Tuberculosis (TB) transmission often occurs within a household or community, leading to heterogeneous spatial patterns. However, apparent spatial clustering of TB could reflect ongoing transmission or co-location of risk factors and can vary considerably depending on the type of data available, the analysis methods employed and the dynamics of the underlying population. Thus, we aimed to review methodological approaches used in the spatial analysis of TB burden. We conducted a systematic literature search of spatial studies of TB published in English using Medline, Embase, PsycInfo, Scopus and Web of Science databases with no date restriction from inception to 15 February 2017. The protocol for this systematic review was prospectively registered with PROSPERO (
 CRD42016036655
 ). We identified 168 eligible studies with spatial methods used to describe the spatial distribution (n = 154), spatial clusters (n = 73), predictors of spatial patterns (n = 64), the role of congregate settings (n = 3) and the household (n = 2) on TB transmission. Molecular techniques combined with geospatial methods were used by 25 studies to compare the role of transmission to reactivation as a driver of TB spatial distribution, finding that geospatial hotspots are not necessarily areas of recent transmission. Almost all studies used notification data for spatial analysis (161 of 168), although none accounted for undetected cases. The most common data visualisation technique was notification rate mapping, and the use of smoothing techniques was uncommon. Spatial clusters were identified using a range of methods, with the most commonly employed being Kulldorff’s spatial scan statistic followed by local Moran’s I and Getis and Ord’s local Gi(d) tests. In the 11 papers that compared two such methods using a single dataset, the clustering patterns identified were often inconsistent. Classical regression models that did not account for spatial dependence were commonly used to predict spatial TB risk. In all included studies, TB showed a heterogeneous spatial pattern at each geographic resolution level examined. A range of spatial analysis methodologies has been employed in divergent contexts, with all studies demonstrating significant heterogeneity in spatial TB distribution. Future studies are needed to define the optimal method for each context and should account for unreported cases when using notification data where possible. Future studies combining genotypic and geospatial techniques with epidemiologically linked cases have the potential to provide further insights and improve TB control.

/pdf/methods-used-in-the-spatial-analysis-of-tuberculosis-3p0n7dxiso.pdf

Methods used in the spatial analysis of tuberculosis epidemiology: a systematic review.

BACKGROUND: Global control of the tuberculosis (TB) epidemic remains poor, especially in high-burden settings where ongoing transmission sustains the epidemic. In such settings, a significant amount of transmission takes place outside the household, and practical approaches to understanding transmission at community level are needed. OBJECTIVE: To identify and map potential TB transmission 'hot spots' across high-burden communities. SETTING AND DESIGN: Our method draws on data that qualitatively describe a high-burden community in Cape Town, South Africa. Established transmission principles arc applied to grade the potential TB transmission risk posed by congregate settings in the community. Geographic information systems (GIS) technology then creates a visual map, locating potential transmission 'hot spots' in the community. RESULTS: Drinking places (shebeens), clinics and churches (often gatherings in confined homes) emerge as gathering places that potentially pose a high transmission risk, particularly if located in overcrowded and impoverished areas of the community. CONCLUSION: This proof-of-concept study demonstrates that combining qualitative techniques with GIS mapping may improve our understanding of potential TB transmission within a community and guide public health interventions to enhance TB control efforts.

A multidisciplinary method to map potential tuberculosis transmission 'hot spots' in high-burden communities.

M ycobacterium tuberculosis infection remains a major cause of global mortality and morbidity and the resulting disease, tuberculosis (TB), caused an estimated 1.7 million deaths in 2009 [1]. However, the majority of the 2 billion people estimated to be infected with M. tuberculosis have asymptomatic infection, termed latent TB infection (LTBI) [2, 3]. Traditionally, LTBI has been defined by evidence of a cellular immune response to M. tuberculosis -derived antigens, for example by the tuberculin skin test (TST) in asymptomatic individuals who have been potentially exposed to M. tuberculosis . For these individuals, the life time risk of progression from LTBI to active, symptomatic disease is only 10%; however, defects in cellular immunity can increase this risk significantly [4, 5]. Of these, the most important is HIV infection, and the ongoing HIV epidemic has helped to fuel the spread of TB globally over the past 40 yrs with 0.38 million deaths in HIV co-infected individuals in 2009 [1].

Despite dramatic falls in the overall prevalence of TB over the past 100 yrs in Europe, TB is no longer a disease of historical interest and the European region defined by the World Health Organization (WHO) saw a 2.7% mean annual increase in cases from 2004–2008 [6]. Of concern, an estimated 3.6% of all new cases globally were multi-drug resistant (MDR) [1, 7].

With this in mind, we present an update on a selection of important areas in TB clinical practice and clinical research today, with particular relevance to Europe. We will review some of the important epidemiological features of TB, with a focus on migration and recent work on factors which might influence the burden of TB at a population level, such as cigarette smoking/biomass fuel …

https://err.ersjournals.com/content/errev/20/120/71.full.pdf

Update on tuberculosis: TB in the early 21st century

Objectives. We used a geographic information system and cluster analyses to determine locations in need of enhanced Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Program services. Methods. We linked documented births in the 2010 California Birth Statistical Master File with the 2010 data from the WIC Integrated Statewide Information System. Analyses focused on the density of pregnant women who were eligible for but not receiving WIC services in California’s 7049 census tracts. We used incremental spatial autocorrelation and hot spot analyses to identify clusters of WIC-eligible nonparticipants. Results. We detected clusters of census tracts with higher-than-expected densities, compared with the state mean density of WIC-eligible nonparticipants, in 21 of 58 (36.2%) California counties (P < .05). In subsequent county-level analyses, we located neighborhood-level clusters of higher-than-expected densities of eligible nonparticipants in Sacramento, San Francisco, Fresno, and Los Angeles Counties (P< .05). Conclusions. Hot spot analyses provided a rigorous and objective approach to determine the locations of statistically significant clusters of WIC-eligible nonparticipants. Results helped inform WIC program and funding decisions, including the opening of new WIC centers, and offered a novel approach for targeting public health services. (Am J Public Health. 2014;104:S183–S189. doi:

Use of Spatial Epidemiology and Hot Spot Analysis to Target Women Eligible for Prenatal Women, Infants, and Children Services

This paper overviews the emergence of medical/health geography in Canada. The paper discusses the key questions that Canadian health geographers have explored in the past two decades, how these enquiries have featured in the field and how they contribute to the wider discourse of human geography. It also addresses questions on emerging themes and where Canadian health geography will go in the years ahead. With shifting health landscapes in terms of changes in social, political and physical environments, and changes in health care restructuring, Canadian health geographers are entering a new phase of research, teaching and policy. The complexity of the questions that health geographers seek to address means it is necessary to continue to highlight the policy implications of their findings. Health geographers need to emphasize the public agenda through interdisciplinary research and by continuing to work with geographers in other subfields.



La geographie politique et la geopolitique



Ce texte presente les principaux apports des geographes politiques canadiens a la croissance spectaculaire de cette sous discipline au cours des deux dernieres decennies. L'accent est mis sur deux volets de travail en plein essor. Le premier aborde la mutation du pouvoir de l'etat et le second s'interesse a la periode actuelle caracterisee par la guerre, la militarisation et les mesures de surveillance a l'echelle planetaire. Le but n'est pas de dresser un bilan du domaine de la geographie politique. Il est plutot question de definir a travers ces deux themes certains travaux recents et de delimiter un certain nombre de champs d'enquete qui meritent plus d'attention et qui devraient prendre plus d'importance. Ce texte montre, plus specifiquement, a quel point le role des acteurs doit etre pris en compte, c'est-a-dire sa capacite d'agir, en matiere de geographie politique et de geopolitique.

Health geography in Canada: where are we headed?

CONTEXTE : Au Canada, la tuberculose (TB) represente un probleme de sante croissant en milieu urbain. Montreal est la deuxieme plus grande ville du Canada et la deuxieme plus frequente destination pour les nouveaux immigrants et refugies. OBJECTIFS: Detecter l'agregation spatiale des cas afin de determiner les zones d'exces d'incidence et de rechercher les points chauds locaux de la transmission a Montreal. SCHEMA: Nous avons utilise les adresses de residence pour codifier geographiquement les cas actifs de TB signales sur l'Ile de Montreal en 1996-2000. Apres qu'une analyse des «points chauds» ait suggere deux zones de surconcentration, nous avons mene un scanning spatial, en prenant comme unite primaire d'analyse les regions de recensement (population 2500-8000) et en stratifiant en fonction du lieu de naissance. Nous avons combine ces analyses avec un genotypage de tous les isolats disponibles de Mycobacterium tuberculosis grâce a la RFLP IS6110 et au spoligotypage. RESULTATS: Nous avons identifie quatre zones d'incidence excessive parmi les sujets nes a l'etranger (ratios de taux d'incidence 1,3-4,1 par rapport a l'ensemble de l'Ile) et une zone de ce type parmi les sujets nes au Canada (ratio de taux d'incidence 2,3). Il existait une superposition partielle de ces deux points chauds. Le genotypage a indique une transmission recente chez les sujets nes a l'etranger au sein de la zone d'incidence la plus elevee. Alors que cette zone se superposait a l'aire de haute incidence chez les sujets nes au Canada, le genotypage a exclu dans l'ensemble la transmission entre ces deux groupes. CONCLUSIONS: Dans une ville ou l'incidence globale est faible, les analyses spatiales et moleculaires ont mis en evidence une transmission locale recente.

Use of geographic and genotyping tools to characterise tuberculosis transmission in Montreal.

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Use of geographic and genotyping tools to characterise tuberculosis transmission in Montreal.