title: The Risk of Tuberculosis Reinfection Soon after Cure of a First Disease Episode Is Extremely High in a Hyperendemic Community.
abstract: Elevated rates of reinfection tuberculosis in various hyperendemic regions have been reported and, in particular, it has been shown that in a high-incidence setting near Cape Town, South Africa, the rate of reinfection tuberculosis (TB) disease after cure of a previous TB disease episode is about four times greater than the rate of first-time TB disease. It is not known whether this elevated rate is caused by a high reinfection rate due, for instance, to living circumstances, or a high rate of progress to disease specific to the patients, or both. In order to address that question we analysed an extensive data set from clinics attended by TB patients in the high-incidence setting near Cape Town, South Africa and found that, in fact, the (average) rate of reinfection (as opposed to the rate of reinfection disease) after cure of a previous TB disease episode is initially about 0.85 per annum. This rate diminishes rapidly over time and after about ten years this rate is similar to the rate of infection in the general population. Also, the rate of progress to disease after reinfection is initially high but declines in subsequent years down to the figure typical for the general population. These findings suggest that the first few months after cure of a TB disease episode form a critical period for controlling reinfection disease in a hyperendemic setting and that monitoring such cured patients could pre-empt a reinfection progressing to active disease.
authors.affiliation: SACEMA, DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, Western Cape, South Africa.|DST/NRF Centre of Excellence for Biomedical Tuberculosis Research / MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Western Cape, South Africa.
authors.forename: Pieter
authors.initials: P
authors.lastname: Uys
authors.affiliation: SACEMA, DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, Western Cape, South Africa.
authors.forename: Hilmarie
authors.initials: H
authors.lastname: Brand
authors.affiliation: DST/NRF Centre of Excellence for Biomedical Tuberculosis Research / MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Western Cape, South Africa.
authors.forename: Robin
authors.initials: R
authors.lastname: Warren
authors.affiliation: DST/NRF Centre of Excellence for Biomedical Tuberculosis Research / MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Western Cape, South Africa.
authors.forename: Gian
authors.initials: G
authors.lastname: van der Spuy
authors.affiliation: DST/NRF Centre of Excellence for Biomedical Tuberculosis Research / MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Western Cape, South Africa.
authors.forename: Eileen G
authors.initials: EG
authors.lastname: Hoal
authors.affiliation: DST/NRF Centre of Excellence for Biomedical Tuberculosis Research / MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Western Cape, South Africa.
authors.forename: Paul D
authors.initials: PD
authors.lastname: van Helden
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D012008:Recurrence; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission
chemical_list: D000995:Antitubercular Agents