heightened vulnerability to mdr-tb epidemics after controlling drug-susceptible tb脆弱性加剧后耐多药结核病疫情控制药物敏感结核病.pdfVIP

Heightened Vulnerability to MDR-TB Epidemics after Controlling Drug-Susceptible TB 1 2 3 Jason D. Bishai , William R. Bishai , David M. Bishai * 1 School of Humanities and Sciences, Stanford University, Stanford, California, United States of America, 2 Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America, 3 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America Abstract Background: Prior infection with one strain TB has been linked with diminished likelihood of re-infection by a new strain. This paper attempts to determine the role of declining prevalence of drug-susceptible TB in enabling future epidemics of MDR-TB. Methods: A computer simulation of MDR-TB epidemics was developed using an agent-based model platform programmed in NetLogo (See /). Eighty-one scenarios were created, varying levels of treatment quality, diagnostic accuracy, microbial fitness cost, and the degree of immunogenicity elicited by drug-susceptible TB. Outcome measures were the number of independent MDR-TB cases per trial and the proportion of trials resulting in MDR-TB epidemics for a 500 year period after drug therapy for TB is introduced. Results: MDR-TB epidemics propagated more extensively after TB prevalence had fallen. At a case detection rate of 75%, improving therapeutic compliance from 50% to 75% can reduce the probability of an epidemic from 45% to 15%. Paradoxically, improving the case-detection rate from 50% to 75% when compliance with DOT is constant at 75% increases the probability of MDR-TB epidemics from 3% to 45%. Conclusions: The ability of MDR-TB to spread depends on the prevalence of drug-susceptible TB. Immunologic protecti