Abstract
Tuberculosis remains a global health problem with an enormous burden of disease, estimated at 10.4 million new cases in 2015. To stop the tuberculosis epidemic, it is critical that we interrupt tuberculosis transmission. Further, the interventions required to interrupt tuberculosis transmission must be targeted to high-risk groups and settings. A simple cascade for tuberculosis transmission has been proposed in which (1) a source case of tuberculosis (2) generates infectious particles (3) that survive in the air and (4) are inhaled by a susceptible individual (5) who may become infected and (6) then has the potential to develop tuberculosis. Interventions that target these events will interrupt tuberculosis transmission and accelerate the decline in tuberculosis incidence and mortality. The purpose of this article is to provide a high-level overview of what is known about tuberculosis transmission, using the tuberculosis transmission cascade as a framework, and to set the scene for the articles in this series, which address specific aspects of tuberculosis transmission.
Highlights
Tuberculosis remains a global health problem with an enormous burden of disease, estimated at 10.4 million new cases in 2015, of which 10% were among children and 12% involved human immunodeficiency virus (HIV) coinfection [1]
Interrupting tuberculosis transmission is central to achieving the reductions in tuberculosis incidence required to meet the End TB targets
We have a unique opportunity in the era of the United Nations Sustainable Development Goals to address poverty and other social determinants of tuberculosis while simultaneously scaling up currently available effective tuberculosis control interventions to interrupt tuberculosis transmission and thereby maximize impact on reducing tuberculosis incidence and mortality
Summary
A simple cascade for tuberculosis transmission is proposed in which (1) a source case of tuberculosis (2) generates infectious particles (3) that survive in the air and (4) are inhaled by a susceptible individual (5) who may become infected and (6) who has the potential to develop tuberculosis. Interventions that target bacterial, host, or behavioral catalysts of transmission will interrupt tuberculosis transmission and accelerate the decline in tuberculosis incidence and mortality [14] In this article, this cascade of tuberculosis transmission will be used to describe who is transmitting, where transmission is occurring, and who is susceptible to infection and to disease progression. We can understand what it will take to stop tuberculosis transmission (Figure 2)
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