceration had a higher likelihood of being transmitters in direct transmission pairs. Direct transmission was more likely when both patients were drinkers or smokers. Conclusions: This study identifies men, young adults, former prisoners, alcohol consumers, and smokers as priority groups for targeted interventions. Innovative strategies are needed to extend TB screening to social groups such as young adults and prisoners with limited access to routine preventive care.

中文翻译：

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谁将结核病传染给谁：秘鲁利马一项队列研究的横断面分析。


理由：结核病 (TB) 疾病的持续负担强调需要识别结核病患者进行治疗，并识别结核病高危人群进行预防。针对那些发展和传播结核病的高风险人群采取干预措施是一项公共卫生优先事项。目标：我们的目的是确定社区环境中参与结核病传播的个人特征，这可以指导有针对性的干预措施的优先顺序。方法：我们收集了秘鲁利马结核病患者队列的临床和社会人口统计学数据。我们使用全基因组测序数据来评估所有可能的患者对之间的遗传距离；如果配对的 SNP 相差三个或更少，我们就认为它们是直接传播事件的结果，并且我们假设配对中的第一个诊断患者是传播者，第二个是接收者。我们使用逻辑回归来检查宿主因素与结核病直接传播可能性之间的关联。测量和主要结果：通过分析 2,518 名结核病指标患者的数据，我们确定了 1,447 个直接传播对。无论接收者属性如何，34 岁以下的个人、男性和有监禁史的人更有可能成为直接传播对中的传播者。当两个患者都是饮酒者或吸烟者时，直接传播的可能性更大。结论：本研究将男性、年轻人、前囚犯、酗酒者和吸烟者确定为有针对性干预措施的优先群体。需要创新策略，将结核病筛查范围扩大到获得常规预防护理机会有限的年轻人和囚犯等社会群体。