1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
2
|
Abstract
The drug isoniazid (INH) is a key component of global tuberculosis (TB) control programmes. It is estimated, however, that 16.1% of TB disease cases in the former Soviet Union countries and 7.5% of cases outside of these settings have non-multidrug-resistant (MDR) INH resistance. Resistance has been linked to poorer treatment outcomes, post-treatment relapse and death, at least for specific sites of disease. Multiple genetic loci are associated with phenotypic resistance; however, the relationship between genotype and phenotype is complex, and restricts the use of rapid sequencing techniques as part of the diagnostic process to determine the most appropriate treatment regimens for patients. The burden of resistance also influences the usefulness of INH preventive therapy. Despite seven decades of INH use, our knowledge in key areas such as the epidemiology of resistant strains, their clinical consequences, whether tailored treatment regimens are required and the role of INH resistance in fuelling the MDR-TB epidemic is limited. The importance of non-MDR INH resistance needs to be re-evaluated both globally and by national TB control programmes.
Collapse
Affiliation(s)
- H R Stagg
- Institute of Global Health, UCL, London, UK
| | - M C Lipman
- University College London (UCL) Respiratory, Division of Medicine, UCL, London, UK;, Royal Free London National Health Service Foundation Trust, London, UK
| | - T D McHugh
- Centre for Clinical Microbiology, UCL, London, UK
| | - H E Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Seto J, Wada T, Suzuki Y, Ikeda T, Mizuta K, Yamamoto T, Ahiko T. Mycobacterium tuberculosis Transmission among Elderly Persons, Yamagata Prefecture, Japan, 2009-2015. Emerg Infect Dis 2018; 23:448-455. [PMID: 28221133 PMCID: PMC5382749 DOI: 10.3201/eid2303.161571] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In many countries with low to moderate tuberculosis (TB) incidence, cases have shifted to elderly persons. It is unclear, however, whether these cases are associated with recent Mycobacterium tuberculosis transmission or represent reactivation of past disease. During 2009–2015, we performed a population-based TB investigation in Yamagata Prefecture, Japan, using in-depth contact tracing and 24-loci variable-number tandem-repeat typing optimized for Beijing family M. tuberculosis strains. We analyzed 494 strains, of which 387 (78.3%) were derived from elderly patients. Recent transmission with an epidemiologic link was confirmed in 22 clusters (70 cases). In 17 (77.3%) clusters, the source patient was elderly; 11 (64.7%) of the 17 clusters occurred in a hospital or nursing home. In this setting, the increase in TB cases was associated with M. tuberculosis transmissions from elderly persons. Prevention of transmission in places where elderly persons gather will be an effective strategy for decreasing TB incidence among predominantly elderly populations.
Collapse
|
4
|
Seto J, Wada T, Suzuki Y, Ikeda T, Mizuta K, Mitarai S, Ahiko T. Convenient PCR method for variable-number tandem-repeat typing of Mycobacterium tuberculosis clinical isolates. J Microbiol Methods 2017; 139:12-14. [PMID: 28438643 DOI: 10.1016/j.mimet.2017.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/11/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
Variable-number tandem-repeat typing for Mycobacterium tuberculosis clinical isolates contributes to evidence-based tuberculosis control. However, cumbersome PCR procedures for the typing have disturbed routine analyses. We proposed a convenient PCR method for the typing using a PCR master mix that provides rapidity and long-term stability of the frozen PCR cocktail.
Collapse
Affiliation(s)
- Junji Seto
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, 1-6-6 Toka-machi, Yamagata-shi, Yamagata 990-0031, Japan.
| | - Takayuki Wada
- Department of International Health, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Yu Suzuki
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, 1-6-6 Toka-machi, Yamagata-shi, Yamagata 990-0031, Japan
| | - Tatsuya Ikeda
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, 1-6-6 Toka-machi, Yamagata-shi, Yamagata 990-0031, Japan
| | - Katsumi Mizuta
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, 1-6-6 Toka-machi, Yamagata-shi, Yamagata 990-0031, Japan
| | - Satoshi Mitarai
- Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo 204-8533, Japan
| | - Tadayuki Ahiko
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, 1-6-6 Toka-machi, Yamagata-shi, Yamagata 990-0031, Japan
| |
Collapse
|
5
|
Stucki D, Ballif M, Egger M, Furrer H, Altpeter E, Battegay M, Droz S, Bruderer T, Coscolla M, Borrell S, Zürcher K, Janssens JP, Calmy A, Mazza Stalder J, Jaton K, Rieder HL, Pfyffer GE, Siegrist HH, Hoffmann M, Fehr J, Dolina M, Frei R, Schrenzel J, Böttger EC, Gagneux S, Fenner L. Standard Genotyping Overestimates Transmission of Mycobacterium tuberculosis among Immigrants in a Low-Incidence Country. J Clin Microbiol 2016; 54:1862-70. [PMID: 27194683 DOI: 10.1128/JCM.00126-16] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
Collapse
|
6
|
Dutta E, Kar A. A case-control study identifying the characteristics of patients providing incorrect contact information at registration for DOTS in Pune, India. Indian J Tuberc 2016; 63:51-54. [PMID: 27235946 DOI: 10.1016/j.ijtb.2016.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 02/29/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Provision of incorrect contact information by the patient at the time of registration for treatment is a deterrent to treatment adherence. OBJECTIVE To determine the characteristics of patients providing incomplete contact information at the time of registration for Directly Observed Treatment Short course (DOTS) at the tuberculosis units (TUs) in Pune, India. METHODS A nested case-control study was conducted where the characteristics of patients who had provided incorrect contact information (cases) were compared with the characteristics of patients who could be traced (controls). Cases and controls were identified from a cohort of 3802 tuberculosis patients registered at the DOTS centres in Pune. Correct or incorrect contact information was ascertained by visiting each address provided at the time of registration. Characteristics associated with providing incorrect contact information were determined through multinomial regression analysis. RESULTS There were 406 (10.7%) patients who could not be traced due to incorrect address provided at the time of registration at the DOTS centres. Registration at the TUs in the peripheral areas of the city (odds ratio (OR)=3.57, 95% confidence interval (CI)=2.64-4.84) and engagement in migration prone occupation (OR=1.83, 95% CI=1.47-2.26) were associated with odds of providing incorrect information at the time of registration. CONCLUSION Untraceable patients were more likely to be engaged in occupations with a potential for migration. DOTS centres located in developing areas of cities should reinforce validation of contact information of patients.
Collapse
Affiliation(s)
- Eliza Dutta
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune 411007, India
| | - Anita Kar
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune 411007, India.
| |
Collapse
|