title: Comparison of altitude effect on Mycobacterium tuberculosis infection between rural and urban communities in Peru.
abstract: The mechanism of high altitude effect on tuberculosis (TB) infection has not been fully established. We previously reported a lower positive tuberculin skin test (TST) prevalence in high altitude villages compared with sea level communities in Peru. In this study, four additional communities were tested to assess whether decreased TB transmission was also in urban environments at high altitude. TST results from 3,629 individuals in nine communities were analyzed using generalized estimating equations to account for community clustering. Positive TST prevalence was not significantly different between the urban highland and the urban non-highland communities after adjusting for age, household contacts with a TST-positive person or a TB case, and presence of a Bacillus Calmette-Guérin vaccination scar. The effect of population concentration and increased contact with active TB overwhelmed the protective effect of altitude in urban highlands. Highland cities require the same preventive efforts against TB as non-highland communities.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. msaito@jhsph.edu
authors.forename: Mayuko
authors.initials: M
authors.lastname: Saito
authors.forename: William K
authors.initials: WK
authors.lastname: Pan
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: Christian T
authors.initials: CT
authors.lastname: Bautista
authors.forename: Sapna
authors.initials: S
authors.lastname: Bamrah
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Martín
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Tsiouris
authors.forename: D Fermín
authors.initials: DF
authors.lastname: Argüello
authors.forename: Gabriela
authors.initials: G
authors.lastname: Martinez-Carrasco
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000531:Altitude; D001500:BCG Vaccine; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis / Q000502:physiology*; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000453:epidemiology*; D014505:Urban Population
chemical_list: D001500:BCG Vaccine