Ted Cohen

Ted Cohen
Yale School of Public Health

MD MPH DPH

About

376
Publications
34,333
Reads
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11,250
Citations
Citations since 2016
224 Research Items
8092 Citations
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Introduction
Ted Cohen currently works at the Department of Epidemiology of Microbial Diseases, Yale University. Ted does research in Epidemiology, Infectious Diseases and Public Health.
Additional affiliations
September 2014 - present
Yale University
Position
  • Professor (Associate)
June 2012 - December 2016
Harvard University
Position
  • Professor
January 2005 - December 2012
Brigham and Women's Hospital

Publications

Publications (376)
Article
Background Massive internal migration from rural to urban areas poses new challenges for tuberculosis control in China. We aimed to combine genomic, spatial, and epidemiological data to describe the dynamics of tuberculosis in an urban setting with large numbers of migrants. Methods We did a population-based study of culture-positive Mycobacterium...
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Background: In high-incidence settings, recurrent disease among previously treated individuals contributes substantially to the burden of incident and prevalent tuberculosis. The extent to which interventions targeted to this high-risk group can improve tuberculosis control has not been established. We aimed to project the population-level effect...
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Background The introduction of a conjugate vaccine for serogroup A Neisseria meningitidis has dramatically reduced disease in the African meningitis belt. In this context, important questions remain about the performance of different vaccine policies that target remaining serogroups. Here, we estimate the health impact and cost associated with seve...
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Background. We aimed to identify and determine the etiology of ‘hotspots’ of concentrated multi-drug resistant tuberculosis (MDR-TB) risk in Lima, Peru. Methods. From 2009-2012, we conducted a prospective cohort study among households of TB cases from 106 health center (HC) areas in Lima, Peru. All notified TB cases and their household contacts we...
Article
Finding optimal dosing strategies for treating bacterial infections is extremely difficult, and improving therapy requires costly and time-intensive experiments. To date, an incomplete mechanistic understanding of drug effects has limited our ability to make accurate quantitative predictions of drug-mediated bacterial killing and impeded the ration...
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Importance: While a substantial fraction of the US population was infected with SARS-CoV-2 during December 2021-February 2022, the subsequent evolution of population immunity against SARS-CoV-2 Omicron variants reflects the competing influences of waning protection over time and acquisition or restoration of immunity through additional infections a...
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Background Isoniazid preventive therapy (IPT) can prevent tuberculosis among people receiving antiretroviral therapy (ART). HIV programmes are now initiating patients on ART with higher average CD4 cell counts and lower tuberculosis risks under test-and-treat guidelines. We aimed to investigate how this change has affected the health impact and cos...
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The degree to which individual heterogeneity in the production of secondary cases ("superspreading") affects tuberculosis (TB) transmission has not been systematically studied. We searched for population-based or surveillance studies in which whole genome sequencing was used to estimate TB transmission and the size distributions of putative TB tran...
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Tuberculosis (TB) killed more people globally than any other single pathogen over the past decade. Where surveillance is weak, estimating TB burden estimates uses modeling. In many African countries, increases in HIV prevalence and antiretroviral therapy (ART) have driven dynamic TB epidemics, complicating estimation of burden, trends, and potentia...
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BACKGROUND Diagnosing drug resistance is critical for choosing effective TB treatment regimens. Next-generation sequencing (NGS) represents an alternative approach to conventional phenotypic drug susceptibility testing (pDST) for diagnosing TB drug resistance.METHODS We undertook a budget impact analysis estimating the costs of introduction and rou...
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Reliable subnational estimates of TB incidence would allow national policy makers to focus disease control resources in areas of highest need. We developed an approach for generating small area estimates of TB incidence, and the fraction of individuals missed by routine case detection, based on available notification and mortality data. We demonstr...
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Background: Many children with pulmonary tuberculosis remain undiagnosed and untreated with related high morbidity and mortality. Diagnostic challenges in children include low bacterial burden, challenges around specimen collection, and limited access to diagnostic expertise. Algorithms that guide decisions to initiate tuberculosis treatment in res...
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Reported COVID-19 cases and deaths provide a delayed and incomplete picture of SARS-CoV-2 infections in the United States (US). Accurate estimates of both the timing and magnitude of infections are needed to characterize viral transmission dynamics and better understand COVID-19 disease burden. We estimated time trends in SARS-CoV-2 transmission an...
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Background: Multidrug-resistant (MDR) Mycobacterium tuberculosis complex (MTBC) strains are a serious health problem in India, also contributing to one-fourth of the global MDR tuberculosis (TB) burden. About 36% of the MDR MTBC strains are reported fluoroquinolone (FQ) resistant leading to high pre-extensively drug-resistant (pre-XDR) and XDR-TB...
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Background In 2019, tuberculosis incidence and mortality in Brazil were 46 and 3·3 per 100 000 population, respectively, and the country has reported rising tuberculosis case rates since 2016, following an economic crisis beginning in mid-2014. We aimed to estimate the number of excess tuberculosis cases and deaths during the recession period, and...
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Background Limited access to drug-susceptibility tests (DSTs) and delays in receiving DST results are challenges for timely and appropriate treatment of multi-drug resistant tuberculosis (TB) in many low-resource settings. We investigated whether data collected as part of routine, national TB surveillance could be used to develop predictive models...
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Background Both SARS-CoV-2 infection and COVID-19 vaccination contribute to population-level immunity against SARS-CoV-2. This study estimates the immunological exposure and effective protection against future SARS-CoV-2 infection in each US state and county over 2020-2021, and how this changed with the introduction of the Omicron variant. Methods...
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Local information is needed to guide targeted interventions for respiratory infections such as tuberculosis (TB). Case notification rates (CNRs) are readily available, but systematically underestimate true disease burden in neighbourhoods with high diagnostic access barriers. We explored a novel approach, adjusting CNRs for under-notification (P:N...
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Background Globally, prisons are high-incidence settings for tuberculosis. Yet the role of prisons as reservoirs of M. tuberculosis, propagating epidemics through spillover to surrounding communities, has been difficult to measure directly. Methods To quantify the role of prisons in driving wider community M. tuberculosis transmission, we conducte...
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Objectives. To quantify the relationship between the segregation of Black, Indigenous, and Latinx communities and COVID-19 testing sites in populous US cities. Methods. We mapped testing sites as of June 2020 in New York City; Chicago, Illinois; Los Angeles, California; and Houston, Texas; we applied Bayesian methods to estimate the association bet...
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Background Molecular diagnostics are considered the most promising route to achievement of rapid, universal drug susceptibility testing for Mycobacterium tuberculosis complex (MTBC). We aimed to generate a WHO-endorsed catalogue of mutations to serve as a global standard for interpreting molecular information for drug resistance prediction. Method...
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Background The incidence of multidrug-resistant tuberculosis (MDR-TB) remains critically high in countries of the former Soviet Union, where >20% of new cases and >50% of previously treated cases have resistance to rifampin and isoniazid. Transmission of resistant strains, as opposed to resistance selected through inadequate treatment of drug-susce...
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In the absence of point-of-care gonorrhea diagnostics that report antibiotic susceptibility, gonorrhea treatment is empiric and determined by standardized guidelines. These guidelines are informed by estimates of resistance prevalence from national surveillance systems. We examined whether guidelines informed by local, rather than national, surveil...
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Background Spatially-targeted approaches to screen for tuberculosis (TB) could accelerate TB control in high-burden populations. We aimed to estimate gains in case-finding yield under an adaptive decision-making approach for spatially-targeted, mobile digital chest radiography (dCXR)-based screening in communities with varying levels of TB prevalen...
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Background As antibiotic resistance creates a significant global health threat, we need not only to accelerate the development of novel antibiotics but also to develop better treatment strategies using existing drugs to improve their efficacy and prevent the selection of further resistance. We require new tools to rationally design dosing regimens...
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Importance: Prior infection and vaccination both contribute to population-level SARS-CoV-2 immunity. Population-level immunity will influence future transmission and disease burden. Objective: For each US county and state, we estimated the fraction of the population with prior immunological exposure to SARS-CoV-2 (ever infected with SARS-CoV-2 and/...
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Background Many individuals who survive tuberculosis disease face ongoing disability and elevated mortality risks. However, the impact of post-tuberculosis sequelae is generally omitted from policy analyses and disease burden estimates. We therefore estimated the global burden of tuberculosis, inclusive of post-tuberculosis morbidity and mortality....
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Background Many children who develop tuberculosis are thought to be missed by diagnostic and reporting systems. We aimed to estimate paediatric tuberculosis incidence and underreporting between 2013 and 2019 in countries representing more than 99% of the global tuberculosis burden. Methods We developed a mathematical model of paediatric tuberculos...
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Background: In early 2020, the response to the SARS-CoV-2 pandemic focused on non-pharmaceutical interventions, some of which aimed to reduce transmission by changing mixing patterns between people. Aggregated location data from mobile phones are an important source of real-time information about human mobility on a population level, but the degre...
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Understanding factors that contribute to the increased likelihood of disease transmission between two individuals is important for infection control. Measures of genetic relatedness of bacterial isolates between two individuals are often analyzed to determine their associations with these factors using simple correlation or regression analyses. How...
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Background: Effective targeting of latent tuberculosis infection (LTBI) treatment requires identifying those most likely to progress to tuberculosis (TB). We estimated the potential health and economic benefits of diagnostics with improved discrimination for LTBI that will progress to TB. Methods: A base-case scenario represented current LTBI te...
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The evolution and emergence of drug-resistant tuberculosis (TB) has been studied extensively in some contexts, but the ecological drivers of these two processes remain poorly understood. This study sought to describe the joint evolutionary and epidemiological histories of a novel multidrug-resistant Mycobacterium tuberculosis strain recently identi...
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Background Older age is a risk factor for TB in low incidence settings. Using data from the U.S. National TB Surveillance System and American Community Survey, we estimated trends and racial/ethnic differences in TB incidence among US-born cohorts aged ≥50 years. Methods 42,000 TB cases among US-born persons ≥50 years were reported during 2001–201...
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Background The incidence of multidrug-resistant tuberculosis (MDR-TB) remains critically high in countries of the former Soviet Union, where >20% of new cases and >50% of previously-treated cases have resistance to rifampin and isoniazid. Transmission of resistant strains, as opposed to resistance selected through inadequate treatment of drug-susce...
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Background As infectious diseases approach global elimination targets, spatial targeting is increasingly important to identify community hotspots of transmission and effectively target interventions. We aimed to synthesise relevant evidence to define best practice approaches and identify policy and research gaps. Objective To systematically apprai...
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Prisons are high-incidence settings for tuberculosis around the world, yet the contribution of spillover from prisons in driving community epidemics has not been quantified. We whole genome sequenced 1,152 M. tuberculosis isolates from participants diagnosed with tuberculosis within prisons and in the community in Mato Grosso do Sul, Brazil from 20...
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Early in the COVID-19 pandemic, models predicted hundreds of thousands of additional TB deaths as a result of health service disruption. To date, empirical evidence on the effects of COVID-19 on TB outcomes has been limited. Here we summarise the evidence available at a country level, identifying broad mechanisms by which COVID-19 may modify TB bur...
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Background Large-scale rural-to-urban migration has changed the epidemiology of tuberculosis (TB) in large Chinese cities. We estimated the contribution of TB importation, reactivation of latent infection, and local transmission to new TB cases in Shanghai, and compared the potential impact of intervention options. Methods We developed a transmiss...
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Global efforts to prevent the spread of the SARS-COV-2 pandemic in early 2020 focused on non-pharmaceutical interventions like social distancing; policies that aim to reduce transmission by changing mixing patterns between people. As countries have implemented these interventions, aggregated location data from mobile phones have become an important...
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Estimates of the reproductive number for novel pathogens such as severe acute respiratory syndrome coronavirus 2 are essential for understanding the potential trajectory of the epidemic and the level of intervention that is needed to bring the epidemic under control. However, most methods for estimating the basic reproductive number (R0) and time-v...
Article
Importance Taiwan is one of the few countries with initial success in COVID-19 control without strict lockdown or school closure. The reasons remain to be fully elucidated. Objective To compare and evaluate the effectiveness of case-based (including contact tracing and quarantine) and population-based (including social distancing and facial maskin...
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In the past decade, tuberculosis incidence has declined in much of the world, but has risen in central and South America. It is not yet clear what is driving this reversal of progress in tuberculosis control. Since 2000, the incarcerated population in central and South America has grown by 206%, the greatest increase in the world. Over the same per...
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IMPACT: Our study will integrate state-of-the-art methods in pathogen genomics, epidemiology, and geospatial analysis to identify both host- and pathogen-factors driving the MDR-TB transmission and the study outcome can inform the design of targeted interventions OBJECTIVES/GOALS: The emergence of multidrug-resistant tuberculosis (MDR-TB) poses ser...
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Background To meet the transmission reduction goals of the End TB strategy, there is a growing interest in identifying and targeting case-finding efforts to tuberculosis“hotspots,” geographic regions of active transmission. Collecting and interpreting spatial and pathogenic genetic information, the most reliable evidence of active transmission, is...
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We adapted a mathematical modeling approach to estimate tuberculosis (TB) incidence and fraction treated for 101 municipalities of Brazil during 2008-2017. We found the average TB incidence rate decreased annually (0.95%), and fraction treated increased (0.30%). We estimated that 9% of persons with TB did not receive treatment in 2017.
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The Laboratory Costs of Diagnosing Tuberculosis and Tuberculosis Drug Resistance in Moldova LeAnna Cates1, Valeriu Crudu2,3, Alexandru Codreanu2, Nelly Ciobanu2,3, Heather Fosburgh4, Ted Cohen4, Nicolas A. Menzies1 Harvard T.H. Chan School of Public Health, Boston, MA, 02115 Institute of Phthisiopneumology “Chiril Draganiuc”, Chisinau, Moldova Stat...
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Background Prisons are recognised as high-risk environments for tuberculosis, but there has been little systematic investigation of the global and regional incidence and prevalence of tuberculosis, and its determinants, in prisons. We did a systematic review and meta-analysis to assess the incidence and prevalence of tuberculosis in incarcerated po...
Preprint
Full-text available
Background: Drug-resistant tuberculosis is a high priority threat to global public health. There are still critical gaps in understanding how novel drug-resistant M. tuberculosis strains emerge and, once emergent, what drives the differential propagation of certain epidemiologically-successful strains over others. This study sought to describe the...
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There is an emerging consensus that achieving global tuberculosis control targets will require more proactive case finding approaches than are currently used in high-incidence settings. Household contact tracing (HHCT), for which households of newly diagnosed cases are actively screened for additional infected individuals is a potentially efficient...
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Background Evidence on local disease burden and the completeness of case detection represent important information for TB control programs. We present a new method for estimating subnational TB incidence and the fraction of individuals with incident TB who are diagnosed and treated in Brazil. Methods We compiled data on TB notifications and TB-rel...
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Policy makers need decision tools to determine when to use physical distancing interventions to maximize the control of COVID-19 while minimizing the economic and social costs of these interventions. We describe a pragmatic decision tool to characterize adaptive policies that combine real-time surveillance data with clear decision rules to guide wh...
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Background Limitations in the sensitivity and accessibility of diagnostic tools for childhood tuberculosis contribute to the substantial gap between estimated cases and cases notified to national tuberculosis programs. Thus, tools to make accurate and rapid clinical diagnoses are necessary to initiate more children on antituberculosis treatment. M...
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In the United States, new tuberculosis cases are increasingly concentrated within non-native-born populations. We estimated trends and differences in tuberculosis incidence rates for the non-U.S.-born population, at a resolution unobtainable from raw data. We obtained non-U.S.-born tuberculosis case reports for 2000–2016 from the