Abstract
BackgroundIdentifying ongoing tuberculosis infection sites is crucial for breaking chains of transmission in tuberculosis-prevalent urban areas. Previous studies have pointed out that detection of local accumulation of tuberculosis patients based on their residential addresses may be limited by a lack of matching between residences and tuberculosis infection sites. This study aimed to identify possible tuberculosis hotspots using TB genotype clustering statuses and a concept of “activity space”, a place where patients spend most of their waking hours. We further compared the spatial distribution by different residential statuses and describe urban environmental features of the detected hotspots.MethodsCulture-positive tuberculosis patients notified to Shinjuku city from 2003 to 2011 were enrolled in this case-based cross-sectional study, and their demographic and clinical information, TB genotype clustering statuses, and activity space were collected. Spatial statistics (Global Moran’s I and Getis-Ord Gi* statistics) identified significant hotspots in 152 census tracts, and urban environmental features and tuberculosis patients’ characteristics in these hotspots were assessed.ResultsOf the enrolled 643 culture-positive tuberculosis patients, 416 (64.2%) were general inhabitants, 42 (6.5%) were foreign-born people, and 184 were homeless people (28.6%). The percentage of overall genotype clustering was 43.7%. Genotype-clustered general inhabitants and homeless people formed significant hotspots around a major railway station, whereas the non-clustered general inhabitants formed no hotspots. This suggested the detected hotspots of activity spaces may reflect ongoing tuberculosis transmission sites and were characterized by smaller residential floor size and a higher proportion of non-working households.ConclusionsActivity space-based spatial analysis suggested possible TB transmission sites around the major railway station and it can assist in further comprehension of TB transmission dynamics in an urban setting in Japan.
Highlights
Tuberculosis (TB), a bacterial airborne infectious disease caused by Mycobacterium tuberculosis (M. tuberculosis), is one of the world’s deadliest communicable diseases
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Activity space-based spatial analysis suggested possible TB transmission sites around the major railway station and it can assist in further comprehension of TB transmission dynamics in an urban setting in Japan
Summary
Tuberculosis (TB), a bacterial airborne infectious disease caused by Mycobacterium tuberculosis (M. tuberculosis), is one of the world’s deadliest communicable diseases. Much advance has been made as a result of development of new technologies, such as molecular epidemiological techniques, which have enabled revealing of TB transmission dynamics within social networks [2,3,4,5]. Another technique which has recently become available is Geographic Information System (GIS), where geographic data to describe and visualize spatial distributions and to discover spatial association patterns have been applied in TB epidemiological studies. We further compared the spatial distribution by different residential statuses and describe urban environmental features of the detected hotspots
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