title: Transforming the fight against tuberculosis: targeting catalysts of transmission.
abstract: The global tuberculosis control community has committed itself to ambitious 10-year targets. To meet these targets, biomedical advances alone will be insufficient; a more targeted public health tuberculosis strategy is also needed. We highlight the role of "tuberculosis transmission catalysts," defined as variabilities in human behavior, bacillary properties, and host physiology that fuel the propagation of active tuberculosis at the local level. These catalysts can be categorized as factors that increase contact rates, infectiousness, or host susceptibility. Different catalysts predominate in different epidemiological and sociopolitical settings, and public health approaches are likely to succeed only if they are tailored to target the major catalysts driving transmission in the corresponding community. We argue that global tuberculosis policy should move from a country-level focus to a strategy that prioritizes collection of data on key transmission catalysts at the local level followed by deployment of "catalyst-targeted" interventions, supported by strengthened health systems.
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.
authors: David W
authors: DW
authors: Dowdy
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.
authors: Andrew S
authors: AS
authors: Azman
authors: Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Emily A
authors: EA
authors: Kendall
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors: Barun
authors: B
authors: Mathema
mesh_terms: D003140:Communicable Disease Control / Q000379:methods* / Q000639:trends; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D014943:Global Health; D006291:Health Policy / Q000639:trends; D006801:Humans; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*
keywords: communicable disease control; epidemiology; transmission; tuberculosis