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Cancino-Muñoz I, López MG, Torres-Puente M, Villamayor LM, Borrás R, Borrás-Máñez M, Bosque M, Camarena JJ, Colijn C, Colomer-Roig E, Colomina J, Escribano I, Esparcia-Rodríguez O, García-García F, Gil-Brusola A, Gimeno C, Gimeno-Gascón A, Gomila-Sard B, Gónzales-Granda D, Gonzalo-Jiménez N, Guna-Serrano MR, López-Hontangas JL, Martín-González C, Moreno-Muñoz R, Navarro D, Navarro M, Orta N, Pérez E, Prat J, Rodríguez JC, Ruiz-García MM, Vanaclocha H, Comas I. Population-based sequencing of Mycobacterium tuberculosis reveals how current population dynamics are shaped by past epidemics. eLife 2022; 11:76605. [PMID: 35880398 PMCID: PMC9323001 DOI: 10.7554/elife.76605] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Transmission is a driver of tuberculosis (TB) epidemics in high-burden regions, with assumed negligible impact in low-burden areas. However, we still lack a full characterization of transmission dynamics in settings with similar and different burdens. Genomic epidemiology can greatly help to quantify transmission, but the lack of whole genome sequencing population-based studies has hampered its application. Here, we generate a population-based dataset from Valencia region and compare it with available datasets from different TB-burden settings to reveal transmission dynamics heterogeneity and its public health implications. We sequenced the whole genome of 785 Mycobacterium tuberculosis strains and linked genomes to patient epidemiological data. We use a pairwise distance clustering approach and phylodynamic methods to characterize transmission events over the last 150 years, in different TB-burden regions. Our results underscore significant differences in transmission between low-burden TB settings, i.e., clustering in Valencia region is higher (47.4%) than in Oxfordshire (27%), and similar to a high-burden area as Malawi (49.8%). By modeling times of the transmission links, we observed that settings with high transmission rate are associated with decades of uninterrupted transmission, irrespective of burden. Together, our results reveal that burden and transmission are not necessarily linked due to the role of past epidemics in the ongoing TB incidence, and highlight the need for in-depth characterization of transmission dynamics and specifically tailored TB control strategies.
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Affiliation(s)
- Irving Cancino-Muñoz
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain
| | - Mariana G López
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain
| | - Manuela Torres-Puente
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain
| | - Luis M Villamayor
- Unidad Mixta "Infección y Salud Pública" (FISABIO-CSISP), Valencia, Spain
| | - Rafael Borrás
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
| | - María Borrás-Máñez
- Microbiology and Parasitology Service, Hospital Universitario de La Ribera, Alzira, Spain
| | | | - Juan J Camarena
- Microbiology Service, Hospital Universitario Dr Peset, Valencia, Spain
| | - Caroline Colijn
- Department of Mathematics, Faculty of Science, Simon Fraser University, Burnaby, Canada
| | - Ester Colomer-Roig
- Unidad Mixta "Infección y Salud Pública" (FISABIO-CSISP), Valencia, Spain.,Microbiology Service, Hospital Universitario Dr Peset, Valencia, Spain
| | - Javier Colomina
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
| | - Isabel Escribano
- Microbiology Laboratory, Hospital Virgen de los Lirios, Alcoy, Spain
| | | | | | - Ana Gil-Brusola
- Microbiology Service, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Concepción Gimeno
- Microbiology Service, Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Bárbara Gomila-Sard
- Microbiology Service, Hospital General Universitario de Castellón, Castellón, Spain
| | | | | | | | | | - Coral Martín-González
- Microbiology Service, Hospital Universitario de San Juan de Alicante, Alicantes, Spain
| | - Rosario Moreno-Muñoz
- Microbiology Service, Hospital General Universitario de Castellón, Castellón, Spain
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
| | - María Navarro
- Microbiology Service, Hospital de la Vega Baixa, Orihuela, Spain
| | - Nieves Orta
- Microbiology Service, Hospital Universitario de San Juan de Alicante, Alicantes, Spain
| | - Elvira Pérez
- Subdirección General de Epidemiología y Vigilancia de la Salud y Sanidad Ambiental de Valencia (DGSP), Valencia, Spain
| | - Josep Prat
- Microbiology Service, Hospital de Sagunto, Sagunto, Spain
| | | | | | - Hermelinda Vanaclocha
- Subdirección General de Epidemiología y Vigilancia de la Salud y Sanidad Ambiental de Valencia (DGSP), Valencia, Spain
| | | | - Iñaki Comas
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Nordholm AC, Andersen AB, Wejse C, Norman A, Ekstrøm CT, Andersen PH, Koch A, Lillebaek T. Social determinants of tuberculosis: a nationwide case-control study, Denmark, 1990-2018. Int J Epidemiol 2022; 51:1446-1456. [PMID: 35595514 DOI: 10.1093/ije/dyac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The global vision is a world free of tuberculosis (TB). Even in resource-rich TB low-incidence settings, we need more focus on the role of social risk factors to end the TB epidemic. METHODS Nationwide, retrospective register-based, case-control study from 1990 to 2018, including all TB patients in Denmark ≥18 years old (n = 9581) matched 1:3 on sex and age with population controls. TB risk factors were assessed in logistic regression models and estimated by odds ratio (OR). RESULTS All TB patients had considerably lower socio-economic status compared with controls (P < 0.0001). Among ethnic Danes, TB was mostly found among males, persons between 35 and 65 years, those living alone, those with low educational level, persons on social welfare benefits and those with low income. Conversely, for migrants, being younger, sex and living alone were less important, whereas having children was protective. In an adjusted multivariable regression model among Danes, key risk factors for TB were being on disability pension (OR = 2.7) and cash benefits (OR = 4.7). For migrants, fewer social risk factors increased TB risk, although low income and cash benefits did (OR = 3.1). CONCLUSION Even today in a resourceful setting, socio-economic status drives disparities in health. In our study, multifactorial social deprivation was highly associated with TB. Especially household structure, education, employment and income were important risk factors that should be addressed in the future to accelerate TB control and end the TB epidemic.
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Affiliation(s)
- Anne Christine Nordholm
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Aase Bengaard Andersen
- Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark
| | - Anders Norman
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Peter Henrik Andersen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Anders Koch
- Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark.,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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3
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Jørgensen A, Bjørn-Mortensen K, Graff Jensen S, Sloth Andersen E, Ravn P. Prevalence of hepatitis B and C at a major tuberculosis centre in Denmark. Infect Dis (Lond) 2021; 53:196-200. [PMID: 33406978 DOI: 10.1080/23744235.2020.1865562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Denmark is a low-prevalence country for tuberculosis (TB), hepatitis B (HBV), and hepatitis C (HCV) but the three diseases have similar sociodemographic risk factors. We estimated the prevalence and possible risk factors of HBV and HCV among TB-patients in a large TB clinic in Denmark. METHODS All patients starting anti-TB-treatment at Copenhagen University Hospital, Herlev-Gentofte from April 1st 2018 through June 1st 2019 were included. Results from HBV and HCV testing as well as sociodemographic information were collected. Risk factor analyses were carried out using descriptive statistics. RESULTS Of 82 patients tested for HBV, one (1.2%) had chronic HBV and 16 (19.5%) had serocleared HBV. Of 91 patients tested for HCV, three (3.3%) had chronic HCV and one (1.1%) had serocleared HCV. Country of origin other than Denmark was significantly associated with HBV-seropositivity among TB-patients, particularly patients from Greenland, Asia, Africa and Eastern Europe. No other significantly associated risk factors were found. CONCLUSION The prevalences of chronic and prior HBV and HCV among TB-patients were lower compared to studies in TB high endemic areas but higher than those found in the Danish background population. We calculated the number needed to test to find one patient with HBV ranged between 27 and 83 and we suggest continuing screening of chronic HBV and HCV in TB-patients in Denmark.
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Affiliation(s)
- Anja Jørgensen
- Department of Medicine, Unit of Infectious Diseases, Copenhagen University Hospitals Herlev and Gentofte, Herlev and Gentofte, Denmark.,International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Karen Bjørn-Mortensen
- Department of Medicine, Unit of Infectious Diseases, Copenhagen University Hospitals Herlev and Gentofte, Herlev and Gentofte, Denmark
| | - Sidse Graff Jensen
- Department of Medicine, Unit of Respiratory Medicine, Copenhagen University Hospitals Herlev and Gentofte, Herlev and Gentofte, Denmark
| | - Ellen Sloth Andersen
- Department of Medicine, Unit of Infectious Diseases, Copenhagen University Hospitals Herlev and Gentofte, Herlev and Gentofte, Denmark
| | - Pernille Ravn
- Department of Medicine, Unit of Infectious Diseases, Copenhagen University Hospitals Herlev and Gentofte, Herlev and Gentofte, Denmark
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Winter JR, Smith CJ, Davidson JA, Lalor MK, Delpech V, Abubakar I, Stagg HR. The impact of HIV infection on tuberculosis transmission in a country with low tuberculosis incidence: a national retrospective study using molecular epidemiology. BMC Med 2020; 18:385. [PMID: 33308204 PMCID: PMC7734856 DOI: 10.1186/s12916-020-01849-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV is known to increase the likelihood of reactivation of latent tuberculosis to active TB disease; however, its impact on tuberculosis infectiousness and consequent transmission is unclear, particularly in low-incidence settings. METHODS National surveillance data from England, Wales and Northern Ireland on tuberculosis cases in adults from 2010 to 2014, strain typed using 24-locus mycobacterial-interspersed-repetitive-units-variable-number-tandem-repeats was used retrospectively to identify clusters of tuberculosis cases, subdivided into 'first' and 'subsequent' cases. Firstly, we used zero-inflated Poisson regression models to examine the association between HIV status and the number of subsequent clustered cases (a surrogate for tuberculosis infectiousness) in a strain type cluster. Secondly, we used logistic regression to examine the association between HIV status and the likelihood of being a subsequent case in a cluster (a surrogate for recent acquisition of tuberculosis infection) compared to the first case or a non-clustered case (a surrogate for reactivation of latent infection). RESULTS We included 18,864 strain-typed cases, 2238 were the first cases of clusters and 8471 were subsequent cases. Seven hundred and fifty-nine (4%) were HIV-positive. Outcome 1: HIV-positive pulmonary tuberculosis cases who were the first in a cluster had fewer subsequent cases associated with them (mean 0.6, multivariable incidence rate ratio [IRR] 0.75 [0.65-0.86]) than those HIV-negative (mean 1.1). Extra-pulmonary tuberculosis (EPTB) cases with HIV were less likely to be the first case in a cluster compared to HIV-negative EPTB cases. EPTB cases who were the first case had a higher mean number of subsequent cases (mean 2.5, IRR (3.62 [3.12-4.19]) than those HIV-negative (mean 0.6). Outcome 2: tuberculosis cases with HIV co-infection were less likely to be a subsequent case in a cluster (odds ratio 0.82 [0.69-0.98]), compared to being the first or a non-clustered case. CONCLUSIONS Outcome 1: pulmonary tuberculosis-HIV patients were less infectious than those without HIV. EPTB patients with HIV who were the first case in a cluster had a higher number of subsequent cases and thus may be markers of other undetected cases, discoverable by contact investigations. Outcome 2: tuberculosis in HIV-positive individuals was more likely due to reactivation than recent infection, compared to those who were HIV-negative.
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Affiliation(s)
- Joanne R Winter
- Institute for Global Health, University College London, London, UK
| | - Colette J Smith
- Institute for Global Health, University College London, London, UK
| | - Jennifer A Davidson
- Tuberculosis Unit, National Infection Service, Public Health England, London, UK
| | - Maeve K Lalor
- Tuberculosis Unit, National Infection Service, Public Health England, London, UK
| | - Valerie Delpech
- HIV Unit, National Infection Service, Public Health England, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK.
| | - Helen R Stagg
- Institute for Global Health, University College London, London, UK.,Usher Institute, University of Edinburgh, Edinburgh, UK
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Abascal E, Pérez-Lago L, Martínez-Lirola M, Chiner-Oms Á, Herranz M, Chaoui I, Comas I, El Messaoudi MD, Cárdenas JAG, Santantón S, Bouza E, García-de-Viedma D. Whole genome sequencing-based analysis of tuberculosis (TB) in migrants: rapid tools for cross-border surveillance and to distinguish between recent transmission in the host country and new importations. ACTA ACUST UNITED AC 2020; 24. [PMID: 30696526 PMCID: PMC6351995 DOI: 10.2807/1560-7917.es.2019.24.4.1800005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The analysis of transmission of tuberculosis (TB) is challenging in areas with a large migrant population. Standard genotyping may fail to differentiate transmission within the host country from new importations, which is key from an epidemiological perspective. Aim To propose a new strategy to simplify and optimise cross-border surveillance of tuberculosis and to distinguish between recent transmission in the host country and new importations Methods We selected 10 clusters, defined by 24-locus mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR), from a population in Spain rich in migrants from eastern Europe, north Africa and west Africa and reanalysed 66 isolates by whole-genome sequencing (WGS). A multiplex-allele-specific PCR was designed to target strain-specific marker single nucleotide polymorphisms (SNPs), identified from WGS data, to optimise the surveillance of the most complex cluster. Results In five of 10 clusters not all isolates showed the short genetic distances expected for recent transmission and revealed a higher number of SNPs, thus suggesting independent importations of prevalent strains in the country of origin. In the most complex cluster, rich in Moroccan cases, a multiplex allele-specific oligonucleotide-PCR (ASO-PCR) targeting the marker SNPs for the transmission subcluster enabled us to prospectively identify new secondary cases. The ASO-PCR-based strategy was transferred and applied in Morocco, demonstrating that the strain was prevalent in the country. Conclusion We provide a new model for optimising the analysis of cross-border surveillance of TB transmission in the scenario of global migration.
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Affiliation(s)
- Estefanía Abascal
- These authors have contributed equally.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Laura Pérez-Lago
- These authors have contributed equally.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Álvaro Chiner-Oms
- Unidad Mixta Genómica y Salud, Centro Superior de Investigación en Salud Pública (FISABIO)-Universitat de València, Valencia, Spain
| | - Marta Herranz
- CIBER Enfermedades respiratorias (CIBERES), Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Imane Chaoui
- Unité de Biologie et Recherches Médicales, Division des Sciences du Vivant, Centre National de l'Energie, des Sciences et des Techniques Nucléaires (CNESTEN), Rabat, Morocco
| | - Iñaki Comas
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Instituto de Biomedicina de Valencia (IBV) Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain
| | | | | | - Sheila Santantón
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,CIBER Enfermedades respiratorias (CIBERES), Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Darío García-de-Viedma
- CIBER Enfermedades respiratorias (CIBERES), Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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6
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Mathiasen VD, Eiset AH, Andersen PH, Wejse C, Lillebaek T. Epidemiology of tuberculous lymphadenitis in Denmark: A nationwide register-based study. PLoS One 2019; 14:e0221232. [PMID: 31415659 PMCID: PMC6695100 DOI: 10.1371/journal.pone.0221232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background Tuberculous lymphadenitis (TBLA) is the most common extrapulmonary manifestation of tuberculosis (TB), often claimed to be reactivation. We aimed to describe the epidemiology of TBLA in Denmark, as it has not previously been investigated specifically although extrapulmonary TB has been associated with an increased long-term mortality and delays in the diagnosis. Methods Register-based study of all patients notified with TBLA in Denmark from 2007 through 2016 utilizing six different nationwide registers. Patients were identified through the national TB surveillance register, and the diagnosis evaluated based on microbiology, pathology and/or clinical assessment. Results In total, 13.5% (n = 489) of all TB patients in Denmark had TBLA with annual proportions from 9.4 to 15.7%. Most patients were immigrants between 25–44 years. Incidence rates ranged from as high as 1,014/100,000 for Nepalese citizens to as a low as 0.06/100,000 for Danes. Danes had a significant higher median age and significant more risk factors and comorbidities, as well as an increased overall mortality, compared with immigrants (p<0.05). A significant and much higher proportion of unique MIRU-VNTR genotypes were seen among TBLA patients compared to other TB manifestations. Conclusion In Denmark, TBLA is a common manifestation of TB, especially in young immigrants from high-incidence countries. In Danes, it is a rare disease manifestation and associated with higher morbidity and mortality. To our knowledge, this is the first study suggesting that TBLA is predominantly associated with reactivation of latent TB infection based on genotyping although this remains to be clarified.
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Affiliation(s)
- Victor Dahl Mathiasen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Andreas Halgreen Eiset
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Henrik Andersen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
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Guthrie JL, Ronald LA, Cook VJ, Johnston J, Gardy JL. The problem with defining foreign birth as a risk factor in tuberculosis epidemiology studies. PLoS One 2019; 14:e0216271. [PMID: 31039191 PMCID: PMC6490926 DOI: 10.1371/journal.pone.0216271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/17/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine how stratifying persons born outside Canada according to tuberculosis (TB) incidence in their birth country and other demographic factors refines our understanding of TB epidemiology and local TB transmission. BACKGROUND Population-level TB surveillance programs and research studies in low incidence settings often report all persons born outside the country in which the study is conducted as "foreign-born"-a single label for a highly diverse population with variable TB risks. This may mask important TB epidemiologic trends and not accurately reflect local transmission patterns. METHODS We used population-level data from two large cohorts in British Columbia (BC), Canada: an immigration cohort (n = 337,492 permanent residents to BC) and a genotyping cohort (n = 2290 culture-confirmed active TB cases). We stratified active TB case counts, incidence rates, and genotypic clustering (an indicator of TB transmission) in BC by birth country TB incidence, age at immigration, and years since arrival. RESULTS Persons from high-incidence countries had a 12-fold higher TB incidence than those emigrating from low-incidence settings. Estimates of local transmission, as captured by genotyping, versus reactivation of latent TB infection acquired outside Canada varied when data were stratified by birthplace TB incidence, as did patient-level characteristics of individuals in each group, such as age and years between immigration and diagnosis. CONCLUSION Categorizing persons beyond simply "foreign-born", particularly in the context of TB epidemiologic and molecular data, is needed for a more accurate understanding of TB rates and patterns of transmission.
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Affiliation(s)
- Jennifer L. Guthrie
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lisa A. Ronald
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Victoria J. Cook
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - James Johnston
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jennifer L. Gardy
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
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8
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Nordholm AC, Holm LL, Svensson E, Andersen PH, Johansen IS. Tuberculosis Transmission in Danish Children: A Nationwide Register-based Study. Pediatr Infect Dis J 2019; 38:340-343. [PMID: 30882721 DOI: 10.1097/inf.0000000000002139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tuberculosis (TB) remains a major public health issue among children worldwide. Data on TB transmission in children living in low-incidence countries is limited. METHODS We studied TB transmission in ethnic Danish children younger than 15 years of age between 2000 and 2013. Identification of children with TB disease and information on demographics and TB contacts were retrieved from the national TB surveillance register and the International Reference Laboratory of Mycobacteriology. RESULTS In total, 88 children with TB disease were identified in the study period, corresponding to a mean annual incidence of 6.9 per 1,000,000 children younger than 15 years of age. The male to female ratio was 1.3. Median age was 5 years (interquartile range, 3-8.5). Seventy-three (83%) children had a known TB contact of which 60% was among household contacts with recent TB, predominantly parents. Sixty-six (75%) children were classified as part of epidemiologic clusters. Thirty-five (40%) children had culture verified TB of which information on genotypes was available for 34 (97%). Of these, 35% belonged to cluster C2/1112-15, the most prevalent cluster among adult Danes. CONCLUSIONS We found on-going TB transmission in Danish children within the households of a low TB incidence population. These findings emphasize the need for early diagnosis of TB in children, thorough contact tracing and increased focus on risk groups.
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Affiliation(s)
- Anne Christine Nordholm
- From the Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet
- Department of Infectious Diseases, Odense University Hospital
| | | | - Erik Svensson
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Peter H Andersen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
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Sanchini A, Andrés M, Fiebig L, Albrecht S, Hauer B, Haas W. Assessment of the use and need for an integrated molecular surveillance of tuberculosis: an online survey in Germany. BMC Public Health 2019; 19:321. [PMID: 30885160 PMCID: PMC6423790 DOI: 10.1186/s12889-019-6631-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background The implementation of an integrated molecular surveillance (IMS) of tuberculosis (TB) is of high priority for TB control. IMS is defined as the systematic inclusion of molecular typing results in the national TB surveillance system. Although not standardized, an IMS of TB is already implemented in several low TB incidence countries. Germany is in the process of implementing a nationwide IMS of TB. This requires close collaboration between national and local health authorities. We conducted an online survey to understand the current use of molecular typing results for TB surveillance among the local public health offices (PHO)s in Germany, and to collect their perception and expectations towards the implementation of a nationwide IMS of TB. Methods The online survey was developed using the software Voxco and included 31 questions. The survey was sent to all the 377 local PHOs in Germany in April 2017. Responses were collected until June 2017. Results A total of 174/377 (46.2%) local PHOs participated in our survey, and 88/377 (23.3%) used molecular typing results in their routine TB surveillance work. The PHOs used molecular typing results especially as support for epidemiological contact tracing (62/88, 70.4%). We found statistically significant differences between answers of PHOs that did not use molecular typing results (n = 86) vs. PHOs that did use molecular typing results (n = 88): the latter perceived the use of molecular typing results as more beneficial for their work compared to the former (65.9% vs. 34.9%, p < 0.05). Moreover, the PHOs using molecular typing results expect for the future more support and coordination from regional and national public health institutes, especially regarding the identification and analysis of molecular clusters. Conclusions Our study is a step forward in the broader goal of implementing an IMS of TB in Germany. The local PHOs currently using the molecular typing results highlighted their positive attitude towards the implementation of an IMS, but also their needs of more support. Similar assessments might serve as an example for other countries which are on the way to implement a nationwide IMS of TB. Electronic supplementary material The online version of this article (10.1186/s12889-019-6631-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Sanchini
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany.
| | - Marta Andrés
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany.,Current address: Ear Institute, University College London, London, UK
| | - Lena Fiebig
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany.,Current address: Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling - APOPO, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Stefan Albrecht
- Department for Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Barbara Hauer
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany
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10
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Davidson JA, Thomas HL, Maguire H, Brown T, Burkitt A, Macdonald N, Campbell CNJ, Lalor MK. Understanding Tuberculosis Transmission in the United Kingdom: Findings From 6 Years of Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeats Strain Typing, 2010-2015. Am J Epidemiol 2018; 187:2233-2242. [PMID: 29878041 DOI: 10.1093/aje/kwy119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/04/2018] [Indexed: 11/14/2022] Open
Abstract
Genotyping provides the opportunity to better understand tuberculosis (TB) transmission. We utilized strain typing data to assess trends in the proportion of clustering and identify the characteristics of individuals and clusters associated with recent United Kingdom (UK) transmission. In this retrospective cohort analysis, we included all culture-confirmed strain-typed TB notifications from the UK between 2010 and 2015 to estimate the proportion of patients that clustered over time. We explored the characteristics of patients in a cluster using multivariable logistic regression. Overall, 58.5% of TB patients were concentrated in 2,701 clusters. The proportion of patients in a cluster decreased between 2010 (58.7%) and 2015 (55.3%) (P = 0.001). Being a clustered patient was associated with being male and UK-born, having pulmonary disease, having a previous TB diagnosis, and having a history of drug misuse or imprisonment. Our results suggest that TB transmission in the UK decreased between 2010 and 2015, during which time TB incidence also decreased. Targeted cluster investigation and extended contact tracing should be aimed at persons at risk of being in a transmission chain, including UK-born individuals with social risk factors in clusters with a high proportion of patients having pulmonary disease.
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Affiliation(s)
- Jennifer A Davidson
- Tuberculosis Unit, National Infection Service, Public Health England, London, United Kingdom
| | - H Lucy Thomas
- Tuberculosis Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Helen Maguire
- Field Service, National Infection Service, Public Health England, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Timothy Brown
- National Mycobacterium Reference Service South, National Infection Service, Public Health England, London, United Kingdom
| | - Andy Burkitt
- Field Service, National Infection Service, Public Health England, Newcastle, United Kingdom
| | - Neil Macdonald
- Field Service, National Infection Service, Public Health England, London, United Kingdom
| | - Colin N J Campbell
- Tuberculosis Unit, National Infection Service, Public Health England, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Maeve K Lalor
- Tuberculosis Unit, National Infection Service, Public Health England, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
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11
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Folkvardsen DB, Norman A, Andersen ÅB, Rasmussen EM, Lillebaek T, Jelsbak L. A Major Mycobacterium tuberculosis outbreak caused by one specific genotype in a low-incidence country: Exploring gene profile virulence explanations. Sci Rep 2018; 8:11869. [PMID: 30089859 PMCID: PMC6082827 DOI: 10.1038/s41598-018-30363-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/10/2018] [Indexed: 12/30/2022] Open
Abstract
Denmark, a tuberculosis low burden country, still experiences significant active Mycobacterium tuberculosis (Mtb) transmission, especially with one specific genotype named Cluster 2/1112-15 (C2), the most prevalent lineage in Scandinavia. In addition to environmental factors, antibiotic resistance, and human genetics, there is increasing evidence that Mtb strain variation plays a role for the outcome of infection and disease. In this study, we explore the reasons for the success of the C2 genotype by analysing strain specific polymorphisms identified through whole genome sequencing of all C2 isolates identified in Denmark between 1992 and 2014 (n = 952), and the demographic distribution of C2. Of 234 non-synonymous (NS) monomorphic SNPs found in C2 in comparison with Mtb reference strain H37Rv, 23 were in genes previously reported to be involved in Mtb virulence. Of these 23 SNPs, three were specific for C2 including a NS mutation in a gene associated with hyper-virulence. We show that the genotype is readily transmitted to different ethnicities and is also found outside Denmark. Our data suggest that strain specific virulence factor variations are important for the success of the C2 genotype. These factors, likely in combination with poor TB control, seem to be the main drivers of C2 success.
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Affiliation(s)
- Dorte Bek Folkvardsen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
| | - Anders Norman
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Åse Bengård Andersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Research Unit for Infectious Diseases, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Erik Michael Rasmussen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Lars Jelsbak
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
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12
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Andrés M, Göhring-Zwacka E, Fiebig L, Priwitzer M, Richter E, Rüsch-Gerdes S, Haas W, Niemann S, Brodhun B. Integration of molecular typing results into tuberculosis surveillance in Germany-A pilot study. PLoS One 2017; 12:e0188356. [PMID: 29166403 PMCID: PMC5699808 DOI: 10.1371/journal.pone.0188356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022] Open
Abstract
An integrated molecular surveillance for tuberculosis (TB) improves the understanding of ongoing TB transmission by combining molecular typing and epidemiological data. However, the implementation of an integrated molecular surveillance for TB is complex and requires thoughtful consideration of feasibility, demand, public health benefits and legal issues. We aimed to pilot the integration of molecular typing results between 2008 and 2010 in the German Federal State of Baden-Württemberg (population 10.88 Million) as preparation for a nationwide implementation. Culture positive TB cases were typed by IS6110 DNA fingerprinting and results were integrated into routine notification data. Demographic and clinical characteristics of cases and clusters were described and new epidemiological links detected after integrating typing data were calculated. Furthermore, a cross-sectional survey was performed among local public health offices to evaluate their perception and experiences. Overall, typing results were available for 83% of notified culture positive TB cases, out of which 25% were clustered. Age <15 years (OR = 4.96, 95% CI: 1.69–14.55) and being born in Germany (OR = 2.01, 95% CI: 1.44–2.80) were associated with clustering. At cluster level, molecular typing information allowed the identification of previously unknown epidemiological links in 11% of the clusters. In 59% of the clusters it was not possible to identify any epidemiological link. Clusters extending over different counties were less likely to have epidemiological links identified among their cases (OR = 11.53, 95% CI: 3.48–98.23). The majority of local public health offices found molecular typing useful for their work. Our study illustrates the feasibility of integrating typing data into the German TB notification system and depicts its added public health value as complementary strategy in TB surveillance, especially to uncover transmission events among geographically separated TB patients. It also emphasizes that special efforts are required to strengthen the communication between local public health offices in different counties to enhance TB control.
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Affiliation(s)
- Marta Andrés
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- * E-mail:
| | - Elke Göhring-Zwacka
- State Health Department (Landesgesundheitsamt) Baden-Württemberg, Stuttgart, Germany
| | - Lena Fiebig
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Martin Priwitzer
- Local Public Health Office (Gesundheitsamt) Stuttgart, Stuttgart, Germany
| | | | - Sabine Rüsch-Gerdes
- National Reference Center (NRC) for Mycobacteria, Research Center Borstel, Borstel, Germany
| | - Walter Haas
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Stefan Niemann
- National Reference Center (NRC) for Mycobacteria, Research Center Borstel, Borstel, Germany
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Leibniz-Center for Medicine and Biosciences, Borstel, Germany
- German Center for Infection Research, Partner Site Hamburg-Borstel-Lübeck, Borstel, Germany
| | - Bonita Brodhun
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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13
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Pedersen MK, Lillebaek T, Andersen AB, Soini H, Haanperä M, Groenheit R, Jonsson J, Svensson E. Trends and differences in tuberculosis incidences and clustering among natives in Denmark, Sweden and Finland: comparison of native incidences and molecular epidemiology among three low-incidence countries. Clin Microbiol Infect 2017; 24:717-723. [PMID: 29031789 DOI: 10.1016/j.cmi.2017.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To compare the epidemiology of tuberculosis (TB) in Denmark, Sweden and Finland, by focusing on the native population in order to identify epidemiologic differences and thus indirectly possible differences in TB control. METHODS TB incidence trends from 1990 through 2015 were compared among the countries. In addition, for the periods 2012-2013 and 2014-2015, genotyping data were compared. Genotyping was performed using the 24-locus mycobacterial interspersed repetitive unit-variable number of tandem repeat (MIRU-VNTR) method in Denmark and Sweden. For Finland, spoligotyping in conjunction with the 15-locus MIRU-VNTR method was used for 2012-2013 and translated into the 24-locus MIRU-VNTR when feasible, and for 2014-2015 only MIRU-VNTR was used. Both incidence trends and molecular epidemiology were assessed for native cases. RESULTS The average annual rate of change in TB incidence for native Danes was -2.4% vs. -6.1% and -6.9% for native Swedes and Finns respectively. In 2012-2013 Denmark had 52 native cases in the largest transmission chain vs. three cases in Sweden and ten in Finland, and during the same period the clustering rate for native Danes was 48.8% vs. 6.5% and 18.2% for native Swedes and Finns respectively. For 2014-2015, a similar pattern was seen. CONCLUSIONS The decline of TB among natives in Denmark is slower than for Sweden and Finland, and it seems Denmark has more active transmission among natives. The focused assessment on basic native TB epidemiology reveals striking differences in TB transmission among otherwise similar low-TB-incidence countries.
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Affiliation(s)
- M K Pedersen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
| | - T Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - A B Andersen
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - H Soini
- National Institute for Health and Welfare (THL), Department of Health Security, Helsinki, Finland
| | - M Haanperä
- National Institute for Health and Welfare (THL), Department of Health Security, Helsinki, Finland
| | - R Groenheit
- Department of Microbiology, Public Health Agency of Sweden, Stockholm, Sweden
| | - J Jonsson
- Department of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden
| | - E Svensson
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
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14
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Folkvardsen DB, Norman A, Andersen ÅB, Michael Rasmussen E, Jelsbak L, Lillebaek T. Genomic Epidemiology of a Major Mycobacterium tuberculosis Outbreak: Retrospective Cohort Study in a Low-Incidence Setting Using Sparse Time-Series Sampling. J Infect Dis 2017; 216:366-374. [PMID: 28666374 DOI: 10.1093/infdis/jix298] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/20/2017] [Indexed: 11/14/2022] Open
Abstract
Since 1992, Denmark has documented the largest outbreak of tuberculosis in Scandinavia ascribed to a single genotype, termed C2/1112-15. As of spring 2017, the International Reference Laboratory of Mycobacteriology in Copenhagen has collected and identified isolates from more than a thousand cases belonging to this outbreak via routine mycobacterial interspersed repetitive units-variable number of tandem repeats typing. Here, we present a retrospective analysis of the C2/1112-15 dataset, based on whole-genome data from a sparse time series consisting of 5 randomly selected isolates from 23 years of sampling. Even if these data are derived from only 12% of the collected isolates, we have been able to extract important key information, such as mutation rate and conserved single-nucleotide polymorphisms to identify discrete transmission chains, as well as the possible historical origins of the outbreak.
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Affiliation(s)
- Dorte Bek Folkvardsen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen
| | - Anders Norman
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen.,Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby
| | - Åse Bengård Andersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet.,Research Unit for Infectious Diseases, Department of Clinical Research, University of Southern Denmark, Odense
| | - Erik Michael Rasmussen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen
| | - Lars Jelsbak
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen
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15
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Fløe A, Hilberg O, Wejse C, Ibsen R, Løkke A. Comorbidities, mortality and causes of death among patients with tuberculosis in Denmark 1998-2010: a nationwide, register-based case-control study. Thorax 2017; 73:70-77. [PMID: 28778918 DOI: 10.1136/thoraxjnl-2016-209240] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 05/19/2017] [Accepted: 07/10/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the impact of comorbidities, age and clinical presentation of TB on mortality among Danish patients with TB. METHODS Danish patients with an ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) diagnosis of TB in 1998-2010 were identified in the National Patient Registry and matched with controls (1:4) on age, gender, civil status and geography. Comorbid diagnoses up to 3 years before and after TB diagnosis or enrolment as control as well as survival data were obtained from national databases RESULTS: We included 8433 cases and 33 707 controls. Respiratory diseases were the most common comorbidities among cases (12.4% of cases, 3.8% of controls (p<0.001)). Overall HR of death was 2.45 (2.31; 2.59). Relative mortality was especially increased among younger adults (HR 8.70 (95% CI 5.53 to 13.69) among the 30 to 39-year-olds). While overall mortality increased with Deyo-Charlson comorbidity (DCC) score, relative mortality among cases was highest in the low-DCC group. Additionally, male gender, low income and central nervous system TB were risk factors for death among TB cases. The most common cause of death in both groups was non-lung cancers, among TB cases followed by COPD, TB and lung cancer, all being significantly more common among TB cases. CONCLUSION In Denmark, TB carries substantial mortality. Among those who die, 12% are reported to die from TB. A high relative mortality among younger adults underscores the importance of continually targeting high-risk TB groups in low-incidence countries.
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Affiliation(s)
- Andreas Fløe
- Department of Respiratory Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Hilberg
- Department of Respiratory Diseases, Sygehus Lillebaelt, Vejle, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark
| | | | - Anders Løkke
- Department of Respiratory Diseases, Aarhus University Hospital, Aarhus, Denmark
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16
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Chao WC, Chuang PC, Wu DH, Wu CL, Liu PY, Shieh CC, Jou R. Using genotyping to delineate tuberculosis transmission in long-term care facilities: single facility 4-year experience. BMC Infect Dis 2017; 17:421. [PMID: 28610564 PMCID: PMC5470217 DOI: 10.1186/s12879-017-2526-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 06/05/2017] [Indexed: 11/13/2022] Open
Abstract
Background Residents in long-term care facilities (LTCFs) are vulnerable to tuberculosis (TB) transmission; however, to delineate possible routes of TB transmission in LTCFs is difficult. This study aimed to address the use of regular genotyping surveillance to delineate TB transmission in LTCFs. Methods All of Mycobacterium tuberculosis isolates in the reported 620-bed LTCF between July 2011 and August 2015 were genotyped, and we retrospectively compared epidemiological data and genotyping results. Results A total of 42 subjects were diagnosed with culture-positive pulmonary TB infection during the 4-year period. Their median age was 76.5 years, and 64.3% (27/42) of them were male. Genotyping identified 5 clustered TB infections involving 76.2% (32/42) of all TB subjects. In a multivariate logistic regression model adjusted for age, sex, chronic obstructive pulmonary disease, and body mass index, subjects with clustered TB infection were less likely to be Activities of Daily Living (ADL)-dependence (adjOR 0.073, 95% CI 0.007–0.758) when compared with subjects having individual TB infections. Prolonged surveillance is essential given that the median interval to diagnose secondary subjects was 673 days. Finally, only 63.0% (17/27) of the 27 secondary TB subjects in this study had contact history with index subject in the same ward. Conclusions In conclusion, possible routes of TB transmission in a complex TB outbreak at LTCFs might be delineated by routine genotyping surveillance and regular health check-up. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2526-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wen-Cheng Chao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
| | - Pei-Chun Chuang
- Reference Laboratory of Mycobacteriology, Tuberculosis Research Center, Centers for Disease Control, No.6, Linsen S. Rd., Jhongjheng District, Taipei City, 10050, Taiwan
| | - Don-Han Wu
- Department of Internal Medicine, Taichung Veterans General Hospital Chiayi branch, Chiayi, Taiwan
| | - Chieh-Liang Wu
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Center for Quality Management, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Yu Liu
- Center for Quality Management, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chi-Chang Shieh
- Institute of Clinical Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
| | - Ruwen Jou
- Reference Laboratory of Mycobacteriology, Tuberculosis Research Center, Centers for Disease Control, No.6, Linsen S. Rd., Jhongjheng District, Taipei City, 10050, Taiwan. .,Institute of Microbiology and Immunology, National Yang-Ming University, Taipei, Taiwan.
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17
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Noppert GA, Yang Z, Clarke P, Ye W, Davidson P, Wilson ML. Individual- and neighborhood-level contextual factors are associated with Mycobacterium tuberculosis transmission: genotypic clustering of cases in Michigan, 2004-2012. Ann Epidemiol 2017; 27:371-376.e5. [PMID: 28571914 PMCID: PMC5583706 DOI: 10.1016/j.annepidem.2017.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/10/2017] [Accepted: 05/05/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE Using genotyping data of Mycobacterium tuberculosis isolates from new cases reported to the tuberculosis (TB) surveillance program, we evaluated risk factors for recent TB transmission at both the individual- and neighborhood- levels among U.S.-born and foreign-born populations. METHODS TB cases (N = 1236) reported in Michigan during 2004 to 2012 were analyzed using multivariable Poisson regression models to examine risk factors for recent transmission cross-sectionally for U.S.-born and foreign-born populations separately. Recent transmission was defined based on spoligotype and 12-locus-mycobacterial interspersed repetitive unit-variable number tandem repeat typing matches of bacteria from cases that were diagnosed within 1 year of each other. Four classes of predictor variables were examined: demographic factors, known TB risk factors, clinical characteristics, and neighborhood-level factors. RESULTS Overall, 22% of the foreign-born cases resulted from recent transmission. Among the foreign-born, race and being a contact of an infectious TB case were significant predictors of recent transmission. More than half (52%) of U.S.-born cases resulted from recent transmission. Among the U.S.-born, recent transmission was predicted by both individual- and neighborhood-level sociodemographic characteristics. CONCLUSIONS Interventions aimed at reducing TB incidence among foreign-born should focus on reducing reactivation of latent infection. However, reducing TB incidence among the U.S.-born will require decreasing transmission among socially disadvantaged groups at the individual- and neighborhood- levels. This report fills an important knowledge gap regarding the contemporary social context of TB in the United States, thereby providing a foundation for future studies of public health policies that can lead to the development of more targeted, effective TB control.
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Affiliation(s)
- Grace A Noppert
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
| | - Zhenhua Yang
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Philippa Clarke
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor; Institute for Social Research, University of Michigan, Ann Arbor
| | - Wen Ye
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Peter Davidson
- Michigan Department of Health and Human Services, Lansing, MI
| | - Mark L Wilson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
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18
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Roth D, Otterstatter M, Wong J, Cook V, Johnston J, Mak S. Identification of spatial and cohort clustering of tuberculosis using surveillance data from British Columbia, Canada, 1990-2013. Soc Sci Med 2016; 168:214-222. [PMID: 27389850 DOI: 10.1016/j.socscimed.2016.06.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/27/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
Since 2000, the global incidence of tuberculosis (TB) has decreased by 1.5% per year, becoming increasingly clustered in key subpopulations in low incidence settings. TB clustering can manifest spatially from recent transmission, or in non-spatial cohort clusters resulting from reactivation of latent infection in populations with shared risk factors. Identifying and interrupting disease clusters is required to eliminate TB in low incidence countries. Here we demonstrate an analytical approach for detecting both spatial and cohort clustering of TB among population subgroups, and describe the value in differentiating these forms of clustering. TB cases in British Columbia meeting the Canadian case definition were geocoded and mapped using Geographic Information Systems (GIS). Incidence rates were calculated for three periods (1990-1997, n = 2556; 1998-2005, n = 2488; 2006-2013, n = 2225) among Canadian born (CB) and foreign-born (FB) populations using denominator data from the Canadian Census. Spatial clusters were identified using a scanning window statistic (SaTScan) and overlaid on provincial incidence maps. Country of birth (cohort) clustering in the FB was identified using Lorenz curves and Gini coefficients. TB incidence in the CB population was generally low, but punctuated with few areas of high incidence; the spatial clusters identified in the CB match previously identified clusters. TB incidence in the FB did not show spatially localized clusters. However, Lorenz curves revealed substantial, and increasing, cohort clustering in the FB in semi-urban and rural regions of British Columbia, and less pronounced, and decreasing, clustering in urban regions. In general, the TB incidence in groups defined by country of birth shifted over time to become increasingly uniform across regions. Our approach, based on spatial analysis and the application of Lorenz curves revealed a complex coexistence of spatial and cohort clustering. Spatial and cohort clusters require differing public health responses, and differentiating types of clustering can inform TB prevention programs.
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Affiliation(s)
- David Roth
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada
| | - Michael Otterstatter
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Victoria Cook
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia V5Z 1M9, Canada
| | - James Johnston
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia V5Z 1M9, Canada
| | - Sunny Mak
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada.
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19
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Genomic Diversity of Mycobacterium tuberculosis Complex Strains in Cantabria (Spain), a Moderate TB Incidence Setting. PLoS One 2016; 11:e0157266. [PMID: 27315243 PMCID: PMC4912061 DOI: 10.1371/journal.pone.0157266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/26/2016] [Indexed: 12/02/2022] Open
Abstract
Background Tuberculosis (TB) control strategies are focused mainly on prevention, early diagnosis, compliance to treatment and contact tracing. The objectives of this study were to explore the frequency and risk factors of recent transmission of clinical isolates of Mycobacterium tuberculosis complex (MTBC) in Cantabria in Northern Spain from 2012 through 2013 and to analyze their clonal complexity for better understanding of the transmission dynamics in a moderate TB incidence setting. Methods DNA from 85 out of 87 isolates from bacteriologically confirmed cases of MTBC infection were extracted directly from frozen stocks and genotyped using the mycobacterial interspersed repetitive units-variable number tandem repeat (MIRU-VNTR) method. The MIRU-VNTRplus database tool was used to identify clusters and lineages and to build a neighbor joining (NJ) phylogenetic tree. In addition, data were compared to the SITVIT2 database at the Pasteur Institute of Guadeloupe. Results The rate of recent transmission was calculated to 24%. Clustering was associated with being Spanish-born. A high prevalence of isolates of the Euro-American lineage was found. In addition, MIRU-VNTR profiles of the studied isolates corresponded to previously found MIRU-VNTR types in other countries, including Spain, Belgium, Great Britain, USA, Croatia, South Africa and The Netherlands. Six of the strains analyzed represented clonal variants. Conclusion Transmission of MTBC is well controlled in Cantabria. The majority of TB patients were born in Spain. The population structure of MTBC in Cantabria has a low diversity of major clonal lineages with the Euro-American lineage predominating.
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20
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Standard Genotyping Overestimates Transmission of Mycobacterium tuberculosis among Immigrants in a Low-Incidence Country. J Clin Microbiol 2016; 54:1862-1870. [PMID: 27194683 DOI: 10.1128/jcm.00126-16] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/29/2016] [Indexed: 11/20/2022] Open
Abstract
Immigrants from regions with a high incidence of tuberculosis (TB) are a risk group for TB in low-incidence countries such as Switzerland. In a previous analysis of a nationwide collection of 520 Mycobacterium tuberculosis isolates from 2000 to 2008, we identified 35 clusters comprising 90 patients based on standard genotyping (24-locus mycobacterial interspersed repetitive-unit-variable-number tandem-repeat [MIRU-VNTR] typing and spoligotyping). Here, we used whole-genome sequencing (WGS) to revisit these transmission clusters. Genome-based transmission clusters were defined as isolate pairs separated by ≤12 single nucleotide polymorphisms (SNPs). WGS confirmed 17/35 (49%) MIRU-VNTR typing clusters; the other 18 clusters contained pairs separated by >12 SNPs. Most transmission clusters (3/4) of Swiss-born patients were confirmed by WGS, as opposed to 25% (4/16) of the clusters involving only foreign-born patients. The overall clustering proportion was 17% (90 patients; 95% confidence interval [CI], 14 to 21%) by standard genotyping but only 8% (43 patients; 95% CI, 6 to 11%) by WGS. The clustering proportion was 17% (67/401; 95% CI, 13 to 21%) by standard genotyping and 7% (26/401; 95% CI, 4 to 9%) by WGS among foreign-born patients and 19% (23/119; 95% CI, 13 to 28%) and 14% (17/119; 95% CI, 9 to 22%), respectively, among Swiss-born patients. Using weighted logistic regression, we found weak evidence of an association between birth origin and transmission (adjusted odds ratio of 2.2 and 95% CI of 0.9 to 5.5 comparing Swiss-born patients to others). In conclusion, standard genotyping overestimated recent TB transmission in Switzerland compared to WGS, particularly among immigrants from regions with a high TB incidence, where genetically closely related strains often predominate. We recommend the use of WGS to identify transmission clusters in settings with a low incidence of TB.
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Morbidity, Self-Perceived Health and Mortality Among non-Western Immigrants and Their Descendants in Denmark in a Life Phase Perspective. J Immigr Minor Health 2016; 19:448-476. [DOI: 10.1007/s10903-016-0347-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Lim LKY, Enarson DA, Reid AJ, Satyanarayana S, Cutter J, Kyi Win KM, Chee CBE, Wang YT. Notified tuberculosis among Singapore residents by ethnicity, 2002-2011. Public Health Action 2015; 3:311-6. [PMID: 26393053 DOI: 10.5588/pha.13.0055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 09/17/2013] [Indexed: 01/17/2023] Open
Abstract
SETTING The National Tuberculosis Programme in Singapore where, among resident cases, higher tuberculosis (TB) rates have been reported in ethnic Malays. OBJECTIVE To describe the socio-demographic and clinical characteristics of resident TB cases by ethnicity, and to assess whether Malays differ from other groups in terms of the above parameters. DESIGN Cross-sectional review of records from the tuberculosis registry's electronic database. RESULTS Among 15 622 resident cases notified, 72.2% were Chinese, 18.7% Malay, 5.8% Indian and 2.9% were from other minorities. Compared to other ethnicities, Malays were more likely to be incarcerated at the time of notification (odds ratio [OR] 3.70, 95%CI 3.03-4.52) and clustered at the same residential address (OR 1.65, 95%CI 1.44-1.89), but were less likely to be aged ≥65 years (OR 0.61, 95%CI 0.54-0.70) or to reside in high-cost housing (OR 0.11, 95%CI 0.07-0.17). In terms of disease characteristics, more Malays had diabetes mellitus (OR 1.54, 1.37-1.73), a highly-positive acid-fast bacilli smear (OR 1.64, 95%CI 1.47-1.83) and cavitary disease on chest X-ray (OR 1.41, 95%CI 1.28-1.55). CONCLUSION Compared to other ethnicities, reported TB cases among Malays were more severe and were likely to be more infectious. Increased vigilance in case management and contact investigations, as well as an improvement in the socio-economic conditions of this community, are required to reduce TB rates in this ethnic group.
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Affiliation(s)
- L K-Y Lim
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore
| | - D A Enarson
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A J Reid
- Operational Research Unit, Médecins Sans Frontières Operational Centre, Brussels, Luxembourg
| | | | - J Cutter
- Communicable Diseases Division, Ministry of Health, Singapore
| | - K M Kyi Win
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore
| | - C B-E Chee
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore
| | - Y T Wang
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore
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González Díaz A, Battaglioli T, Díaz Rodríguez R, Goza Valdés R, González Ochoa E, Van der Stuyft P. Molecular epidemiology of tuberculosis in Havana, Cuba, 2009. Trop Med Int Health 2015. [PMID: 26211409 DOI: 10.1111/tmi.12569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To estimate the proportion of tuberculosis cases attributable to recent transmission and the risk factors possibly associated with tuberculosis clustering. METHODS Population-based study combining information from epidemiological investigation of tuberculosis cases notified to the National Tuberculosis Control Program in Havana, Cuba, in 2009 with the results of genotyping of Mycobacterium tuberculosis isolates with variable number tandem repeat of mycobacterial interspersed repetitive units (MIRU-VNTR) typing. RESULTS Of 186 cases, 61 were genotyped: 33 patterns and five clusters with 19, 7, 3, 2 and 2 cases were found. The proportion of cases due to recent transmission was 45% (95% confidence interval 33-58%). Routine contact investigation failed to identify a substantial number of epidemiological links. A history of living in a closed setting was strongly associated with clustering. CONCLUSIONS The proportion of cases due to recent transmission in Havana in 2009 is high. The existing control measures in closed settings should be strengthened. A study on a larger number of cases and for a longer time period should be carried out to obtain more precise estimates. Further studies on the utility and cost-effectiveness of the addition of molecular epidemiology techniques to support the progress towards tuberculosis elimination in Cuba, a low-incidence resource-limited setting, are also needed.
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Affiliation(s)
- Alexander González Díaz
- Research and Surveillance Group on TB, Leprosy and ARI, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
| | - Tullia Battaglioli
- Epidemiology and Disease Control Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Raúl Díaz Rodríguez
- National Reference Laboratory for TB and Mycobacteria, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
| | - Roxana Goza Valdés
- National Reference Laboratory for TB and Mycobacteria, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
| | - Edilberto González Ochoa
- Research and Surveillance Group on TB, Leprosy and ARI, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
| | - Patrick Van der Stuyft
- Epidemiology and Disease Control Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Public Health, Faculty of Medicine, Ghent University, Ghent, Belgium
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Jensen SG, Olsen NW, Seersholm N, Lillebaek T, Wilcke T, Pedersen MK, Kok-Jensen A. Screening for TB by sputum culture in high-risk groups in Copenhagen, Denmark: a novel and promising approach. Thorax 2015; 70:979-83. [DOI: 10.1136/thoraxjnl-2015-207162] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/18/2015] [Indexed: 11/04/2022]
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Saavedra-Campos M, Welfare W, Cleary P, Sails A, Burkitt A, Hungerford D, Okereke E, Acheson P, Petrovic M. Identifying areas and risk groups with localisedMycobacterium tuberculosistransmission in northern England from 2010 to 2012: spatiotemporal analysis incorporating highly discriminatory genotyping data. Thorax 2015; 71:742-8. [DOI: 10.1136/thoraxjnl-2014-206416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/30/2015] [Indexed: 02/04/2023]
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Christensen ASH, Roed C, Andersen PH, Andersen AB, Obel N. Long-term mortality in patients with pulmonary and extrapulmonary tuberculosis: a Danish nationwide cohort study. Clin Epidemiol 2014; 6:405-21. [PMID: 25419160 PMCID: PMC4235508 DOI: 10.2147/clep.s65331] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Long-term mortality and causes of death in patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) are poorly documented. In this study, long-term mortality and causes of death in PTB and EPTB patients were compared with the background population and it was investigated whether mortality was associated with family-related risk factors. METHODS A NATIONWIDE COHORT STUDY WAS CONDUCTED INCLUDING: all adult Danes notified with PTB or EPTB from 1977 to 2008 and alive 1 year after diagnosis; a randomly selected comparison cohort matched on birth date and sex; adult siblings of PTB patients; and population controls. Data were extracted from national registries. All-cause and cause-specific mortality rate ratios were calculated for patients and siblings and compared with their respective control cohorts. A total of 8,291 patients (6,402 PTB and 1,889 EPTB), 24,873 population controls, 1,990 siblings of PTB patients and 11,679 siblings of PTB population controls were included. RESULTS Overall, the mortality rate ratio was 1.86 (95% confidence interval [CI] 1.77-1.96) for PTB patients and 1.24 (95% CI 1.12-1.37) for EPTB patients. Both patient cohorts had significantly increased risk of death due to infectious diseases and diabetes. Further, the PTB patients had increased mortality due to cancers (mainly respiratory and gastrointestinal tract), liver and respiratory system diseases, and alcohol and drug abuse. The PTB patients had increased mortality compared with their siblings (mortality rate ratio 3.55; 95% CI 2.57-4.91) as did the siblings of the PTB patients compared with the siblings of population controls (mortality rate ratio 2.16; 95% CI 1.62-2.87). CONCLUSION We conclude that adult PTB patients have an almost two-fold increased long-term mortality whereas EPTB patients have a slightly increased long-term mortality compared with the background population. The increased long-term mortality in PTB patients stems from diseases associated with alcohol, tobacco, and drug abuse as well as immune suppression, and family-related factors.
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Affiliation(s)
| | - Casper Roed
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter H Andersen
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | | | - Niels Obel
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Comparison between RFLP and MIRU-VNTR genotyping of Mycobacterium tuberculosis strains isolated in Stockholm 2009 to 2011. PLoS One 2014; 9:e95159. [PMID: 24733167 PMCID: PMC3986374 DOI: 10.1371/journal.pone.0095159] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 03/25/2014] [Indexed: 11/19/2022] Open
Abstract
Our aim was to analyze the difference between methods for genotyping of Mycobacterium tuberculosis complex isolates. We collected genotyping results from Restriction Fragment Length Polymorphism (RFLP) and Mycobacterial Interspersed Repetitive Units - Variable Numbers of Tandem Repeat (MIRU-VNTR) in a geographically limited area (Stockholm) during a period of three years. The number and proportion of isolates belonging to clusters was reduced by 45 and 35% respectively when combining the two methods compared with using RFLP or MIRU-VNTR only. The mean size of the clusters was smaller when combining methods and smaller with RFLP compared to MIRU-VNTR. In clusters with confirmed epidemiological links RFLP coincided slightly better than MIRU-VNTR but where there was a difference, the variation in MIRU-VNTR pattern was only in a single locus. In isolates with few IS6110 bands in RFLP, MIRU-VNTR differentiated the isolates more, dividing the RFLP clusters. Since MIRU-VNTR is faster and less labour-intensive it is the method of choice for routine genotyping. In most cases it will be sufficient for epidemiological purposes but true clustering might still be considered if there are epidemiological links and the MIRU-VNTR results differ in only one of its 24 loci.
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Smit PW, Haanperä M, Rantala P, Couvin D, Lyytikäinen O, Rastogi N, Ruutu P, Soini H. Molecular epidemiology of tuberculosis in Finland, 2008-2011. PLoS One 2013; 8:e85027. [PMID: 24386443 PMCID: PMC3873426 DOI: 10.1371/journal.pone.0085027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/20/2013] [Indexed: 01/21/2023] Open
Abstract
In industrialized countries the majority of tuberculosis (TB) cases are linked to immigration. In Finland, most cases are still Finnish born but the number of foreign born cases is steadily increasing. In this 4-year population based study, the TB situation in Finland was characterized by a genotypic analysis of Mycobacterium tuberculosis isolates. A total of 1048 M. tuberculosis isolates (representing 99.4% of all culture positive cases) were analyzed by spoligotyping and MIRU. Spoligotype lineages belonging to the Euro-American family were predominant among the Finnish isolates, particularly T (n=346, 33.0%) and Haarlem (n=237, 22.6%) strains. The lineage signature was unknown for 130 (12.4%) isolates. Out of the 17 multi-drug resistant TB strains, 10 (58.8%) belonged to the Beijing lineage. In total, 23 new SIT designations were given and 51 orphan strains were found, of which 58 patterns were unique to Finland. Phylogeographical TB mapping as compared to neighboring countries showed that the population structure in Finland most closely resembled that observed in Sweden. By combining spoligotyping and MIRU results, 98 clusters comprising 355 isolates (33.9%) were found. Only 10 clusters contained both Finnish and foreign born cases. In conclusion, a large proportion of the M. tuberculosis isolates were from Finnish born elderly patients. Moreover, many previously unidentified spoligotype profiles and isolates belonging to unknown lineages were encountered.
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Affiliation(s)
- Pieter Willem Smit
- European Public Health Microbiology Training Programme, (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Helsinki, Finland
- * E-mail:
| | - Marjo Haanperä
- Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Helsinki, Finland
| | - Pirre Rantala
- Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Helsinki, Finland
| | - David Couvin
- WHO Supranational TB Reference Laboratory, Tuberculosis & Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Abymes, France
| | - Outi Lyytikäinen
- Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Helsinki, Finland
| | - Nalin Rastogi
- WHO Supranational TB Reference Laboratory, Tuberculosis & Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Abymes, France
| | - Petri Ruutu
- Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Soini
- Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Helsinki, Finland
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Mycobacterium tuberculosis outbreak strain of Danish origin spreading at worrying rates among greenland-born persons in Denmark and Greenland. J Clin Microbiol 2013; 51:4040-4. [PMID: 24068008 DOI: 10.1128/jcm.01916-13] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Transmission of Mycobacterium tuberculosis continues at high rates among Greenland-born persons in Greenland and Denmark, with 203 and 450 notified cases per 10(5) population, respectively, in the year 2010. Here, we document that the predominant M. tuberculosis outbreak strain C2/1112-15 of Danish origin has been transmitted to Greenland-born persons in Denmark and subsequently to Greenland, where it is spreading at worrying rates and adding to the already heavy tuberculosis burden in this population group. It is now clear that the C2/1112-15 strain is able to gain new territories using a new population group as the "vehicle." Thus, it might have the ability to spread even further, considering the potential clinical consequences of strain diversity such as that seen in the widely spread Beijing genotype. The introduction of the predominant M. tuberculosis outbreak strain C2/1112-15 into the Arctic circumpolar region is a worrying tendency which deserves attention. We need to monitor whether this strain already has, or will, spread to other countries.
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