Use of a mathematical model to estimate tuberculosis transmission risk in an Internet café

ABSTRACT

<p><b>OBJECTIVE</b>People who live under fragile living conditions may stay overnight in Internet cafés in urban areas. An outbreak of tuberculosis (TB), the routes of which were possibly related to such a facility, has been reported. The purpose of this study was to use a mathematical model to quantify the public health risk of TB infection in such a facility.</p><p><b>METHODS</b>The reproduction number for airborne infection in an enclosed space (R (A)) was estimated using a Wells-Riley model. First, we estimated R (A) for the TB infection based on the report of the TB outbreak in the Internet café. Second, TB infectious dose, number of days of exposure, and air-exchange rate in the facility were varied to estimate the effect of TB risk settings and environmental factors.</p><p><b>RESULTS</b>We assumed that TB patients and 59 susceptible subjects stayed for 150 days in a room where the air-exchange rate was five per hour. Using the estimated median R (A) of 44.14, the TB infection rate was 74.6%. This result was similar to the epidemiological report that the TB infection rate among employees in the Internet café was 70%. The median R (A) increased linearly as the number of days of exposure increased. The slope of the change in median R (A) divided by the change in the number of days of exposure increased exponentially as air-exchange rate decreased; thus air ventilation in a facility may be essential to prevent TB infection.</p><p><b>CONCLUSIONS</b>Appropriate air ventilation in facilities such as Internet cafés is needed as part of a TB-control program in metropolitan areas.</p>