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. 1998 Nov 10;95(23):13881-6.
doi: 10.1073/pnas.95.23.13881.

Modeling the impact of global tuberculosis control strategies

C J Murray  1 , J A Salomon
Affiliations

Modeling the impact of global tuberculosis control strategies

C J Murray et al. Proc Natl Acad Sci U S A. .

Abstract

An epidemiological model of tuberculosis has been developed and applied to five regions of the world. Globally, 6.7 million new cases of tuberculosis and 2.4 million deaths from tuberculosis are estimated for 1998. Based on current trends in uptake of the World Health Organization's strategy of directly observed treatment, short-course, we expect a total of 225 million new cases and 79 million deaths from tuberculosis between 1998 and 2030. Active case-finding by using mass miniature radiography could save 23 million lives over this period. A single contact treatment for tuberculosis could avert 24 million cases and 11 million deaths; combined with active screening, it could reduce mortality by nearly 40%. A new vaccine with 50% efficacy could lower incidence by 36 million cases and mortality by 9 million deaths. Support for major extensions to global tuberculosis control strategies will occur only if the size of the problem and the potential for action are recognized more widely.

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Figures

Figure 1
Figure 1
The model of tuberculosis includes nineteen states: uninfected (U); infected subject to fast or slow breakdown (IF and IS, respectively); superinfected subject to fast breakdown (SF); INH recipient subject to slow breakdown (HS); untreated cases (CUi,j), in which the index i takes on values 1, 2, and 3 (smear-positive pulmonary, smear-negative pulmonary, and extra-pulmonary, respectively), and the index j takes on values 1 and 2 (fast and slow rates of diagnosis, respectively); treated cases (CTi,k), in which the index i takes on values 1, 2, and 3 (as above), and the index k takes on values 1 and 2 (good treatment and bad treatment, respectively); recovered cases subject to fast or slow relapse (RF and RS, respectively). A detailed description of the equations and parameters that specify the model appears in the Appendix.
Figure 2
Figure 2
Projections of global deaths from tuberculosis, 1998 to 2030. Three scenarios are shown, reflecting high (DOTS-H), medium (DOTS-M), and low (DOTS-L) assumptions about uptake of the WHO DOTS strategy. All three scenarios assume baseline HIV projections and no sustained efficacy for BCG.
Figure 3
Figure 3
Projections of global deaths from tuberculosis, 1998 to 2030. Each graph shows the baseline DOTS strategy and alternative strategies incremental to baseline DOTS. The top graph shows expectations of the epidemic given various aggressive applications of existing strategies, including mass preventive therapy (MassPT) and single-cycle or continuous active case-finding using mass miniature radiography (ACF-MMR-1 and ACF-MMR, respectively). The bottom graph shows the results of strategies using new technologies, including a vaccine preventing breakdown with 50% efficacy (VacBr50), a single-dose treatment regimen for active tuberculosis (UltraSCC), and this single-dose regimen combined with active screening (ACF-MMR + UltraSCC).
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Comment in

  • Tuberculosis: old problems and new approaches.
    Anderson RM. Anderson RM. Proc Natl Acad Sci U S A. 1998 Nov 10;95(23):13352-4. doi: 10.1073/pnas.95.23.13352. Proc Natl Acad Sci U S A. 1998. PMID: 9811803 Free PMC article. No abstract available.

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