{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T05:20:48Z","timestamp":1771305648863,"version":"3.50.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T00:00:00Z","timestamp":1654473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R35GM141821"],"award-info":[{"award-number":["R35GM141821"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 AI134430"],"award-info":[{"award-number":["R01 AI134430"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 AI1043314093"],"award-info":[{"award-number":["R01 AI1043314093"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 AI146555"],"award-info":[{"award-number":["R01 AI146555"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01 AI152980"],"award-info":[{"award-number":["U01 AI152980"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32 AI52074"],"award-info":[{"award-number":["T32 AI52074"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["F32 MH128120-01"],"award-info":[{"award-number":["F32 MH128120-01"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NU CDC38PS004651"],"award-info":[{"award-number":["NU CDC38PS004651"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Modeling studies have concluded that 60\u201380% of tuberculosis (TB) infections result from reinfection of previously infected persons. The annual rate of infection (ARI), a standard measure of the risk of TB infection in a community, may not accurately reflect the true risk of infection among previously infected persons. We constructed a model of infection and reinfection with Mycobacterium tuberculosis to explore the predictive accuracy of ARI and its effect on disease incidence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We created a deterministic simulation of the progression from TB infection to disease and simulated the prevalence of TB infection at the beginning and end of a theoretical year of infection. We considered 10 disease prevalence scenarios ranging from 100\/100 000 to 1000\/100 000 in simulations where TB exposure probability was homogeneous across the whole simulated population or heterogeneously stratified into high-risk and low-risk groups. ARI values, rates of progression from infection to disease, and the effect of multiple reinfections were obtained from published studies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>With homogeneous exposure risk, observed ARI values produced expected numbers of infections. However, when heterogeneous risk was introduced, observed ARI was seen to underestimate true ARI by 25\u201358%. Of the cases of TB disease that occurred, 36% were among previously infected persons when prevalence was 100\/100 000, increasing to 79% of cases when prevalence was 1000\/100 000.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Measured ARI underestimates true ARI as a result of heterogeneous population mixing. The true force of infection in a community may be greater than previously appreciated. Hyperendemic communities likely contribute disproportionally to the global TB disease burden.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciac451","type":"journal-article","created":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T15:23:03Z","timestamp":1654528983000},"page":"e965-e972","source":"Crossref","is-referenced-by-count":15,"title":["Contribution of Reinfection to Annual Rate of Tuberculosis Infection (ARI) and Incidence of Tuberculosis Disease"],"prefix":"10.1093","volume":"76","author":[{"suffix":"Jr","given":"C Robert","family":"Horsburgh","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Boston University School of Public Health , Boston, Massachusetts , USA"},{"name":"Department of Medicine, Boston University School of Medicine , Boston, Massachusetts , USA"},{"name":"Department of Global Health, Boston University School of Public Health , Boston, Massachusetts , USA"},{"name":"Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youngji","family":"Jo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Boston University School of Medicine , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4682-4999","authenticated-orcid":false,"given":"Brooke","family":"Nichols","sequence":"additional","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen E","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin A","family":"Russell","sequence":"additional","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health , Boston, Massachusetts , USA"},{"name":"Department of Medical Microbiology, Amsterdam University Medical Center , Amsterdam , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura F","family":"White","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,6,6]]},"reference":[{"key":"2023053119000984400_ciac451-B1","first-page":"503","article-title":"Annual risk of tuberculous infection. 1988","volume":"80","author":"Cauthen","year":"2002","journal-title":"Bull World Health Organ"},{"key":"2023053119000984400_ciac451-B2","doi-asserted-by":"crossref","first-page":"e1002152","DOI":"10.1371\/journal.pmed.1002152","article-title":"The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling","volume":"13","author":"Houben","year":"2016","journal-title":"PLoS Med"},{"key":"2023053119000984400_ciac451-B3","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1093\/cid\/cir951","article-title":"Risk of progression to active tuberculosis following reinfection with Mycobacterium tuberculosis","volume":"54","author":"Andrews","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2023053119000984400_ciac451-B4","first-page":"1","article-title":"Recent studies in the epidemiology of tuberculosis, based on the risk of being infected with tubercle bacilli","volume":"19","author":"Sutherland","year":"1976","journal-title":"Adv Tuberc Res"},{"key":"2023053119000984400_ciac451-B5","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/S0041-3879(82)80013-5","article-title":"The development of clinical tuberculosis following infection with tubercle bacilli. 1. 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