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COMPARISON OF ALTITUDE EFFECT ON MYCOBACTERIUM TUBERCULOSIS INFECTION BETWEEN RURAL AND URBAN COMMUNITIES IN PERU

The mechanism of high altitude effect on tuberculosis (TB) infection has not been fully established. We previously reported a lower positive tuberculin skin test (TST) prevalence in high altitude villages compared with sea level communities in Peru. In this study, four additional communities were tested to assess whether decreased TB transmission was also in urban environments at high altitude. TST results from 3,629 individuals in nine communities were analyzed using generalized estimating equations to account for community clustering. Positive TST prevalence was not significantly different between the urban highland and the urban non-highland communities after adjusting for age, household contacts with a TST-positive person or a TB case, and presence of a Bacillus Calmette-Guérin vaccination scar. The effect of population concentration and increased contact with active TB overwhelmed the protective effect of altitude in urban highlands. Highland cities require the same preventive efforts against TB as non-highland communities.

Received December 19, 2005. Accepted for publication March 9, 2006.

Acknowledgments: We thank L. Cabrera, R. Montoya, and P. Maguiña for study coordination, M. Varela for data management, and A. Griffin, J. B. Phu, D. Sarah, and A. Sebastian for technical support. We also thank the communities of Quilcas, Vichaycocha, Las Pampas de San Juan de Miraflores, San Carlos, Buen Villa Pastor, Sachaca, Cerro Colorado, San Jeronimo, and Huascahura for cooperation. Portions of the data contained in this manuscript were presented at the ASTMH 53th Annual Meeting, Miami Beach, Florida, November 7–11, 2004.

Financial support: These studies were supported by D43 TW07646-5 Tutorial in Tropical Health at JHU/Peru Overseas Site NIH/NIAID, D43 TW066581 Infections Diseases Training Program in Peru-Global Research Fund DHHS/Fogarty International, and Research Support Grant from St. Luke’s Life Science Institute.

Disclaimer: The opinions and assertions made by the authors do not reflect the official position or opinion of the US Department of the Army or of any of the other organizations listed.

^* Address correspondence to Robert H. Gilman, Department of International Health, The Johns Hopkins School of Pubic Health, 615 North Wolfe Street, Room W5515, Baltimore, MD 21205. E-mail: rgilman{at}jhsph.edu

Authors’ addresses: Mayuko Saito, Will K. Pan, and Robert H. Gilman, Department of International Health, The Johns Hopkins School of Public Health, 615 North Wolfe Street, Room W5515, Baltimore, MD 21205, E-mails: msaito{at}jhsph.edu and rgilman{at}jhsph.edu. Christian T. Bautista (present affiliation), Department of Epidemiology and Threat Assessment, The US Military HIV Research Program, and the Henry M. Jackson Foundation, 1 Taft Court, Suite 250, Rockville, MD 20850, E-mail: cbautista{at}hivresearch.org. Sapna Bamrah, Christopher A. Martín, Simon J. Tsiouris, D. Fermín Argüello, and Gabriela Martinez-Carrasco, Asociación Benéfica, Proyectos En Informática, Salud, Medicina y Agricultura (A.B. PRISMA), Carlos Gonzales 251, Urb. Maranga, San Miguel, Lima 32, Peru.