epidemiology of tuberculosis

The tubercle bacillus or Mycobacterium tuberculosis is the bacterial microorganism the causes TB (Schiffman, 2010). The Epidemiology of Tuberculosis Tuberculosis (TB) is a highly contagious disease that if not treated, can be fatal. : +41 22 7913155, Fax: +41 22 7914199. Tuberculosis (TB) is a progressive granulomatous infectious disease caused by the gram positive, acid fast bacilli classified under the genus Mycobacterium. 2017 Jan;17(1):e21-e25. Persons should be screened to rule-out active TB disease before TB preventive treatment initiation. . The Use of Bedaquiline in the Treatment of Multidrug-Resistant Tuberculosis: Interim Policy Guidance. Trailer. Before At the same time, some interventions with life-saving potential such as timely ARV administration and IPT are not yet fully implemented. The scope of this plan was to address the MDG challenge and pursue the other international targets in order to halve the 1990 TB prevalence and mortality rate by 2015 and eliminate TB as a public health problem by 2050 (< 1 case per 1 million population).46 Despite all these efforts and the resulting achievements described above, including the reaching of the TB-relevant target in the MDGs, global control is progressing slowly, with a decline in incidence of 2% per year on average. Tuberculosis ( TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. the display of certain parts of an article in other eReaders. The HIV affects the body's immune system and enhances the speed at which TB progresses from a innocuous infection to life threatening condition. All HTML versions of MMWR articles are generated from final proofs through an automated process. Objectives. PMC The functionality is limited to basic scrolling. The selection criteria were chronic cough, hemoptysis, past history of TB and close contact with a tuberculous patient. 2019 Mar 4;14(3):e0209395. Tuberculosis (TB) is a major public health concern worldwide: despite a regular, although slow, decline in incidence over the last decade, as many as 8.6 million new cases and 1.3 million deaths were estimated to have occurred in 2012. Two new oral treatments, delamanid and bedaquiline, have demonstrated favorable efficacy and safety profiles for treating drug-resistant TB strains (9). Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of 3. Methods Data sources In Sabah, all microbiologically confirmed and clinical cases of TB must be notified to the State Health Department where they are recorded in a secure electronic database (myTB). This is an Open Access article distributed under the terms of the Creative Commons Attribution License (. Substantial annual reductions in TB incidence and the number of TB deaths will be necessary to meet the U.N. 20, Avenue Appia 1211 Geneva 27 Switzerland. In 2020, 87% of new TB cases occurred in the 30 high TB burden countries. Active case finding for tuberculosis among high-risk groups in low-incidence countries. They had diabetes as co-morbid condition ( 1 ). Over recent decades, slow and uneven declines in TB incidence have resulted in a falling prevalence of TB disease, which increasingly concentrates in vulnerable populations. The South East Asia Region accounts for 39% of global burden of TB in terms of incidence. This infection is known for initiating in the lungs, however it has the potential to affect any and all of the body. Among persons with HIV infection, TB mortality was derived from the product of incidence among persons with HIV infection and case fatality (1). Tuberculosis in tropical areas and immigrants. URL addresses listed in MMWR were current as of You may switch to Article in classic view. It is estimated that in some developing countries up to 10% of human tuberculosis is due to bovine TB. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Stopping tuberculosis in the 21st century: Goals and strategies. include Presidential or Head of State End TB initiatives and formalized mechanisms for the engagement and accountability of stakeholders in India, Indonesia, Pakistan, Philippines and Viet Nam as well as national campaigns to drive progress such as the Race to End TB. DESIGN: The Rapid Village Survey Method (RVS) was used to investigate the prevalence of pulmonary tuberculosis. All information these cookies collect is aggregated and therefore anonymous. The incidence of TB in the United States is low; in 2016 there were fewer than three cases per 100,000 persons. In 2020, an estimated 10 million people fell ill with tuberculosis (TB) worldwide. government site. Zoonotic tuberculosis in human beings caused by Mycobacterium bovis-a call for action. This is done in the context of global TB commitments, strategies and targets. Tuberculosis (TB) still causes 1.5 million deaths globally each year. In many high-income countries (HIC), migration from countries with a high burden of tuberculosis (TB) has gradually increased, modifying the local epidemiology and making control difficult [].In some European cities disease rates have increased dramatically due to social problems and limitations in disease control activities [].In cities such as London, an increase of more than . Six million men, 3.4 million women and 1.2 million children. Geneva, Switzerland: World Health Organization; 2014. CDC twenty four seven. eCollection 2019. World Health Organization (WHO)/Stop-TB Partnership. endorsement of these organizations or their programs by CDC or the U.S. Ananthakrishnan and coworkers found tuberculosis in 14% of elderly individuals . The bacteria that cause tuberculosis are spread from person to person through tiny droplets released into the air via coughs and sneezes. The implementation of new rapid molecular diagnostic tests will, hopefully, allow to expand testing capacity in low-resource settings worldwide and to improve TB case management. A cautious choice of patients and close monitoring during and after treatment are, therefore, essential to preserving their efficacy. The Global Plan to Stop TB: Phase 1: 20012005. World Migration Report 2013: Migrant Well-being and Development. Gupta RK, Lucas SB, Fielding KL, Lawn SD. ; Temprano ANRS 12136 Study Group. Among priorities in these countries, but also worldwide, a crucial importance was attributed to the introduction and the routine application of new technologies for rapid detection of drug-resistance and to the development of specific diagnostic algorithms, particularly useful for high-risk patients.48. The former actively contribute to further transmission of the disease. Overall, an estimated 558,000 incident cases of RR or MDR TB occurred in 2017, representing 5.6% of all TB cases, 3.6% of newly diagnosed TB cases, and 18% of previously treated cases. A total of 1.6 million people died from TB in 2021 (including 187 000 people with HIV). The World Health Organization (WHO) has recently launched a new global TB strategy for the post-2015 era aimed at ending the global TB epidemic by 2035. TB is by all means a poverty-related disease, mainly affecting the most vulnerable populations in the poorest countries. El Kamel A, Joobeur S, Skhiri N, Cheikh Mhamed S, Mribah H, Rouatbi N. Rev Pneumol Clin. Despite of the decrease in incidence, morbidity and mortality remain important partially due to co-infection with human immunodeficiency virus and emergence of resistant bacilli. Tuberculosis is caused by Mycobacterium tuberculosis, a bacterium that usually affects the victim's lungs and is spread through the air. sharing sensitive information, make sure youre on a federal Infection of human with M. avium and M. africanum is very rare. 2 Global Epidemiology Of Tuberculosis Edx 9-11-2022 lence estimates correlated well to WHO incidence rates (Rs=0.70, p<0.001). Badje A, Moh R, Gabillard D, et al. Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, Dye C. Arch Intern Med. doi: 10.1016/S1473-3099(16)30139-6. Epidemiology; Incidence; Mortality; Mortalit; Prevalence; Prvalence; Tuberculose; Tuberculosis; pidmiologie. Careers. The outcome was a political declaration agreed by all UN Member States, in which existing commitments to the SDGs and WHOs End TB Strategy were reaffirmed, and new ones added. . 2019 May 21;33:45. doi: 10.11604/pamj.2019.33.45.17520. official website and that any information you provide is encrypted The political declaration of the UN high-level meeting included four new global targets: As requested in the political declaration: WHO is working closely with countries, partners and civil society in scaling up the TB response. Human may be infected by M. bovis through milk and milk products or meat of an infected animal. Multi-Drug Resistant TB (MDR-TB) is defined as resistance to, at least, isoniazid and rifampicin among first-line drugs, while Extensively Drug Resistant TB (XDR-TB) refers to MDR-TB with additional resistance to, at least, any fluoroquinolone and any one of three second-line injectable drugs (i.e. Since 2000, an estimated 74 million lives were saved through TB diagnosis and treatment. The latter may be detected outside of national programs and managed inappropriately, also contributing to further transmission and creation of drug resistance. The world did not reach the milestone of 0% TB patients and their households facing catastrophic costs as a result of TB disease by 2020. Globally in 2021, there were 2.2 million new TB cases that were attributable to undernutrition. In 2020, WHO recommended a new shorter (911 months) and fully oral regimen for patients with MDB-TB. There was a decline in global spending on essential TB services from US$ 6.0 billion in 2019 to US$ 5.4 billion in 2021, which is less than half of the global target. Latent TB infection: updated and consolidated guidelines for programmatic management. In 2012, 1.1 million TB cases (i.e. Up to 13 million: estimated number of people in the United States living with latent TB infection. To understand methods of prevention and control of tuberculosis. Fenner L, Gagneux S, Janssens JP, Fehr J, Cavassini M, Hoffmann M, Bernasconi E, Schrenzel J, Bodmer T, Bttger EC, Helbling P, Egger M Swiss HIV Cohort and Molecular Epidemiology of Tuberculosis Study Groups. Abu Horaira Huazhong Agricultural University Abstract and Figures Tuberculosis (TB) is one of the major prevalent disease, which is caused by Mycobacterium. cheap resorts in kumarakom. The Global Plan to Stop TB 20062015: Actions for Life towards a World Free of tuberculosis. By the end of 2021, 92 countries started using shorter MDR-TB treatment regimens and 109 had started using bedaquiline, in an effort to improve the effectiveness of MDR-TB treatment. Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats. TB is present in all countries and age groups. eCollection 2019. It followed the first global ministerial conference on TB hosted by WHO and the Russian government in November 2017. Although the overall incidence of TB in the WHO European region was relatively low, the proportion of TB cases with RR or MDR TB in this region (40%) was substantially higher than that in all other regions (range=3.6%6.3%). http://www.who.int/entity/tb/post2015_TBstrategy.pdf?ua=1, http://creativecommons.org/licenses/by/2.0, http://www.who.int/iris/bitstream/10665/91355/1/9789241564656_eng.pdf?ua=1, http://whqlibdoc.who.int/publications/2010/9789241547833_eng.pdf?ua=1, http://whqlibdoc.who.int/publications/2012/9789241503006_eng.pdf?ua=1, http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2010/JC2034_UNAIDS_Strategy_en.pdf, http://www.who.int/iris/bitstream/10665/85321/1/9789241505727_eng.pdf?ua=1, http://www.who.int/tb/challenges/prisons/en/, http://www.who.int/iris/bitstream/10665/112472/1/9789241506335_eng.pdf?ua=1, http://www.who.int/iris/handle/10665/58749, http://whqlibdoc.who.int/hq/1994/WHO_TB_94.179.pdf?ua=1, http://www.stoptb.org/assets/documents/global/plan/GLOBAL_PLAN_TO_STOP_TB_2001_2005.pdf, http://www.theglobalfund.org/en/about/fundingspending/, http://whqlibdoc.who.int/hq/2006/WHO_HTM_STB_2006.368_eng.pdf?ua=1, http://www.stoptb.org/assets/documents/global/plan/GlobalPlanFinal.pdf, http://www.who.int/tb/post2015_TBstrategy.pdf?ua=1, http://www.who.int/iris/bitstream/10665/84879/1/9789241505482_eng.pdf?ua=1. Zenner D, Southern J, van Hest R, DeVries G, Stagg HR, Antoine D, Abubakar I. The site is secure. An estimated one quarter of the worlds population has latent TB infection and is at risk for future TB disease (10), which has potential to be averted by TPT (7,8). 75% reduction in tuberculosis deaths (compared with 2015); 50% reduction in tuberculosis incidence rate (compared with 2015), No affected families facing catastrophic costs due to tuberculosis, 95% reduction in tuberculosis deaths (compared with 2015), 90% reduction in tuberculosis incidence rate (compared with 2015), Global trends in estimated rates of TB incidence, prevalence and mortality 19902012 and forecast TB prevalence and mortality rates 20132015 [, Percentage of new TB cases with multi-drug resistant tuberculosis in 2012 (MDR-TB) [. Agbodande AK, Dodo RL, Issa A, Adjadohoun S, Azon-Kouanou A, Wanvoegbe AF, Akanni MD, Prudencio R, Zannou DM, Houngbe F. Pan Afr Med J. Of the US$5.4 billion spent on tuberculosis care and services in 2021, 79% was from domestic sources, with the BRICS countries (Brazil, Russian Federation, India, China and South Africa) accounting for US$2.7 billion (64% of total domestic funding). the date of publication. van Hest NA, Aldridge RW, de Vries G, Sandgren A, Hauer B, Hayward A, Arrazola de O-ate W, Haas W, Codecasa LR, Cayl JA, Story A, Antoine D, Gori A, Quabeck L, Jonsson J, Wanlin M, Orcau , Rodes A, Dedicoat M, Antoun F, van Deutekom H, Keizer S, Abubakar I. Social marginalization is often responsible for a limited access to health services leading to diagnostic delay, clinical worsening and poor adherence to treatment, and eventually to a less favourable outcome.1113 A common discouraging factor to seek medical care is the fear of stigmatization that is also an important determinant of poor adherence. Primary tuberculosis 3. World Health Organization. of pages found at these sites. Uploaded on Oct 23, 2019 Pauline R Tillotson + Follow treatment tb cases The presence of multidrug-resistant strains of M. tuberculosis in most countries, with somewhere prevalence is high, is among the major challenges for TB control, which may hinder recent achievements especially in some settings. Human TB is transmitted mainly through droplet infection and droplet nuclei. Disseminated tuberculosis Laboratory diagnosis of tuberculosis caused by Mycobacterium tuberculosis Specimen and processing and transmitted securely. Abstract. For instance, according to GHE, a registered charity commission based in the UK, stated that around 30 high burden countries in the world accounted for 86% of all estimated incidence cases on a global level. Nadjane Batista Lacerda S, Cristina de Abreu Temoteo R, Maria Ribeiro Monteiro de Figueiredo T, Darliane Tavares de Luna F, Alves Nunes de Sousa M, Carlos de Abreu L, Luiz Affonso Fonseca F. Individual and social vulnerabilities upon acquiring tuberculosis: a literature systematic review. In an effort to adapt the new strategy to their settings, the 33 countries, that currently can be considered as low-incidence recently, met in Rome for a Global Consultation, convened by WHO and the European Respiratory Society. Latent tuberculosis infections in hard-to-reach drug using population-detection, prevention and control. Bovine TB (caused by the closely related M. bovis) can be transmitted by consuming unpasteurized dairy products from infected cattle. Global epidemiology of tuberculosis. 2006 Mar;86(2):77-109. doi: 10.1016/j.tube.2005.05.002. and/or the original MMWR paper copy for printable versions of official text, figures, and tables. In some cases, more extensive drug resistance can develop. Objective: To determine the prevalence and risk factors for the human immunodeficiency virus (HIV) and HCV co-infection among patients with TB in Georgia, a cross-sectional study was carried out at hospitals in four Georgian cities. United Nations. You can review and change the way we collect information below. World Health Organization. Bethesda, MD 20894, Web Policies In other words, one-third of cases, corresponding to an estimated 3 million cases, was missed that year. Clipboard, Search History, and several other advanced features are temporarily unavailable. Moreover, the However, all age groups are at risk. In 2017, an estimated 10 million incident cases of TB and 1.57 million TB deaths occurred, representing 1.8% and 3.9% declines, respectively, from 2016. WHO recommends expanded access to all-oral regimens. All rights reserved. The objective of the current study was to estimate prevalence and identify factors associated with tuberculosis-diabetes co-morbidity among TB patients enrolled in the Directly Observed Treatment, Short course program. Tuberculosis is one of the communicable diseases that pose critical health concerns globally. Introduction. Prevalence of tuberculosis in post-mortem studies of HIV-infected adults and children in resource-limited settings: a systematic review and meta-analysis. World Health Organization. In 2017, estimated TB incidence and the total number of TB deaths declined slightly worldwide; however, WHO estimates indicate that the rates of these declines are not sufficient to meet 2020 milestones (1). BMC Public Health. * Cases per 100,000 population. Cases per 100 persons with HIV infection. Per 100 TB cases. West Africa has a unique epidemiology of TB that is characterized by medium- to high-prevalence. We take your privacy seriously. [Report of a case of isolated tuberculous arthritis of the knee: a difficult diagnosis in adolescents]. Van Deun A, et al. and transmitted securely. Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. To understand the cycle of infection of tuberculosis. The strategy is also designed to face the challenges of low-burden countries (namely, those with an incidence below 10/100 000/year). Although the rifapentine component of 3HP is substantially more expensive than conventional isoniazid regimens, the ease of use, improved adherence rates, and comparable safety and efficacy of 3HP have the potential to increase TPT coverage. WHO recommends a 12-component approach of collaborative TB-HIV activities, including actions for prevention and treatment of infection and disease, to reduce deaths. eCollection 2019. Ferrets as a model for tuberculosis transmission. Lnnroth K, Castro KG, Chakaya JM, Chauhan LS, Floyd K, Glaziou P, Raviglione MC. The strategy also includes a 2020 milestone that no TB patients and their households face catastrophic costs as a result of TB disease. Rangchaikul P, Ahn P, Nguyen M, Zhong V, Venketaraman V. Clin Pract. Early TB case detection especially in resource-constrained settings and in marginalized groups remains a challenge, and about 3 million people are estimated to remain undiagnosed or not notified and untreated. This implies that a significant proportion of TB patients remains either unrecognized and untreated or not notified. Before Nehal et al in study carried out in South India found a high prevalence of tuberculosis among elderly (18.7%)) where pulmonary tuberculosis was more commonly noted (82.8%). [1] Tuberculosis generally affects the lungs, but it can also affect other parts of the body. But TB is curable and preventable. Clipboard, Search History, and several other advanced features are temporarily unavailable. The traditional case detection rate (CDR), defined as the proportion of notified cases among the estimated number of new and relapse TB cases, thought to have occurred in a given year, is a problematic indicator in TB epidemiology, though it could potentially provide very useful information on the diagnostic capacity of a TB control program.2 The denominator consists of an estimate: significant efforts are currently ongoing to obtain reliable estimates through the performance of costly prevalence surveys but coverage is still limited.3 In 2012, 6.1 million TB cases were notified by the National TB Programs (NTPs). The site is secure. Keywords: Crucially, the new strategy recognises fully the need for bold policies that go beyond those of national programmes and engage the entire health system, such as rationalising the use of medicines, ensuring their quality, establishing infection control measures etc. * In 2017, 67 and 138 countries reported data on use of TPT among eligible persons with HIV infection and children aged <5 years, respectively. Falzon D, Jaramillo E, Schnemann HJ, et al. Houben RM, Dodd PJ. 1Division of Global HIV and TB, Center for Global Health, CDC; 2Tuberculosis Monitoring and Evaluation, Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland. Data on persons receiving TB preventive treatment, reported to WHO, were compared with estimates of eligible persons. lvarez JL, Kunst AE, Leinsalu M, Bopp M, Strand BH, Menvielle G, Lundberg O, Martikainen P, Deboosere P, Kalediene R, Artnik B, Mackenbach JP, Richardus JH. The highest prevalence of tuberculosis infection and estimated annual risk of tuberculosis infection are in sub-Saharan Africa and Southeast Asia. Tuberculosis (TB) is a progressive granulomatous infectious disease caused by the gram positive, acid fast bacilli classified under the genus Mycobacterium. WHO finalized and published a Multisectoral Accountability Framework for TB (MAF-TB) in 2019. WHO is supporting countries to adapt and use the framework to translate commitments into actions and to monitor, report, and review progress, with the engagement of high-level leadership, all relevant sectors, civil society and other stakeholders. MDR-TB prevalence is estimated from the reported proportion of MDR-TB cases in countries that either have a routine drug resistance surveillance system in place or have undertaken a survey and the global TB prevalence.31 About 450 000 cases of MDR-TB (range 300 000 600 000) were thought to have emerged in 2012, accounting for 3.6% (2.15.1%) of all new TB cases and 20.2% (13.327.2%) of previously treated cases. Accessibility Twelve million (1113 million) prevalent cases of TB were estimated in 2012, corresponding to about 169 cases per 100 000 population.1 TB prevalence is declining globally since the early 1990s (before incidence started to decline). Tuberculosis control and elimination 201050: cure, care, and social development. Muniyandi M, Ramachandran R. Socioeconomic inequalities of tuberculosis in India. FOIA Successful treatment of persons with RR or MDR TB disease remains challenging, as evidenced by the high case fatality rate among RR or MDR TB patients. Overall, almost 3.8 million cases of tuberculosis . Expanding the coverage of ART among HIV-infected TB patients represents the highest current priority for TB/HIV interventions in countries with a high burden of both diseases. Subsequently, a 1.3% per year average reduction rate has been observed since 2002, reaching 2.2% between 2010 and 2011. Drug resistance emerges when TB medicines are used inappropriately, through incorrect prescription by health care providers, poor quality drugs, and patients stopping treatment prematurely. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Introduction and background information. In 2017, an estimated 10 million incident TB cases and 1.6 million TB deaths occurred, representing reductions of 1.8% and 3.9% from 2016, respectively. Hence, TB national programs must devote significant resources to the disease-specific recording and reporting system. The number of individuals infected with both HIV and TB is increasing worldwide. For this review article, data available in books and at the official websites of WHO, MBDC, NTP, DGHS, The Ministry of Health and Family Welfare, Government of Bangladesh were consulted through PubMed central and Google scholar search engines. Childhood deaths from TB are usually caused by tuberculous meningitis or disseminated disease. Since TB does not homogeneously affect the population, selected high-risk groups should be identified in all settings as they deserve special attention and should be addressed specifically with additional interventions. An official website of the United States government. provided as a service to MMWR readers and do not constitute or imply Zumla A, Mwaba P, Huggett J, et al. However, second-line treatment options are limited and require extensive chemotherapy (of at least 9 months and up to 20 months of treatment) with medicines that are expensive and toxic. HHS Vulnerability Disclosure, Help Finally, the new strategy emphasises that action on social and economic, upstream determinants of TB must be addressed if the world truly envisages the elimination of this disease in the decades to come. According to the World Health Organization (WHO), about 8.6 million cases (8.39.0 million) were estimated to have occurred in 2012, approximately 2.9 of whom were in women. Weekly / March 22, 2019 / 68(11);263266, Adam MacNeil, PhD1; Philippe Glaziou, MD2; Charalambos Sismanidis, PhD2; Susan Maloney, MD1; Katherine Floyd, PhD2 (View author affiliations). Primary or pulmonary tuberculosis 2. TB is a treatable and curable disease. Tuberculosis (TB) is one of the major public health threats, competing with the human immunodeficiency virus (HIV) as the cause of death due to infectious diseases worldwide. About one-quarter of the world's population has a TB infection, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit it. TB occurs in every part of the world. Falling prevalence, while welcome, poses new challenges for TB surveillance. Tuberculosis mostly affects adults in their most productive years. Please enable it to take advantage of the complete set of features! The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling. Evolution of Tuberculosis Control and Prospects for Reducing Tuberculosis Incidence, Prevalence, and Deaths Globally (Reprinted). HHS Vulnerability Disclosure, Help Moreover, in some of these groups TB may remain for a long time undiagnosed, thus representing a source of infection for the entire community.10. M. microti is not known to cause TB in human, while M. bovis has a wider host range. Most cases are estimated to be in Asia and Africa (58% and 27% respectively), with the highest incidence in India (range 2.02.4 million) and China (0.9 1.1 million), together accounting for 38% of the total number of cases.1. Sustainable development goals. In addition, multi-drug-resistant tuberculosis (MDR TB) is becoming a major challenge. Download (3.7 MB) Overview Each year, the WHO Global TB Report provides a comprehensive and up-to-date assessment of the TB epidemic, and of progress in prevention, diagnosis and treatment of the disease, at global, regional and country levels. sharing sensitive information, make sure youre on a federal Diagnosing multidrug-resistant and other resistant forms of TB (see Multidrug-resistant TB section below) as well as HIV-associated TB can be complex and expensive. Overall, the incidence and prevalence of tuberculosis 2 Volume 54 Number 2 April-June., 2016 has not declined, even though the death rate associated with tuberculosis is going down. Tuberculosis is a contagious disease caused by Mycobacterium tuberculosis. TRANSMISSION Tuberculosis (TB) transmission occurs when a contagious patient coughs, spreading bacilli through the air.

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