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Megan Murray

Harvard Medical School

Professor of Global Health and Social Medicine

Department of Medicine

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Megan Murray is a Professor of Epidemiology at the Harvard School of Public Health where she leads a research team which conducts multidisciplinary research on MDR and XDR TB involving conventional and molecular epidemiology, cost-effectiveness and mathematical modeling, outcomes and operations research, and genomic epidemiology. Dr. Murray is also an Associate Professor of Medicine and the Director of Research at the Brigham and Women’s Hospital Division of Global Health Equity and its sister organizations, Partners In Health and the Department of Global Health and Social Medicine at Harvard Medical School.

Dr. Murray's research group has the following major areas of interest:

1. Epidemiology and transmission dynamics of drug sensitive and resistant tuberculosis

2. Evolution and within-host dynamics of drug resistant M tuberculosis

3. Host iron metabolism and TB susceptibility

4. Social, economic and biologic determinants of tuberculosis

5. Methodological approaches to evaluation of the impact of global health interventions

Modeling challenges in context: lessons from malaria, HIV, and tuberculosis.

Childs LM, Abuelezam NN, Dye C, Gupta C, Murray MB, Williams B, Buckee CO

In Revision   2014 Aug.

Genomic analysis identifies targets of convergent positive selection in drug-resistant Mycobacterium tuberculosis.

Farhat MR, Shapiro BJ, Kieser KJ, Sultana R, Jacobson KR, Victor TC, Warren RM, Streicher EM, Calver A, Sloutsky A, Kaur D, Posey JE, Plikaytis B, Oggioni MR, Gardy JL, Johnston JC, Rodrigues M, Tang PK, Kato-Maeda M, Borowsky ML, Muddukrishna B, Kreiswirth BN, Kurepina N, Galagan J, Gagneux S, Birren B, Rubin EJ, Lander ES, Sabeti PC, Murray M.

M. tuberculosis is evolving antibiotic resistance, threatening attempts at tuberculosis epidemic control. Mechanisms of resistance, including genetic changes favored by selection in resistant isolates, are incompletely understood. Using 116 newly seq... (more »).

Nat Genet.   2013 Oct. 45 (10): 1183-9  

Research areas: tuberculosis

Mycobacterium tuberculosis mutation rate estimates from different lineages predict substantial differences in the emergence of drug-resistant tuberculosis

Ford CB, Shah RR, Maeda MK, Gagneux S, Murray MB, Cohen T, Johnston JC, Gardy J, Lipsitch M, Fortune SM.

A key question in tuberculosis control is why some strains of M. tuberculosis are preferentially associated with resistance to multiple drugs. We demonstrate that M. tuberculosis strains from lineage 2 (East Asian lineage and Beijing sublineage) acqu... (more »).

Nature Genetics   2013 Jun.

Research areas: tuberculosis

How does sex trafficking increase the risk of HIV Infection? An observational study from Southern India

Wirth KE, Tchetgen Tchetgen EJ, Silverman JG, Murray MB.

Studies have documented the substantial risk of human immunodeficiency virus (HIV) infection endured by sex-trafficked women, but it remains unclear how exposure to trafficking puts its victims at risk.... (more »).

Am J Epidemiol.   2013 Feb.

Research areas: HIV

Population health impact and cost-effectiveness of tuberculosis diagnosis with Xpert MTB/RIF: a dynamic simulation and economic evaluation.

Menzies NA, Cohen T, Lin HH, Murray M, Salomon JA.

The Xpert MTB/RIF test enables rapid detection of tuberculosis (TB) and rifampicin resistance. The World Health Organization recommends Xpert for initial diagnosis in individuals suspected of having multidrug-resistant TB (MDR-TB) or HIV-associated T... (more »).

PLoS Med.   2012 Nov. 9 (11): e1001347.  

Research areas: tuberculosis

Modeling the dynamic relationship between HIV and the risk of drug-resistant tuberculosis

Sergeev R, Colijn C, Murray M, Cohen T

The emergence of highly drug-resistant tuberculosis (TB) and interactions between TB and HIV epidemics pose serious challenges for TB control. Previous researchers have presented several hypotheses for why HIV-coinfected TB patients may suf... (more »).

Science Translational Medicine   2012 Apr. 4 (135): 135ra67  

Research areas: tuberculosis

Bayesian methods of identifying and comparing branching tree structures: An application to development of resistant TB strains

Izu A, Cohen T, Mitnick C, Murray M, Gruttola VD.

For pathogens that must be treated with combinations of antibiotics and acquire resistance through genetic mutation, knowledge of the order in which drug-resistance mutations occur may be important for determining treatment policies. Diagnostic speci... (more »).

Stat Med   2011 Aug. 30 (22): 2708-20  

Research areas: tuberculosis

Treatment outcomes of Isoniazid-resistant tuberculosis patients, Western Cape Province, South Africa

Jacobson KR, Theron D, Victor TC, Streicher EM, Warren R, Murray M

We report treatment outcomes from a retrospective cohort of patients with isoniazid-monoresistant tuberculosis in rural South Africa. Sixteen percent of patients had poor outcomes, 61% of whom progressed to multidrug-resistant tuberculosis. These dat... (more »).

Clin Infect Dis   2011 Jul. 53 (4): 369-72  

Research areas: tuberculosis

A modelling framework to support the selection and implementation of new tuberculosis diagnostic tools

Lin HH, Langley I, Mwenda R, Doulla B, Egwaga S, Millington KA, Mann GH, Murray M, Squire SB, Cohen T

Efforts to stimulate technological innovation in the diagnosis of tuberculosis (TB) have resulted in the recent introduction of several novel diagnostic tools. As these products come to market, policy makers must make difficult decisions about which ... (more »).

Int J Tuberc Lung Dis   2011 Jul. 15 (8): 996-1004  

Research areas: tuberculosis

The impact of diabetes on tuberculosis treatment outcomes: a systematic review

Baker MA, Harries AD, Jeon CY, Hart JE, Kapur A, Lonnroth K, Ottmani SE, Goonesekera SD, Murray MB

BACKGROUND: Multiple studies of tuberculosis treatment have indicated that patients with diabetes mellitus may experience poor outcomes. We performed a systematic review and meta-analysis to quantitatively summarize evidence for the impact of diabete... (more »).

BMC Med   2011 Jun. 9 81  

Research areas: tuberculosis

Rifampicin reduces susceptibility to Ofloxacin in Rifampicin resistant Mycobacterium tuberculosis through efflux

Louw GE, Warren RM, Gey van Pittius NC, Leon R, Jimenez A, Hernandez-Pando R, McEvoy CR, Grobbelaar M, Murray M, van Helden PD, Victor TC

Rationale: Central dogma suggests that rifampicin resistance in Mycobacterium tuberculosis develops solely through rpoB gene mutations. Objective: To determine whether rifampicin induces efflux pumps activation in rifampicin resistant M. tuberculosis... (more »).

Am J Respir Crit Care Med   2011 Jun. 184 (2): 269-76  

Research areas: tuberculosis

Modeling social, environmental and biological determinants of tuberculosis

Murray M, Oxlade O, Lin HH

Mathematical models have facilitated our understanding of infectious diseases dynamics and proved useful tools to compare control scenarios when interventional studies are not feasible or ethical. Here, we summarize evidence linking social, economic ... (more »).

Int J Tuberc Lung Dis   2011 May. Suppl 2 S64-70  

Research areas: tuberculosis

Epidemiologic inference from the distribution of tuberculosis cases in households in Lima, Peru

Brooks-Pollock E, Becerra MC, Goldstein E, Cohen T, Murray MB

Tuberculosis (TB) often occurs among household contacts of people with active TB. It is unclear whether clustering of cases represents household transmission or shared household risk factors for TB. Methods. We used cross-sectional data from 764... (more »).

J Infect Dis   2011 May.

Research areas: tuberculosis

Effectiveness of early antiretroviral therapy initiation to improve survival among HIV-infected adults with tuberculosis: a retrospective cohort study

Franke MF, Robins JM, Mugabo J, Kaigamba F, Cain LE, Fleming JG, Murray MB

BACKGROUND: Randomized clinical trials examining the optimal time to initiate combination antiretroviral therapy (cART) in HIV-infected adults with sputum smear-positive tuberculosis (TB) disease have demonstrated improved survival among those who in... (more »).

PLoS Med   2011 Apr. 8 (5): e1001029  

Research areas: tuberculosis

Diabetes mellitus and tuberculosis in countries with high tuberculosis burdens: individual risks and social determinants

Goldhaber-Fiebert JD, Jeon CY, Cohen T, Murray MB

BACKGROUND: A growing body of evidence supports the role of type 2 diabetes as an individual-level risk factor for tuberculosis (TB), though evidence from developing countries with the highest TB burdens is lacking. In developing countries, TB is mos... (more »).

Int J Epidemio   2011 Mar. 40 (2): 417-28  

Research areas: tuberculosis

Diabetes mellitus and tuberculosis in countries with high tuberculosis burdens: individual risks and social determinants

Goldhaber-Fiebert J, Jeon C, Cohen T, Murray M..

BACKGROUND: A growing body of evidence supports the role of type 2 diabetes as an individual-level risk factor for tuberculosis (TB), though evidence from developing countries with the highest TB burdens is lacking. In developing countries, TB is mos... (more »).

Int J Epidemiol   2011 Mar. 40 (2): 417-28  

Research areas: tuberculosis

Spontaneous emergence of multiple drug resistance in tuberculosis before and during therapy

Colijn C, Cohen T, Ganesh A, Murray M

The emergence of drug resistance in M. tuberculosis undermines the efficacy of tuberculosis (TB) treatment in individuals and of TB control programs in populations. Multiple drug resistance is often attributed to sequential functional monotherapy, an... (more »).

PLoS One   2011 Feb. 6 (3): e18327  

Research areas: tuberculosis

Tuberculosis burden in households of patients with multi-drug resistant tuberculosis and extensively drug resistant tuberculosis

Becerra MC, Appleton SC, Franke MF, Chalco K, Arteaga F, Bayona J, Murray M, Atwood SS, Mitnick CD

BACKGROUND: Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis have emerged as major global health threats. WHO recommends contact investigation in close contacts of patients with MDR and XDR tuberculosis. We aimed to assess ... (more »).

Lancet   2010 Dec. 377 (9760): 147-52  

Research areas: tuberculosis

Use of fluoroquinolone antibiotics leads to tuberculosis treatment delay in a South African gold mining community

Jeon CY, Calver AD, Victor TC, Warren RM, Shin SS, Murray MB

BACKGROUND: Empiric use of fluoroquinolone (FQ) antibiotics could delay tuberculosis (TB) treatment and lead to FQ-resistant TB. METHODS: We examined the impact of FQ use on TB outcomes, including smear status, treatment delay and FQ resistance,... (more »).

Int J Tuberc Lung Dis   2010 Dec. 15 (1): 77-83  

Research areas: tuberculosis

Mixed strain M. tuberculosis infections among patients dying in hospital in KwaZulu-Natal, South Africa

Cohen T, Wilson D, Wallengren K, Samuel E, Murray M

We performed spoligotyping and 24-locus mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) typing on M. tuberculosis culture-positive biopsy specimens collected from adults dying in a hospital in KwaZulu-Natal. Of 56... (more »).

J Clin Microbiol   2010 Dec. 49 (1): 385-8  

Research areas: tuberculosis

Consultation meeting on tuberculosis and diabetes mellitus: meeting summary and recommendations

Ottmani SE, Murray MB, Jeon CY, Baker MA, Kapur A, Lönnroth K, Harries AD

The steadily growing epidemic of diabetes mellitus (DM) poses a threat for global tuberculosis (TB) control. Previous studies have identified an important association between DM and TB. However, these studies have limitations: very few were carried o... (more »).

Int J Tuberc Lung Dis   2010 Nov. 14 (12): 1513-7  

Research areas: tuberculosis

Bidrectional screening for tuberculosis and diabetes: a systematic review

Jeon CY, Harries AD, Baker MA, Hart JE, Kapur A, Lönnroth K, Ottmani SE, Goonesekera S, Murray MB

BACKGROUND: To assess the yield of finding additional TB or diabetes mellitus (DM) cases through systematic screening and to determine the effectiveness of preventive TB therapy in people with DM. METHODS: We systematically reviewed studies that had ... (more »).

Trop Med Int Health   2010 Oct. 15 (11): 1300-14  

Research areas: tuberculosis

Adjustment for missing data in complex surveys using doubly robust estimation: application to commercial sexual contact among Indian men

Wirth KE, Tchetgen Tchetgen EJ, Murray M

BACKGROUND: The Demographic and Health Survey program routinely collects nationally representative information on HIV-related risk behaviors in many countries, using face-to-face interviews and a complex sampling scheme. If respondents skip questions... (more »).

Epidemiology   2010 Oct. 21 (6): 863-71  

Adjustment for missing data in complex surveys using doubly robust estimation: application to commercial sexual contact among Indian men.

Wirth KE, Tchetgen Tchetgen E, Murray M..

The Demographic and Health Survey program routinely collects nationally representative information on HIV-related risk behaviors in many countries, using face-to-face interviews and a complex sampling scheme. If respondents skip questions about behav... (more »).

Epidemiology   2010 Oct. 21 (6): 863-71  

Prolonged deferral of antiretroviral therapy in the SAPIT trial: Did we need a clinical trial to tell us that this would increase mortality?

Boulle A, Clayden P, Cohen K, Cohen T, Conradie F, Dong K, Geffen N, Grimwood A, Hurtado R, Kenyon C, Lawn S, Maartens G, Meintjes G, Mendelson M, Murray M, Rangaka M, Sanne I, Spencer D, Taljaard J, Variava E, Venter WD, Wilson D

Tuberculosis is the major cause of morbidity and mortality in HIVinfected patients in sub-Saharan Africa. HIV infection is often first diagnosed following a diagnosis of tuberculosis, with many patients needing antiretroviral therapy (... (more »).

S Afr Med J   2010 Aug. 100 (9): 566, 568, 570-1  

The prevalence and drug sensitivity of tuberculosis among patients dying in hospital in KwaZulu-Natal, South Africa

Cohen T, Murray M, Wallengren K, Alvarez GG, Samuel EY, Wilson D

Background Tuberculosis is the leading cause of death in South Africa by death notification, but accurate diagnosis of tuberculosis is challenging in this setting of high HIV prevalence. We conducted limited autopsies on young adults dying in a singl... (more »).

PLoS Med   2010 May. 7 (6): e10002967  

Research areas: tuberculosis

The impact of realistic age structure in simple models of tuberculosis transmission

Brooks-Pollock E, Cohen T, Murray M.

Mathematical models of tuberculosis (TB) transmission have been used to characterize disease dynamics, investigate the potential effects of public health interventions, and prioritize control measures. While previous work has addressed the mathematic... (more »).

PLoS ONE   2009 Dec. 5 (1): e8479  

Research areas: tuberculosis

Mathematical models of the epidemiology and control of drug-resistant TB

Cohen T, Dye C, Colijn C, Williams B, Murray M......

Recent reports of extensively drug-resistant TB in South Africa have renewed concerns that antibiotic resistance may undermine progress in TB control. We review three major questions for which mathematical models elucidate the epidemiology and contro... (more »).

Expert Rev. Resp. Med.   2009 Jan. 3 (1): 61-69  

Research areas: tuberculosis

Latent coinfection and maintenance of strain diversity

Colijn C, Cohen T, Murray M.

Technologies for strain differentiation and typing have made it possible to detect genetic diversity of pathogens, both within individual hosts and within communities. Coinfection of a host by more than one pathogen strain may affect the r... (more »).

Bull Math Biol.   2008 Dec. 71 (1): 247-263  

Integrated analysis of respiratory diseases and risk factors in China: the effects of smoking and solid fuel use on COPD, lung cancer, and tuberculosis

Lin H, Murray M, Cohen T, Colijn C, Ezzati M....

Chronic obstructive pulmonary disease (COPD), lung cancer, and tuberculosis are three leading causes of death in China, where prevalences of smoking and solid-fuel use are also high. We aimed to predict the effects of risk-factor trends on COPD, lung... (more »).

Lancet   2008 Sep. 372 (9648): 1473-1483  

Research areas: tuberculosis

Modeling the effects of strain diversity and mechanisms of strain competition on the potential performance of new tuberculosis vaccines

Cohen T, Colijn C, Murray M...

While bacillus Calmette-Guérin vaccination plays an important role in reducing the morbidity of tuberculosis (TB) infection during childhood, new tuberculosis vaccines are necessary to disrupt the transmission of disease and improve global con... (more »).

Proceedings of the National Academy of Sciences   2008 Sep. 105 (42): 16302-16307  

Research areas: tuberculosis

Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies

Jeon CY, Murray M....

BACKGROUND: Several studies have suggested that diabetes mellitus (DM) increases the risk of active tuberculosis (TB). The rising prevalence of DM in TB-endemic areas may adversely affect TB control. We conducted a systematic review and a meta-analys... (more »).

PLos Med   2008 Jun. 5 (7): e1512-  

Research areas: tuberculosis

Challenges in estimating the total burden of drug-resistant tuberculosis

Cohen T, Colijn C, Wright A, Zignol M, Pym A, Murray M.......

The International Union Against Tuberculosis and Lung Disease/World Health Organization Global Proect on Anti-Tuberculosis Drug Resistance Surveillance recently released the fourth global survey, which documents the highest burden of multidrug-resi... (more »).

Am J Respir Crit Care Med.   2008 May. 177 (12): 1302-1306  

Research areas: tuberculosis

Are survey based estimates of the burden of drug resistant TB too low?: insight from a simulation study

Cohen T, Colijn C, Finklea B, Wright A, Zignol M, Pym A, Murray M....

The emergence of tuberculosis resistant to multiple first- and second-line antibiotics poses challenges to a global control strategy that relies on standard drug treatment regimens. Highly drug-resistant strains of Mycobacterium tuberculosis have bee... (more »).

PLoS ONE   2008 May. 3 (6): e2363-  

Research areas: tuberculosis

Emergent heterogeneity in declining tuberculosis epidemics

Colijn C, Cohen T, Murray M....

Tuberculosis is a disease of global importance: over 2 million deaths are attributed to this infectious disease each year. Even in areas where tuberculosis is in decline, there are sporadic outbreaks which are often attributed either to increased hos... (more »).

J Theor Biol.   2007 Jul. 247 (4): 765-774   10.1016/j.jtbi.2007.04.015

Research areas: tuberculosis

Exogenous re-infection and the dynamics of tuberculosis epidemics: local effects in a network model of transmission

Cohen T, Colijn C, Finklea B, Murray M.....

Infection with Mycobacterium tuberculosis leads to tuberculosis (TB) disease by one of the three possible routes: primary progression after a recent infection; re-activation of a latent infection; or exogenous re-infection of a previously infected in... (more »).

J R Soc Interface   2007 May. 4 (14): 523-531  

Research areas: tuberculosis

Antiviral resistance and the control of pandemic influenza

Lipsitch M, Cohen T, Murray M, Levin BR...

The response to the next influenza pandemic will likely include extensive use of antiviral drugs (mainly oseltamivir), combined with other transmission-reducing measures. Animal and in vitro studies suggest that some strains of influenza may become r... (more »).

Public Library of Science (PLoS) Medicine   2006 Dec. 4 (1): e15-  

Research areas: influenza

Beneficial and perverse effects of isoniazid preventive therapy for latent tuberculosis infection in HIV-TB co-infected populations

Cohen T, Lipsitch M, Walensky R, Murray M...

In sub-Saharan Africa, where the emergence of HIV has caused dramatic increases in tuberculosis (TB) case notifications, new strategies for TB control are necessary. Isoniazid preventive therapy (IPT) for HIV-TB coinfected individuals reduces the rea... (more »).

Proceedings of the National Academy of Sciences of the United States of America   2006 Apr. 103 (18): 7042-7047  

Research areas: tuberculosis

Cost-effectiveness of alternative blood screening strategies for West Nile virus in the United States

Korves C, Goldie S, Murray M.

Background West Nile virus (WNV) is endemic in the US, varying seasonally and by geographic region. WNV can be transmitted by blood transfusion, and mandatory screening of blood for WNV was recently introduced throughout the US. Guidelines for select... (more »).

PLoS Med.   2005 Dec. 3 (2): e21 0211-e21 0221  

Modeling epidemics of multidrug-resistant M. tuberculosis of heterogeneous fitness

Cohen T, Murray M.

Mathematical models have recently been used to predict the future burden of multidrug-resistant tuberculosis (MDRTB). These models suggest the threat of multidrug resistance to TB control will depend on the relative 'fitness' of MDR strains and imply... (more »).

Nat Med.   2004 Sep. 10 (10): 1117-1121  

Research areas: tuberculosis

Isoniazid resistance and the future of drug-resistant tuberculosis

Cohen T, Becerra MC, Murray MB...

Bacterial chromosomal mutations that confer antibiotic resistance often have deleterious effects that impose costs on reproductive fitness. This observation has led to the generalization that in the absence of the selection pressure exerted through t... (more »).

Microb Drug Resist.   2003 Dec. 10 (4): 280-285  

Research areas: tuberculosis

Transmission dynamics and control of severe acute respiratory syndrome

Lipsitch M, Cohen T, Cooper B, Robins JM, Ma S, James L, Gopalakrishna G, Chew SK, Tan CC, Samore MH, Fisman D, Murray M.

Severe acute respiratory syndrome (SARS) is a recently described illness of humans that has spread widely over the past 6 months. With the use of detailed epidemiologic data from Singapore and ep... (more »).

Science   2003 May. 300 (5627): 1966-1970  

The effect of drug resistance on the fitness of Mycobacterium tuberculosis

Cohen T, Sommers B, Murray M

Mycobacterium tuberculosis remains a leading infectious cause of morbidity and mortality. While antibiotic resistance is cited as a potential threat to efforts aimed at controlling the spread of this pathogen, it is not clear how drug resistance affe... (more »).

Lancet Infect Dis   2002 Dec. 3 13-21  

Research areas: tuberculosis

Molecular epidemiology and the dynamics of tuberculosis transmission among foreign-born people

Murray M.

As incidence rates of tuberculosis fall in wealthy countries and rise in at least some poorer countries, it is not surprising that much of tuberculosis in Canada and the United States occurs in foreign-born people. The high risk of tuberculosis in im... (more »).

CMAJ   2002 Jul. 167 (4): 355-356  

Research areas: tuberculosis

Sampling bias in the molecular epidemiology of tuberculosis

Murray M.

Among the goals of the molecular epidemiology of infectious disease are to quantify the extent of ongoing transmission of infectious agents and to identify host- and strain-specific risk factors for disease spread. I demonstrate the potential bias in... (more »).

Emerging Infectious Diseases   2002 Mar. 8 (4): 363-369  

Research areas: tuberculosis

Methodological problems in the molecular epidemiology of tuberculosis

Murray MB, Alland D.

In systematic studies of the molecular epidemiology of tuberculosis, DNA fingerprinting is used to estimate the fraction of incident cases attributable to recent transmission of Mycobacterium tuberculosis rather than reactivation disease and to ident... (more »).

Am. J. Epidemiol.   2002 Feb. 155 (6): 565-571  

Research areas: tuberculosis

Determinants of cluster distribution in the molecular epidemiology of tuberculosis

Murray M.

Recently developed molecular techniques have revolutionized the epidemiology of tuberculosis. Multiple studies have used these tools to examine the population structure of Mycobacterium tuberculosis isolates in different communities. The distribut... (more »).

Proceedings of the National Academy of Sciences   2002 Jan. 5 (99): 1538-43  

Research areas: tuberculosis

Incident tuberculosis among recent US immigrants and exogenous reinfection

Cohen T, Murray M.

Mathematical models and molecular epidemiologic investigation support the argument that exogenous reinfection plays an important role in tuberculosis transmission in high-incidence regions. We offer additional data from tuberculosis cases among recen... (more »).

Emerg Infect Dis.   -1 Nov. 11 (5): 725-728  

Research areas: tuberculosis

EPI 501 Dynamics of Infectious Diseases

Instructor(s): Megan Murray

Term: Fall 2