Accuracy of prospective space-time surveillance in detecting tuberculosis transmission.

To improve detection of tuberculosis transmission, public health can supplement contact tracing with space-time surveillance. However, investigation of space-time clusters not due to transmission (false alarms), may lead to costly, unnecessary interventions. We measured the accuracy of prospective space-time surveillance in detecting tuberculosis transmission, assessing the number of clusters containing transmission and the false alarm rate. We simulated monthly prospective applications of a scan statistic using the home addresses and diagnosis dates of all 1566 culture-positive TB cases reported in Montreal during 1996-2007. We verified transmission within the space-time clusters by analyzing the TB genotype. Over 11.5 years, at 1.3 false alarms per month, we detected 89 transmission chains; at 0.05 false alarms per month we detected 5 transmission chains. We found evidence that prospective space-time surveillance for TB leads to a high false alarm rate, limiting its practical utility in settings with TB epidemiology similar to Montreal.
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