Modeling the Transmission of Tuberculosis in Long-Term Care Facilities using a Network Model

Abstract

Tuberculosis (TB) infection in the elderly is frequently misdiagnosed. The resulting treatment delay may increase TB transmission which is higher in long-term care (LTC) facilities. The CDC's recommendations to prevent and control TB in LTC facilities include TB education and better initial screening methods on entry into the facility. However, TB education programs might not always be given priority and comparing screening methods experimentally is often not feasible. To address these problems, we develop a general conceptual SEIR network model for LTC facilities and present a case study of a specific outbreak that occurred in a nursing home in Arkansas. We investigate the impact of reducing diagnosis delay on the Arkansas outbreak and evaluate potential screening programs for that setting. Our results quantify the effectiveness of reducing diagnosis delay, justifying a good TB education program. We also suggest multiple screening programs that were found to produce equivalent results.