title: A field-validated approach using surveillance and genotyping data to estimate tuberculosis attributable to recent transmission in the United States.
abstract: Tuberculosis genotyping data are frequently used to estimate the proportion of tuberculosis cases in a population that are attributable to recent transmission (RT). Multiple factors influence genotype-based estimates of RT and limit the comparison of estimates over time and across geographic units. Additionally, methods used for these estimates have not been validated against field-based epidemiologic assessments of RT. Here we describe a novel genotype-based approach to estimation of RT based on the identification of plausible-source cases, which facilitates systematic comparisons over time and across geographic areas. We compared this and other genotype-based RT estimation approaches with the gold standard of field-based assessment of RT based on epidemiologic investigation in Arkansas, Maryland, and Massachusetts during 1996-2000. We calculated the sensitivity and specificity of each approach for epidemiologic evidence of RT and calculated the accuracy of each approach across a range of hypothetical RT prevalence rates plausible for the United States. The sensitivity, specificity, and accuracy of genotype-based RT estimates varied by approach. At an RT prevalence of 10%, accuracy ranged from 88.5% for state-based clustering to 94.4% with our novel approach. Our novel, field-validated approach allows for systematic assessments over time and across public health jurisdictions of varying geographic size, with an established level of accuracy.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: France
authors.forename: Juliana
authors.initials: J
authors.lastname: Grant
authors.forename: J Steve
authors.initials: JS
authors.lastname: Kammerer
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Navin
mesh_terms: D016000:Cluster Analysis; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D012680:Sensitivity and Specificity; D014376:Tuberculosis / Q000453:epidemiology* / Q000235:genetics* / Q000635:transmission*; D014481:United States / Q000453:epidemiology
keywords: disease transmission; genotyping; molecular epidemiology; recent transmission; tuberculosis