Knowledge gaps and research priorities for understanding the transmission of Mycobacterium tuberculosis and other airborne infections

J. Peter CegielskiDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

Sevim AhmedovBureau for Global Health, TB Division, USAID, Washington, DC, USA

Jun ChengChinese Center for Disease Control and Prevention, Beijing, China

Collin DubickDepartment of Pediatric Infectious Diseases, Emory University, Atlanta, GA, USA

Emily EvansDivision of Infectious Diseases, Emory University, Atlanta, GA, USA

Paul A. JensenEnd TB Transmission Initiative, Stop TB Partnership, Geneva, Switzerland

Avinash KancharTB Prevention, Treatment, Care & Innovation Unit, Global Programme on Tuberculosis & Lung Health, World Health Organization, Geneva, Switzerland

Anita Rani KansalNational Institute of TB and Respiratory Diseases, New Delhi, India

Che-Chi LinDepartment of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA

Yuhong LiuBeijing Chest Hospital, Capital Medical University, Beijing, China

Michael MarllDepartment of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, GA, USA

Gyanshankar MishraDepartment of Respiratory Medicine, Indira Gandhi Government Medical College, Nagpur, India

Matsie MphahleleThe Aurum Institute, Parktown, South Africa

Edward NardellDivision of Global Health Equity, Brigham and Woman’s Hospital, Harvard Medical School, Boston, MA, USA

Jako-Albert NiceDepartment Architecture and Industrial Design, Tshwane University of Technology, Pretoria, GAU, RSA

Jerod N. ScholtenDivision of TB Elimination and Innovation, KNCV Tuberculosis Foundation, The Hague, The Netherlands

Carrie TudorJohns Hopkins University School of Nursing, Baltimore, MD, USA

Martie van der WaltIndependent Consultant, Pretoria, South Africa

Helene Mari van der WesthuizenNuffield Department of Medicine, Oxford University, Oxford, United Kingdom

Varvara VauhkonenIndependent Consultant, Helsinki, Finland

Richard L. VincentIcahn School of Medicine, Mount Sinai, New York, NY, USA

Grigory VolchenkovIndependent Consultant, Vladimir, Russia

DOI:

https://doi.org/10.3396/ijic.v21.23851

Keywords:

tuberculosis, SARS-CoV-2, COVID-19, airborne infections, airborne transmission, infectious aerosols, infection prevention and control

Abstract

Despite 5 years of SARS-CoV-2 research, as well as decades of research on tuberculosis (TB), large gaps remain in understanding the transmission of airborne pathogens. Our aim was to delineate these gaps. Understanding them would enable evidence-based, practical efforts to reduce transmission. Building upon the 2017 Roadmap for TB Transmission Science, we interviewed experts in the field and identified six salient topics harboring holes in knowledge that impede prevention and control efforts. These include 1) fundamental elements of aerobiology, 2) detecting and measuring infectious respiratory particles directly in the air, 3) the infectiousness of asymptomatic TB (by extension, other lung infections) and 4) of calm tidal breathing – including their contributions to global epidemiology, 5) the role of ‘superspreading’ in disease incidence, and 6) the duration of infectiousness of highly drug-resistant TB treated with the newest, all-oral short-course regimens. Based on an extensive literature review, we update advances in science since 2017 and then summarize knowledge gaps and research priorities. Several recent systematic reviews all noted the relatively low quality of published research, so there is an overriding need for high-quality studies to provide evidence for national and international entities upon which to base recommendations, guidelines, and standards.

How to Cite:

Cegielski, J. P., Ahmedov, S., Cheng, J., Dubick, C., Evans, E., Jensen, P. A., … Volchenkov, G. (2025). Knowledge gaps and research priorities for understanding the transmission of Mycobacterium tuberculosis and other airborne infections. International Journal of Infection Control, 21. https://doi.org/10.3396/ijic.v21.23851

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Copyright (c) 2025 J. Peter Cegielski, Sevim Ahmedov, Jun Cheng, Collin Dubick, Emily Evans, Paul A. Jensen, Avinash Kanchar, Anita Rani Kansal, Che-Chi Lin, Yuhong Liu, Michael Marll, Gyanshankar Mishra, Matsie Mphahlele, Edward Nardell, Jako-Albert Nice, Jerod N. Scholten, Carrie Tudor, Martie van der Walt, Helene Mari van der Westhuizen, Varvara Vauhkonen, Richard L. Vincent, Grigory Volchenkov

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