One third of the world’s population is infected with Tuberculosis (TB), and TB is one of the top 10 causes of death worldwide. In 2015, 10 million people contracted TB, roughly 1 million of whom were children. In the same year, 1.8 million people died from the disease, including 170,000 children. Most TB deaths occur in low- and middle-income countries. Although TB incidence has fallen by an average of 1.5% per year since 2000, drug resistant TB (MDR-TB) has become a critical issue, with almost 500,000 people diagnosed with resistance in 2015.
There is currently no broadly effective, long-lasting TB vaccine. Treatment for TB is available but requires adherence to a complex multidrug regimen over many months, with a host of side effects ranging from mild to severe. And while TB diagnosis and treatment has saved an estimated 49 million lives between 2000 and 2015, decreasing TB transmission is imperative to stemming the epidemic.
We are a research team focused on identifying and testing innovative methods to reduce TB transmission. Working closely with partners in high TB burden, low resource settings, we concentrate on two broad areas: 1) environmental controls such as building design and germicidal UV (GUV) to reduce the risk of transmission in congregate settings and 2) administrative controls including rapid diagnosis and treatment of TB among hospitalized patients to decrease the risk of transmission in health care settings. In addition, we seek to build local capacity in these areas through fellowship opportunities and a unique Building Design, Engineering, and Airborne Infection Control course.
Based in Boston at the Brigham and Women’s Hospital/Division of Global Health Equity, we work in partnership with a number of organizations around the world. For the past 9 years, we have been conducting research projects at the Airborne Infections Research (AIR) facility just outside of Pretoria, South Africa. Modeled upon Wells and Riley’s work in the 1950s, the AIR facility allows MDR-TB patients to serve as sources of infection for sentinel guinea pigs. Given their exquisite sensitivity to infectious TB droplet nuclei, the guinea pigs serve as excellent living air samplers to quantify the infectiousness of MDR-TB patients and the effectiveness of various infection control interventions, including GUV, patient masks, air filters, and novel inhaled antibiotics.
We are in the early stages of implementing a re-focused administrative approach to TB infection control in a large general hospital in Lima, Peru. Called FAST – Find cases Actively, Separate temporarily, and Treat effectively – the aim is to more quickly identify unsuspected TB and unsuspected drug resistance among hospitalized patients and initiate effective therapy in order to reduce TB transmission risk in the health care setting.
We are working to strengthen and expand TB infection control measures and related training – focused heavily on GUV and FAST – in Vietnam, Swaziland, Namibia, South Africa, and Myanmar. A significant challenge is the sustainability of these efforts and we are working with partners in both India and Ethiopia to develop a sustainable business model for the design, installation and maintenance of GUV in the health care setting.