Using genomic epidemiology and geographic activity spaces to investigate tuberculosis outbreaks in Botswana.

Background: The integration of genomic and geospatial data into infectious disease transmission analyses typically includes residential locations and excludes other activity spaces where transmission may occur ( work, school, or social venues). The objective of this analysis was to explore residential as well as other activity spaces of tuberculosis (TB) outbreaks to identify potential geospatial 'hotspots' of transmission.

Methods: We analyzed data that included geospatial coordinates for residence and other activity spaces collected during 2012-2016 for the Kopanyo Study, a population-based study of TB transmission in Botswana. We included participants with results from whole genome sequencing conducted on archived samples from the original study. We used a spatial log-Gaussian Cox process model to detect core areas of increased activity spaces of individuals belonging to TB outbreaks (genotypic groups with ≤5 single-nucleotide polymorphisms), which we compared to ungrouped participants (those not in a genotypic group of any size).

Findings: We analyzed data collected from 636 participants, including 70 participants belonging to six outbreak groups with a combined total of 293 locations, and 566 ungrouped participants with a combined total of 2289 locations. Core areas of activity space for each outbreak group were geographically distinct, and we found evidence of localized transmission in four of six outbreaks. For most of the outbreaks, including activity space data led to the detection of larger areas of higher spatial intensity and more focal points compared to residential location alone.

Interpretation: Geospatial analysis using activity space data (social gathering places as well as residence) may lead to improved understanding of areas of infectious disease transmission compared to using residential data alone.

Funding: This work was supported by funding from the National Institute of Allergy and Infectious Diseases R01AI097045, R01AI147336, and R01AI170204.