Assessing the transmission risk of multidrug-resistant Mycobacterium tuberculosis epidemics in regions of Taiwan

Objective: The objective of this study was to link transmission dynamics with a probabilistic risk model to provide a mechanistically explicit assessment for estimating the multidrug-resistant tuberculosis (MDR TB) infection risk in regions of Taiwan. Methods: A relative fitness (RF)-based MDR TB model was used to describe transmission, validated with disease data for the period 2006-2010. A dose-response model quantifying by basic reproduction number (R₀) and total proportion of infected population was constructed to estimate the site-specific MDR TB infection risk. Results: We found that the incidence rate of MDR TB was highest in Hwalien County (4.91 per 100 000 population) in eastern Taiwan, with drug-sensitive and multidrug-resistant R₀ estimates of 0.89 (95% CI 0.23-2.17) and 0.38 (95% CI 0.05-1.30), respectively. The predictions were in apparent agreement with observed data in the 95% credible intervals. Our simulation showed that the incidence of MDR TB will be falling by 2013-2016. Our results indicated that the selected regions of Taiwan had only ∼1% probability of exceeding 50% of the population with infection attributed to MDR TB. Conclusions: Our study found that the ongoing control programs implemented in Taiwan may succeed in curing most patients with MDR TB and will reduce the TB incidence countrywide.