Cargando…

Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Tuberculosis Infection

A key metric in tuberculosis epidemiology is the annual risk of infection (ARI), which is usually derived from tuberculin skin test (TST) and interferon-γ release assay (IGRA) prevalence surveys carried out in children. Derivation of the ARI assumes that immunoreactivity is persistent over time; how...

Descripción completa

Detalles Bibliográficos
Autores principales: Schwalb, Alvaro, Emery, Jon C, Dale, Katie D, Horton, Katherine C, Ugarte-Gil, César A, Houben, Rein M G J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10691197/
https://www.ncbi.nlm.nih.gov/pubmed/36749011
http://dx.doi.org/10.1093/aje/kwad028
_version_ 1785152693200748544
author Schwalb, Alvaro
Emery, Jon C
Dale, Katie D
Horton, Katherine C
Ugarte-Gil, César A
Houben, Rein M G J
author_facet Schwalb, Alvaro
Emery, Jon C
Dale, Katie D
Horton, Katherine C
Ugarte-Gil, César A
Houben, Rein M G J
author_sort Schwalb, Alvaro
collection PubMed
description A key metric in tuberculosis epidemiology is the annual risk of infection (ARI), which is usually derived from tuberculin skin test (TST) and interferon-γ release assay (IGRA) prevalence surveys carried out in children. Derivation of the ARI assumes that immunoreactivity is persistent over time; however, reversion of immunoreactivity has long been documented. We used a deterministic, compartmental model of Mycobacterium tuberculosis (Mtb) infection to explore the impact of reversion on ARI estimation using age-specific reversion probabilities for the TST and IGRA. Using empirical data on TST reversion (22.2%/year for persons aged ≤19 years), the true ARI was 2–5 times higher than that estimated from immunoreactivity studies in children aged 8–12 years. Applying empirical reversion probabilities for the IGRA (9.9%/year for youths aged 12–18 years) showed a 1.5- to 2-fold underestimation. ARIs are increasingly underestimated in older populations, due to the cumulative impact of reversion on population reactivity over time. Declines in annual risk did not largely affect the results. Ignoring reversion leads to a stark underestimation of the true ARI in populations and our interpretation of Mtb transmission intensity. In future surveys, researchers should adjust for the reversion probability and its cumulative effect with increasing age to obtain a more accurate reflection of the burden and dynamics of Mtb infection.
format Online
Article
Text
id pubmed-10691197
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-106911972023-12-02 Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Tuberculosis Infection Schwalb, Alvaro Emery, Jon C Dale, Katie D Horton, Katherine C Ugarte-Gil, César A Houben, Rein M G J Am J Epidemiol Original Contribution A key metric in tuberculosis epidemiology is the annual risk of infection (ARI), which is usually derived from tuberculin skin test (TST) and interferon-γ release assay (IGRA) prevalence surveys carried out in children. Derivation of the ARI assumes that immunoreactivity is persistent over time; however, reversion of immunoreactivity has long been documented. We used a deterministic, compartmental model of Mycobacterium tuberculosis (Mtb) infection to explore the impact of reversion on ARI estimation using age-specific reversion probabilities for the TST and IGRA. Using empirical data on TST reversion (22.2%/year for persons aged ≤19 years), the true ARI was 2–5 times higher than that estimated from immunoreactivity studies in children aged 8–12 years. Applying empirical reversion probabilities for the IGRA (9.9%/year for youths aged 12–18 years) showed a 1.5- to 2-fold underestimation. ARIs are increasingly underestimated in older populations, due to the cumulative impact of reversion on population reactivity over time. Declines in annual risk did not largely affect the results. Ignoring reversion leads to a stark underestimation of the true ARI in populations and our interpretation of Mtb transmission intensity. In future surveys, researchers should adjust for the reversion probability and its cumulative effect with increasing age to obtain a more accurate reflection of the burden and dynamics of Mtb infection. Oxford University Press 2023-02-07 /pmc/articles/PMC10691197/ /pubmed/36749011 http://dx.doi.org/10.1093/aje/kwad028 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Contribution
Schwalb, Alvaro
Emery, Jon C
Dale, Katie D
Horton, Katherine C
Ugarte-Gil, César A
Houben, Rein M G J
Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Tuberculosis Infection
title Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Tuberculosis Infection
title_full Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Tuberculosis Infection
title_fullStr Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Tuberculosis Infection
title_full_unstemmed Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Tuberculosis Infection
title_short Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Tuberculosis Infection
title_sort impact of reversion of mycobacterium tuberculosis immunoreactivity tests on the estimated annual risk of tuberculosis infection
topic Original Contribution
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10691197/
https://www.ncbi.nlm.nih.gov/pubmed/36749011
http://dx.doi.org/10.1093/aje/kwad028
work_keys_str_mv AT schwalbalvaro impactofreversionofmycobacteriumtuberculosisimmunoreactivitytestsontheestimatedannualriskoftuberculosisinfection
AT emeryjonc impactofreversionofmycobacteriumtuberculosisimmunoreactivitytestsontheestimatedannualriskoftuberculosisinfection
AT dalekatied impactofreversionofmycobacteriumtuberculosisimmunoreactivitytestsontheestimatedannualriskoftuberculosisinfection
AT hortonkatherinec impactofreversionofmycobacteriumtuberculosisimmunoreactivitytestsontheestimatedannualriskoftuberculosisinfection
AT ugartegilcesara impactofreversionofmycobacteriumtuberculosisimmunoreactivitytestsontheestimatedannualriskoftuberculosisinfection
AT houbenreinmgj impactofreversionofmycobacteriumtuberculosisimmunoreactivitytestsontheestimatedannualriskoftuberculosisinfection