International Journal of Epidemiology 2003;32:763-769
© International Epidemiological Association 2003
Special Theme: Infectious Diseases |
Recent transmission of tuberculosis in Madrid: application of capture–recapture analysis to conventional and molecular epidemiology
1 Dirección General de Salud Pública, Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain.
2 Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo.
3 Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, Spain.
4 Servicio de Microbiología. Hospital Universitario Doce de Octubre, Madrid, Spain.
Dr Jesús Iñigo, Servicio de Epidemiología, Dirección General de Salud Pública, Aduana 29, 28013 Madrid, Spain. E-mail: jesus.inigo{at}madrid.org
Background Population-based studies using a combination of molecular techniques and conventional epidemiological methods have been used to study the dynamics of tuberculosis (TB) transmission but the relative utility of each technique has not yet been established.
Methods A prospective population-based molecular and epidemiological study of patients diagnosed with TB was conducted in three urban districts of Madrid (Spain) during 1997–1999. Analysis was performed using the capture-recapture method including covariates in which conventional epidemiological data and the information on clustered cases obtained by DNA fingerprinting were regarded as independent and complementary procedures.
Results The estimate obtained by molecular analysis alone, that 31.6% of TB cases were due to recent transmission, was revised to 44.8% (95% CI: 31.4–58.2) using the capture-recapture method. The estimated completeness of the combined databases for identification of recent transmission was 59.2%. Underestimation of the true prevalence of recent transmission was higher with conventional epidemiology than molecular analysis, particularly for patients <35 years old and those with a history of imprisonment.
Conclusions In this study, use of the capture-recapture technique allowed us to combine epidemiological information obtained by conventional and molecular methods to quantify the number of cases of recently transmitted TB in the community and identify specific populations at high risk of disease. This information is clearly important because such groups are a prime target for improved TB control measures. In the long term, this combination of techniques may contribute significantly to control the spread of TB.
Keywords Tuberculosis, capture-recapture method, epidemiology, transmission, molecular techniques
Accepted 9 January 2003
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