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      Detection of Tuberculosis Infection Hotspots Using Activity Spaces Based Spatial Approach in an Urban Tokyo, from 2003 to 2011

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          Abstract

          Background

          Identifying ongoing tuberculosis infection sites is crucial for breaking chains of transmission in tuberculosis-prevalent urban areas. Previous studies have pointed out that detection of local accumulation of tuberculosis patients based on their residential addresses may be limited by a lack of matching between residences and tuberculosis infection sites. This study aimed to identify possible tuberculosis hotspots using TB genotype clustering statuses and a concept of “activity space”, a place where patients spend most of their waking hours. We further compared the spatial distribution by different residential statuses and describe urban environmental features of the detected hotspots.

          Methods

          Culture-positive tuberculosis patients notified to Shinjuku city from 2003 to 2011 were enrolled in this case-based cross-sectional study, and their demographic and clinical information, TB genotype clustering statuses, and activity space were collected. Spatial statistics (Global Moran’s I and Getis-Ord Gi* statistics) identified significant hotspots in 152 census tracts, and urban environmental features and tuberculosis patients’ characteristics in these hotspots were assessed.

          Results

          Of the enrolled 643 culture-positive tuberculosis patients, 416 (64.2%) were general inhabitants, 42 (6.5%) were foreign-born people, and 184 were homeless people (28.6%). The percentage of overall genotype clustering was 43.7%. Genotype-clustered general inhabitants and homeless people formed significant hotspots around a major railway station, whereas the non-clustered general inhabitants formed no hotspots. This suggested the detected hotspots of activity spaces may reflect ongoing tuberculosis transmission sites and were characterized by smaller residential floor size and a higher proportion of non-working households.

          Conclusions

          Activity space-based spatial analysis suggested possible TB transmission sites around the major railway station and it can assist in further comprehension of TB transmission dynamics in an urban setting in Japan.

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          Most cited references17

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          Tuberculosis transmission patterns in a high-incidence area: a spatial analysis.

          In the Cape Town suburbs of Ravensmead and Uitsig, tuberculosis has reached epidemic levels, with notifications of 1340/100,000 in 1996. These suburbs are characterised by overcrowding, high unemployment and poverty. It is traditionally believed that tuberculosis transmission takes place mainly in households after close contact with an infectious person. Studies have recently linked tuberculosis transmission to locations outside the household, and have associated these places with a particular high-risk lifestyle. Anthropological studies in some suburbs of Cape Town, in which a very high number of local drinking places (shebeens) were identified (17 per km2), have suggested that social drinking is part of such a lifestyle. To investigate various risk factors and places of transmission of tuberculosis using a geographical information system (GIS). The 1128 bacteriologically-proven cases of tuberculosis studied over the period 1993-1998 were investigated using spatial epidemiological techniques of exploratory disease mapping. Point pattern analysis and spatial statistics indicated clustering of cases in the areas of high incidence. Significant associations of tuberculosis notifications were found with unemployment, overcrowding and number of shebeens per enumerator sub-district. High tuberculosis notifications with unemployment and its associated poverty emerged as the strongest association.
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            Transmission of multidrug-resistant tuberculosis in the UK: a cross-sectional molecular and epidemiological study of clustering and contact tracing

            Between 2000 and 2012 the number of multidrug-resistant (MDR) tuberculosis cases in the UK increased from 28 per year to 81 per year. We investigated the proportion of MDR tuberculosis cases arising from transmission in the UK and associated risk factors.
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              Neighborhood poverty and the resurgence of tuberculosis in New York City, 1984-1992.

              The resurgence of tuberculosis (TB) in NewYork City has been attributed to AIDS and immigration; however, the role of poverty in the epidemic is unclear. We assessed the relation between neighborhood poverty and TB at the height of the epidemic and longitudinally from 1984 through 1992. Census block groups were used as proxies for neighborhoods. For each neighborhood, we calculated TB and AIDS incidence in 1984 and 1992 with data from the Bureaus of Tuberculosis Control and AIDS Surveillance and obtained poverty rates from the census. For 1992, 3,343 TB cases were mapped to 5,482 neighborhoods, yielding a mean incidence of 46.5 per 100,000. Neighborhood poverty was associated with TB (relative risk = 1.33; 95% confidence interval = 1.30, 1.36 per 10% increase in poverty). This association persisted after adjustment for AIDS, proportion foreign born, and race/ethnicity. Neighborhoods with declining income from 1980 to 1990 had larger increases in TB incidence than did neighborhoods with increasing income. Leading up to and at the height of the TB epidemic in New York City, neighborhood poverty was strongly associated with TB incidence. Public health interventions should target impoverished areas.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 September 2015
                2015
                : 10
                : 9
                : e0138831
                Affiliations
                [1 ]Department of Epidemiology and Clinical Research, the Research Institute of Tuberculosis, Japan Anti-tuberculosis Association (RIT/JATA), Kiyose city, Tokyo, Japan
                [2 ]Nagasaki University Graduate School of Biomedical Sciences, Nagasaki city, Nagasaki, Japan
                [3 ]Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-tuberculosis Association (RIT/JATA), Kiyose city, Tokyo, Japan
                [4 ]Shinjuku City Public Health Center, Shinjuku city, Tokyo, Japan
                [5 ]The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association (RIT/JATA), Kiyose city, Tokyo, Japan
                University of Minnesota, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: KI AO KU. Analyzed the data: KI AO KU. Contributed reagents/materials/analysis tools: KI KU AO YM YT AK YW. Wrote the paper: KI. Edited and approved the manuscript: KI AO KU YM YT AK YW NI.

                Article
                PONE-D-15-25710
                10.1371/journal.pone.0138831
                4575109
                26382251
                6bcf0f46-b6d8-42de-a9a2-8c0946135b3c
                Copyright @ 2015

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                : 17 June 2015
                : 3 September 2015
                Page count
                Figures: 5, Tables: 5, Pages: 16
                Funding
                This research was supported by the Research Program on Emerging and Re-emerging Infectious Diseases from Japan Agency for Medical Research and development, AMED, Government of Japan, and double-barred cross seal donation fund, Japan Anti-Tuberculosis Association. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Custom metadata
                Due to ethical and confidentiality restrictions imposed by Shinjuku Public Health Center (PHC) on disclosure of data including personal and sensitive information, aggregated data sets can be made available only upon request and with permission of Shinjuku PHC. All interested researchers may contact Kiyohiko Izumi ( kizumi@ 123456jata.or.jp ) to explore data availability.

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