Understanding and exploiting superspreading to disrupt Mycobacterium tuberculosis transmission

Tuberculosis remains a persistent threat to global public health. Ultimately, future progress towards tuberculosis elimination is contingent on our ability to interrupt Mycobacterium tuberculosis transmission between individuals who are infectious and their susceptible contacts. This Personal View examines individual heterogeneity in M tuberculosis infectiousness and secondary transmission and focuses specifically on M tuberculosis superspreading, ie, the observation that most secondary M tuberculosis infections and tuberculosis clinical cases are attributable to transmission from a relatively small number of individuals. Reviewing both historical and contemporary data, we argue that superspreading is not only an important, ubiquitous feature of tuberculosis epidemiology, but also represents a potential opportunity for disruptive, strategic interventions with potentially outsized impacts on M tuberculosis transmission.