{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T15:11:09Z","timestamp":1767625869070,"version":"3.40.5"},"reference-count":27,"publisher":"Cambridge University Press (CUP)","issue":"11","license":[{"start":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T00:00:00Z","timestamp":1649203200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X21005171_as1\"><jats:title>Objective:<\/jats:title><jats:p>Healthcare facilities are a well-known high-risk environment for transmission of <jats:italic>M. tuberculosis<\/jats:italic>, the etiologic agent of tuberculosis (TB) disease. However, the link between <jats:italic>M. tuberculosis<\/jats:italic> transmission in healthcare facilities and its role in the general TB epidemic is unknown. We estimated the proportion of overall TB transmission in the general population attributable to healthcare facilities.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21005171_as2\"><jats:title>Methods:<\/jats:title><jats:p>We combined data from a prospective, population-based molecular epidemiologic study with a universal electronic medical record (EMR) covering all healthcare facilities in Botswana to identify biologically plausible transmission events occurring at the healthcare facility. Patients with <jats:italic>M. tuberculosis<\/jats:italic> isolates of the same genotype visiting the same facility concurrently were considered an overlapping event. We then used TB diagnosis and treatment data to categorize overlapping events into biologically plausible definitions. We calculated the proportion of overall TB cases in the cohort that could be attributable to healthcare facilities.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21005171_as3\"><jats:title>Results:<\/jats:title><jats:p>In total, 1,881 participants had TB genotypic and EMR data suitable for analysis, resulting in 46,853 clinical encounters at 338 healthcare facilities. We identified 326 unique overlapping events involving 370 individual patients; 91 (5%) had biologic plausibility for transmission occurring at a healthcare facility. A sensitivity analysis estimated that 3%\u20138% of transmission may be attributable to healthcare facilities.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21005171_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>Although effective interventions are critical in reducing individual risk for healthcare workers and patients at healthcare facilities, our findings suggest that development of targeted interventions aimed at community transmission may have a larger impact in reducing TB.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2021.517","type":"journal-article","created":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T07:12:26Z","timestamp":1649229146000},"page":"1603-1609","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":5,"title":["Tuberculosis attributed to transmission within healthcare facilities, Botswana\u2014The Kopanyo Study"],"prefix":"10.1017","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6396-9164","authenticated-orcid":false,"given":"Jonathan P.","family":"Smith","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chawangwa","family":"Modongo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3550-2065","authenticated-orcid":false,"given":"Patrick K.","family":"Moonan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mbatshi","family":"Dima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ogopotse","family":"Matsiri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Othusitse","family":"Fane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleanor S.","family":"Click","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosanna","family":"Boyd","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyssa","family":"Finlay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3931-1423","authenticated-orcid":false,"given":"Diya","family":"Surie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8694-5002","authenticated-orcid":false,"given":"James L.","family":"Tobias","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola M.","family":"Zetola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9728-8746","authenticated-orcid":false,"given":"John E.","family":"Oeltmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2022,4,6]]},"reference":[{"key":"S0899823X21005171_ref20","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1093\/aje\/kws331","article-title":"Modeling the role of public transportation in sustaining tuberculosis transmission in South Africa","volume":"177","author":"Andrews","year":"2013","journal-title":"Am J Epidemiol"},{"key":"S0899823X21005171_ref18","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1080\/01621459.1994.10476768","article-title":"Missing data, imputation, and the bootstrap","volume":"89","author":"Efron","year":"1994","journal-title":"J Am Statist 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Guidelines for the investigation of contacts of persons with infectious tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC. MMWR Recomm Rep 2005;54(Rr-15):1\u201347."},{"key":"S0899823X21005171_ref19","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1002\/bimj.4710360405","article-title":"A bootstrap method for using imputation techniques for data with missing values","volume":"36","author":"Bello","year":"1994","journal-title":"Biometr J"},{"key":"S0899823X21005171_ref22","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1056\/NEJMoa1003176","article-title":"Whole-genome sequencing and social-network analysis of a tuberculosis outbreak","volume":"364","author":"Gardy","year":"2011","journal-title":"N Engl J Med"},{"key":"S0899823X21005171_ref7","doi-asserted-by":"crossref","first-page":"191","DOI":"10.7326\/0003-4819-117-3-191","article-title":"Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. 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Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}