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It is obvious that there will be no
exposure without incident infectious cases. However, there
are important modifiers which will increase or decrease the risk of
exposure in the community at large. The most
important modifier is the duration of infectiousness of an incident
infectious case of tuberculosis. The longer the duration of
infectiousness, the larger the number of susceptibles that come into
contact with the case. The shorter duration of
infectiousness is, the fewer such
encounters will take place. This is important for considering
intervention strategies: while it is difficult to influence incidence of
tuberculosis directly, early case-finding and institution of appropriate
curative chemotherapy can markedly reduce the duration of infectiousness. Another
factor that enters is the number of persons an infectious patient meets
per unit of time of infectiousness. This will greatly vary,
for instance by: Age: The extent of
social interactions varies at different ages. Gender:
Men and women behave differently both in number of contacts and in the
type of persons contacted. Such differences may be more or less pronounced
in different cultural contexts, depending the roles in society accorded to
men and women. Geographic location:
The most conspicuous differences are found between urban and rural
areas. The number of people who can become exposed by a single case
of tuberculosis will be vastly larger in urban compared to rural settings.
Climatic conditions: Climates that allow much
outdoor activity will lead to less relevant exposure than cold and
un-hospital climates that force people to congregate indoors much of their
time.
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