In the mid-1980's, the long-standing historical decline in tuberculosis cases in the United States reversed itself and case rates began to rise. With the tuberculosis epidemic came the recognition that this disease was becoming increasingly concentrated in defined segments of the overall population. Though total case rates are falling again, groups in the US at significantly higher risk for tuberculosis than the general population exist. It is unknown whether the current recommendations for the control of tuberculosis in the US general population are as effective for these groups. To address this issue, a desktop Computer based mathematical model has been developed to simultaneously project tuberculosis cases and deaths over a l 0 year period using the best available epidemiological data. By adapting this model for US groups at increased risk for tuberculosis, this project will evaluate tuberculosis control strategies for four high risk groups. The groups are persons infected with human immunodeficiency virus, health care workers, immigrants, and the homeless. For each group, a database of inputs based on the epidemiology of tuberculosis within that group will be created. These databases will draw on the published literature and available government information such as that provided by the Centers for Disease Control and Prevention revised report of verified case of tuberculosis. The following tuberculosis control strategies will be evaluated singly and in combinations: increased coverage and improved efficacy of preventive therapy, increased coverage and improved efficacy of treatment, increased effectiveness of contact tracing, and the introduction of bacille Calmette-Guerin vaccination. The robustness of the model results will be assessed in sensitivity analyses by simultaneously varying all inputs using Latin hypercube sampling. The combination of mathematical modeling and epidemiology provides the most complete evaluation of TB control measures among these high risk groups to date, and forms a basis for improving approaches to control this epidemic among these populations.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Clinical Investigator Award (CIA) (K08)
Project #
Application #
Study Section
Microbiology and Infectious Diseases B Subcommittee (MID)
Program Officer
Sizemore, Christine F
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Brigham and Women's Hospital
United States
Zip Code
Brewer, Timothy F; Heymann, S Jody (2004) To control and beyond: moving towards eliminating the global tuberculosis threat. J Epidemiol Community Health 58:822-5
Brewer, Timothy F; Butzler, Jean-Paul (2002) Towards building truly global professional associations: the role of international congresses. Int J Infect Dis 6:2-3
Brewer, T F; Heymann, S J; Krumplitsch, S M et al. (2001) Strategies to decrease tuberculosis in us homeless populations: a computer simulation model. JAMA 286:834-42
Heymann, S J; Brewer, T F; Wilson, M E et al. (2000) Pediatric tuberculosis: what needs to be done to decrease morbidity and mortality. Pediatrics 106:E1
Brewer, T; Colditz, G A (1999) Postmarketing surveillance and adverse drug reactions: current perspectives and future needs. JAMA 281:824-9
Brewer, T F; Heymann, S J (1998) Reducing the impact of tuberculosis transmission in institutions: beyond infection control measures. Int J Tuberc Lung Dis 2:S118-23