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Am. J. Trop. Med. Hyg., 68(6), 2003, pp. 721-727
Copyright © 2003 by The American Society of Tropical Medicine and Hygiene

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LOW PREVALENCE AND INCREASED HOUSEHOLD CLUSTERING OF MYCOBACTERIUM TUBERCULOSIS INFECTION IN HIGH ALTITUDE VILLAGES IN PERU

SUSAN OLENDER, MAYUKO SAITO, JANE APGAR, KARI GILLENWATER, CHRISTIAN T. BAUTISTA, ANDRES G. LESCANO, PEDRO MORO, LUZ CAVIEDES, EVELYN J. HSIEH, AND ROBERT H. GILMAN
New York University School of Medicine, New York, New York; Proyectos en Informatica, Salud, Medicina y Agricultura (A. B. PRISMA), Lima, Peru; University of Texas School of Medicine, Galveston, Texas; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Microbiology, School of Public Health and Health Administration and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; State University of New York at Stony Brook School of Medicine, Stony Brook, New York

Anecdotal historical evidence suggests that tuberculosis was uncommon at high altitude, but whether transmission is affected by high altitude is not known. To test whether high altitude lowers infection by Mycobacterium tuberculosis, the prevalence of tuberculin skin test (TST) positivity was compared between two high altitude villages (3,340 meters [10,960 feet] and 3,500 meters [11,480 feet]) and three sea-level sites in Peru. High altitude villages had lower TST-positive prevalence rates (5.7% and 6.8%) than sea level areas (25–33%), and the difference remained significant (odds ratio = 4.5–6.0) after adjusting for age, education, bacille Calmette-Guérin vaccination, and contact with tuberculosis patients. The TST-positive individuals clustered within highland families more than within sea level families. These data suggest that prevention and control efforts targeted to families may be more effective at high altitude. The mechanism by which TST-positivity prevalence is decreased at high altitude is unknown, but may reflect relative hypoxia, low humidity, or an increased ultraviolet effect.

Received October 1, 2002. Accepted for publication March 3, 2003.

Acknowledgments: We thank Drs. Carlton Evans, Lawrence Moulton, Richard Oberhelman, Yutaka Aoki, and Dimitris Placantonakis for their advice on this paper and comments on the manuscript; Jenny Centeno and Pamela Limo for preparation of the map; Marco Varela for data management; and J. B. Phu, D. Sara, E. Talula for technical support. We also thank the communities of Quilcas, Vichaycocha, Las Pampas de San Juan de Miraflores, San Carlos, and Buen Pastor for their cooperation.

Financial support: This study was supported by the United States Agency for International Development Tuberculosis Award HRN-5986-A-00-6006-00, National Institutes of Health (NIH) International Training and Research in Emerging Infectious Diseases grant 5D43-TW00910, Fogarty-NIH AIDS training program 3T22-TW00016-05S3, National Institute of Allergy and Infectious Diseases (NIAID) tutorial training grant 5T35-AI-07646-02, NIAID predoctoral training grant 5T32AI-007526, and the anonymous RG-ER fund for the advancement of tropical medicine research.

Authors’ addresses: Susan Olender, Mayuko Saito, Jane Apgar, Kari Guillenwater, Christian T. Bautista, Andres G. Lescano, Pedro Moro, Luz Caviedes, and Evelyn J. Hsieh, A.B. PRISMA Carlos Gonzales 251, Urb. Maranga, San Miguel, Lima 32, Peru, Telephone: 51-1-464-0221, Fax: 51-1-464-0781. Robert H. Gilman, Department of International Health, The Johns Hopkins School of Public Health, 615 North Wolfe Street, Room W3503, Baltimore, MD 21205, Telephone: 410-614-3959, Fax: 410-614-6060, E-mail: rgilman{at}jhsph.edu.




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Copyright © 2003 by the American Society of Tropical Medicine and Hygiene.