• Joshua L Warren, Louis Grandjean, MooreDavid A JDAJLaboratorio de Investigacion y Desarrollo, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru.TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK., Anna Lithgow, Jorge Coronel, Patricia Sheen, Jonathan L Zelner, Jason R Andrews, and Ted Cohen.
• Department of Biostatistics, Yale University, New Haven, CT, 06510, USA. joshua.warren@yale.edu.
• Bmc Med. 2018 Aug 3; 16 (1): 122.

BackgroundCongregate settings may serve as institutional amplifiers of tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB). We analyze spatial, epidemiological, and pathogen genetic data prospectively collected from neighborhoods surrounding a prison in Lima, Peru, where inmates experience a high risk of MDR-TB, to investigate the risk of spillover into the surrounding community.MethodsUsing hierarchical Bayesian statistical modeling, we address three questions regarding the MDR-TB risk: (i) Does the excess risk observed among prisoners also extend outside the prison? (ii) If so, what is the magnitude, shape, and spatial range of this spillover effect? (iii) Is there evidence of additional transmission across the region?ResultsThe region of spillover risk extends for 5.47 km outside of the prison (95% credible interval: 1.38, 9.63 km). Within this spillover region, we find that nine of the 467 non-inmate patients (35 with MDR-TB) have MDR-TB strains that are genetic matches to strains collected from current inmates with MDR-TB, compared to seven out of 1080 patients (89 with MDR-TB) outside the spillover region (p values: 0.022 and 0.008). We also identify eight spatially aggregated genetic clusters of MDR-TB, four within the spillover region, consistent with local transmission among individuals living close to the prison.ConclusionsWe demonstrate a clear prison spillover effect in this population, which suggests that interventions in the prison may have benefits that extend to the surrounding community.

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