Infection prevention and control measures during the COVID-19 pandemic and airborne tuberculosis transmission during primary care visits in South Africa
Background: Tuberculosis (TB) transmission in crowded health care settings poses considerable risks in high-burden regions. We assessed how COVID-19 pandemic-related infection prevention and control (IPC) measures might impact TB transmission in a South African primary care clinic. Methods: In 2019...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-07-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971225001444 |
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| author | Nicolas Banholzer Keren Middelkoop Remo Schmutz Juane Leukes Kathrin Zürcher Matthias Egger Robin Wood Lukas Fenner |
| author_facet | Nicolas Banholzer Keren Middelkoop Remo Schmutz Juane Leukes Kathrin Zürcher Matthias Egger Robin Wood Lukas Fenner |
| author_sort | Nicolas Banholzer |
| collection | DOAJ |
| description | Background: Tuberculosis (TB) transmission in crowded health care settings poses considerable risks in high-burden regions. We assessed how COVID-19 pandemic-related infection prevention and control (IPC) measures might impact TB transmission in a South African primary care clinic. Methods: In 2019 (prepandemic) and 2021 (pandemic), we collected clinical data, patient tracking data (person-time and spatial density), indoor CO2 levels, and concentrations of Mycobacterium tuberculosis (Mtb) DNA in bio-aerosol samples. We estimated the risk of Mtb transmission during a 1-hour visit based on ventilation rate and duration of exposure. Results: During the pandemic, clinics were less crowded, with lower mean person-time per day (209 vs 258 hours; P < 0.001). TB prevalence among patients also declined (1.1% vs 4.7%; P = 0.052). Environmental indicators suggested improved air quality, with lower CO₂ levels (555 vs 856 parts-per-million; P < 0.001) and higher ventilation rates (15.8 vs 6.3 air changes per hour; P < 0.001). These changes corresponded with a reduction in modeled Mtb transmission risk (0.04% vs 1.36%; P = 0.046). Airborne Mtb DNA was detected in both periods. Conclusion: Pandemic-related IPC measures to control COVID-19 transmission were rigorously implemented and likely reduced transmission of airborne respiratory infections, supporting their continued implementation in healthcare settings postpandemic. |
| format | Article |
| id | doaj-art-1913a593ff5340a99b4fe3d03748276e |
| institution | OA Journals |
| issn | 1201-9712 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj-art-1913a593ff5340a99b4fe3d03748276e2025-08-20T02:09:04ZengElsevierInternational Journal of Infectious Diseases1201-97122025-07-0115610792110.1016/j.ijid.2025.107921Infection prevention and control measures during the COVID-19 pandemic and airborne tuberculosis transmission during primary care visits in South AfricaNicolas Banholzer0Keren Middelkoop1Remo Schmutz2Juane Leukes3Kathrin Zürcher4Matthias Egger5Robin Wood6Lukas Fenner7Institute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandInstitute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, Cape Town, South AfricaInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandInstitute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, Cape Town, South AfricaInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UKInstitute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Desmond Tutu Health Foundation, Cape Town, South AfricaInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Corresponding author: Lukas Fenner, Institute of Social and Preventive Medicine, University of Bern (ISPM), Mittelstrasse 43, 3012 Bern, Switzerland.Background: Tuberculosis (TB) transmission in crowded health care settings poses considerable risks in high-burden regions. We assessed how COVID-19 pandemic-related infection prevention and control (IPC) measures might impact TB transmission in a South African primary care clinic. Methods: In 2019 (prepandemic) and 2021 (pandemic), we collected clinical data, patient tracking data (person-time and spatial density), indoor CO2 levels, and concentrations of Mycobacterium tuberculosis (Mtb) DNA in bio-aerosol samples. We estimated the risk of Mtb transmission during a 1-hour visit based on ventilation rate and duration of exposure. Results: During the pandemic, clinics were less crowded, with lower mean person-time per day (209 vs 258 hours; P < 0.001). TB prevalence among patients also declined (1.1% vs 4.7%; P = 0.052). Environmental indicators suggested improved air quality, with lower CO₂ levels (555 vs 856 parts-per-million; P < 0.001) and higher ventilation rates (15.8 vs 6.3 air changes per hour; P < 0.001). These changes corresponded with a reduction in modeled Mtb transmission risk (0.04% vs 1.36%; P = 0.046). Airborne Mtb DNA was detected in both periods. Conclusion: Pandemic-related IPC measures to control COVID-19 transmission were rigorously implemented and likely reduced transmission of airborne respiratory infections, supporting their continued implementation in healthcare settings postpandemic.http://www.sciencedirect.com/science/article/pii/S1201971225001444Airborne transmissionTuberculosisCarbon dioxideInfection prevention and controlGenomic DNAHealthcare facilities |
| spellingShingle | Nicolas Banholzer Keren Middelkoop Remo Schmutz Juane Leukes Kathrin Zürcher Matthias Egger Robin Wood Lukas Fenner Infection prevention and control measures during the COVID-19 pandemic and airborne tuberculosis transmission during primary care visits in South Africa International Journal of Infectious Diseases Airborne transmission Tuberculosis Carbon dioxide Infection prevention and control Genomic DNA Healthcare facilities |
| title | Infection prevention and control measures during the COVID-19 pandemic and airborne tuberculosis transmission during primary care visits in South Africa |
| title_full | Infection prevention and control measures during the COVID-19 pandemic and airborne tuberculosis transmission during primary care visits in South Africa |
| title_fullStr | Infection prevention and control measures during the COVID-19 pandemic and airborne tuberculosis transmission during primary care visits in South Africa |
| title_full_unstemmed | Infection prevention and control measures during the COVID-19 pandemic and airborne tuberculosis transmission during primary care visits in South Africa |
| title_short | Infection prevention and control measures during the COVID-19 pandemic and airborne tuberculosis transmission during primary care visits in South Africa |
| title_sort | infection prevention and control measures during the covid 19 pandemic and airborne tuberculosis transmission during primary care visits in south africa |
| topic | Airborne transmission Tuberculosis Carbon dioxide Infection prevention and control Genomic DNA Healthcare facilities |
| url | http://www.sciencedirect.com/science/article/pii/S1201971225001444 |
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