Onset of infectiousness explains differences in transmissibility across Mycobacterium tuberculosis lineages

Mycobacterium tuberculosis complex (MTBC) lineages show substantial variability in virulence, but the epidemiological consequences of this variability have not been studied in detail. Here, we aimed for a lineage-specific epidemiological characterization by applying phylodynamic models to genomic data from different countries, representing the most abundant MTBC lineages. Our results suggest that all lineages are associated with similar durations and levels of infectiousness, resulting in similar reproductive numbers. However, L1 and L6 are associated with a delayed onset of infectiousness, leading to longer periods between subsequent transmission events. Together, our findings highlight the role of MTBC genetic diversity in tuberculosis disease progression and transmission. • Previous studies identified differences in MTBC lineage transmissibility based on genetic distance metrics. • Here we quantify all relevant epidemiological parameters, including the R e , in detail using phylodynamics. • Our results emphasize the importance of the initial non-infectious period in infected individuals. • Our phylodynamic approach is fully tailored to M. tuberculosis transmission and could inspire future studies in TB epidemiology.