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Open Access Highly Accessed Research article

Evidence for waning of latency in a cohort study of tuberculosis

Harald G Wiker12, Tehmina Mustafa1, Gunnar A Bjune3 and Morten Harboe4*

Author Affiliations

1 Section for Microbiology and Immunology, The Gade Institute, University of Bergen, Bergen, Norway

2 Department of Microbiology and Immunology, Haukeland University Hospital, Bergen, Norway

3 Section for International Health, Institute for General Practice and Community Medicine, University of Oslo, Oslo, Norway

4 Institute of Immunology, University of Oslo and Oslo University Hospital, Rikshospitalet, Oslo, Norway

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BMC Infectious Diseases 2010, 10:37  doi:10.1186/1471-2334-10-37

Published: 23 February 2010

Abstract

Background

To investigate how the risk of active tuberculosis disease is influenced by time since original infection and to determine whether the risk of reactivation of tuberculosis increases or decreases with age.

Methods

Cohort analysis of data for the separate ten year birth cohorts of 1876-1885 to 1959-1968 obtained from Statistics Norway and the National Tuberculosis Registry. These data were used to calculate the rates and the changes in the rates of bacillary (or active) tuberculosis. Data on bacillary tuberculosis for adult (20+) age groups were obtained from the National Tuberculosis Registry and Statistics Norway from 1946 to 1974. Most cases during this period arose due to reactivation of remote infection. Participants in this part of the analysis were all reported active tuberculosis cases in Norway from 1946 to 1974 as recorded in the National Tuberculosis Registry.

Results

Tuberculosis decreased at a relatively steady rate when following individual birth cohorts, but with a tendency of slower decline as time passed since infection. A mean estimate of this rate of decline was 57% in a 10 year period.

Conclusions

The risk of reactivation of latent tuberculosis decreases with age. This decline may reflect the rate at which latent tuberculosis is eliminated from a population with minimal transmission of tubercle bacilli. A model for risk of developing active tuberculosis as a function of time since infection shows that the rate at which tuberculosis can be eliminated from a society can be quite substantial if new infections are effectively prevented. The findings clearly indicate that preventative measures against transmission of tuberculosis will be the most effective. These results also suggest that the total population harbouring live tubercle bacilli and consequently the future projection for increased incidence of tuberculosis in the world is probably overestimated.