Characterizing infectiousness of subclinical TB and identifying novel early diagnostic strategies for preventing transmission

表征亚临床结核病的传染性并确定预防传播的新型早期诊断策略

• 批准号: 9889831
• 负责人: Jason Randolph Andrews
• 金额: $ 15.77万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-11 至 2024-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9889831
• 关键词: Address; Aerosols; Algorithms; Biological Assay; Blood; Brazil; Caring; Cause of Death; Characteristics; Clinical; Collaborations; Communicable Diseases; Communities; Coughing; Country; Data; Development; Diagnosis; Diagnostic; Disease; Early Diagnosis; Early treatment; Effectiveness of Interventions; Environment; Epidemic; Exhalation; Gene Expression; Gene Expression Profile; Gene Expression Profiling; General Population; Goals; HIV Seronegativity; Health; Imprisonment; Incidence; Individual; Infection; Intervention; Joints; Knowledge; Masks; Mass Screening; Measures; Medical; Methods; Microbiology; Modality; Modeling; Mycobacterium tuberculosis; Population; Prevalence; Prisoner; Prisons; Reference Standards; Research; Research Infrastructure; Roentgen Rays; Role; Sampling; Sputum; Sustainable Development; Symptoms; System; Testing; Time; Tuberculosis; Whole Blood; base; case finding; cost effective; cost effectiveness; design; diagnostic screening; effective therapy; epidemiologic data; genetic signature; genomic data; mathematical model; molecular diagnostics; novel; novel diagnostics; novel strategies; point of care; prevent; screening; symptom treatment; tool; transmission process

Project Summary Tuberculosis remains the leading cause of death by an infectious disease worldwide, despite the widespread availability of effective therapy. Two major scientific knowledge gaps constrain our ability to effectively respond this epidemic: 1) understanding characteristics of individuals who are transmitting infection within the population; and 2) identifying efficient means of diagnosing these individuals early in their course of disease to prevent ongoing transmission. Our preliminary research and that of others has demonstrated that, for any given time in a population, a substantial proportion of individuals with microbiologically confirmed tuberculosis have few or no classical symptoms. This state has been described as “subclinical tuberculosis”. What fraction of cases are subclinical, how infectious these individuals are, and the total contribution of subclinical tuberculosis towards transmission in the population is poorly understood. This proposal leverages our unique research infrastructure in prisons in Central-Western Brazil to evaluate novel tools, including a disposable mask to capture exhaled bioaerosols, for early detection of tuberculosis in asymptomatic individuals. We will test the following hypotheses: 1) individuals with tuberculosis who lack symptoms are on average at least 50% as infectious as those with symptoms, and contribute equally to overall transmission; 2) mask aerosol sampling will be more effective than sputum testing for tuberculosis diagnosis in individuals with few or no symptoms; 3) biannual mass screening with diagnostics targeted at subclinical tuberculosis would be cost- effective in prisons. Overall, this project will address fundamental questions about tuberculosis transmission, while testing practical approaches to control tuberculosis in high burden settings.

项目概要 结核病仍然是全世界传染病死亡的主要原因， 尽管有效的治疗方法广泛存在，但有两个主要的科学知识。 差距限制了我们有效应对这一流行病的能力：1）理解 在人群中传播感染的个体的特征；以及 2) 确定在病程早期诊断这些人的有效方法 为了防止持续传播。 证明，在人口中的任何给定时间内，相当大比例的人 经微生物学证实患有结核病的个体很少或没有经典结核病 这种状态被描述为“亚临床结核病”。 病例是否处于亚临床状态，这些人的传染性如何，以及 亚临床结核病在人群中传播的情况尚不清楚。 该提案利用了我们中西部监狱独特的研究基础设施 巴西将评估新型工具，包括用于捕获呼出气体的一次性口罩 我们将测试生物气溶胶，用于早期检测无症状个体的结核病。 以下假设：1) 没有症状的结核病患者正在接受治疗 平均至少 50% 的传染性与有症状的人一样，并且同样有助于 整体传播；2）口罩气溶胶采样会比痰液采样更有效 3）每年两次对症状很少或没有症状的个体进行结核病诊断检测； 针对亚临床结核病进行大规模筛查和诊断的成本很高 总体而言，该项目将解决有关监狱的基本问题。 结核病传播，同时测试控制结核病的实用方法 高负担设置。