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Questioning the Epidemiology of Subclinical Tuberculosis

Project description

Transmission of asymptomatic tuberculosis

Current interventions for tuberculosis (TB) focus on M tuberculosis infection or symptomatic disease. However, emerging evidence suggests that the natural history of TB is more complex and varied than previously known. In fact, recent studies have shown that up to 50 % of laboratory-confirmed TB cases in prevalence surveys report no traditional symptoms, highlighting the potential for subclinical (or asymptomatic) TB to contribute to transmission. Funded by the European Research Council, the TB-QUEST project aims to better characterise subclinical TB and identify its significance in transmitting the disease using pathogen genome sequencing. The project will improve our understanding of the subclinical stage of the natural history of TB, and its potential implications for case finding and global TB control policies.

Objective

Tuberculosis (TB) remains a major cause of morbidity and mortality around the world. The majority of TB control policies rely on the binary paradigm of TB, which focus on interventions tackling ‘latent’ TB infection and ‘active’ TB disease stages. However, recent evidence disputes this longstanding conceptualization of TB natural history, demonstrating that TB exists on a continuous spectrum of bacterial and immunological responses. Several active case-finding studies have shown that around 50% of the cases in whom Mycobacterium tuberculosis was isolated in sputum were asymptomatic. Subclinical (asymptomatic) TB has lately attracted increased scientific interest since it could play an important role in TB transmission, despite the absence of cough. However, beyond limited evidence on TB transmission based on modelling studies using retrospective data collection, there is not a single field study showing a direct transmission from an index subclinical TB case to a secondary laboratory-confirmed case. If subclinical TB does spread the disease, the consequences for global TB control and research are of paramount importance. I propose to characterize the subclinical TB stage within the natural history of TB and to understand its role in spreading the disease.
I have designed a field epidemiological study (TB-QUEST) with the potential to show evidence of effective transmission from subclinical TB cases to close contacts, using pathogen genome sequencing. Additionally, by using innovative wearable technology, I will assess whether objective tools to measure classical TB symptoms match the self-reported absence of symptoms. Thus, I might challenge the current definition of subclinical TB and the usefulness of current TB screening algorithms. Lastly, I will study the clinical trajectory of subclinical TB in order to improve our understanding of its natural history, duration of infectiousness, and factors associated with self-clearance or progression to symptomatic disease.

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Topic(s)

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HORIZON-ERC - HORIZON ERC Grants

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Call for proposal

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(opens in new window) ERC-2023-STG

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Host institution

FUNDACION PRIVADA INSTITUTO DE SALUD GLOBAL BARCELONA
Net EU contribution

Net EU financial contribution. The sum of money that the participant receives, deducted by the EU contribution to its linked third party. It considers the distribution of the EU financial contribution between direct beneficiaries of the project and other types of participants, like third-party participants.

€ 1 462 200,00
Address
C ROSSELLO 132 PLANTA 05
08036 Barcelona
Spain

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Region
Este Cataluña Barcelona
Activity type
Research Organisations
Links
Total cost

The total costs incurred by this organisation to participate in the project, including direct and indirect costs. This amount is a subset of the overall project budget.

€ 1 574 700,00

Beneficiaries (3)

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