Identifying Hotspots of Multidrug-Resistant Tuberculosis Transmission Using Spatial and Molecular Genetic Data

Autor: Ted Cohen, Mercedes C. Becerra, Zibiao Zhang, Jonathan L. Zelner, Leonid Lecca, Bryan T. Grenfell, Roger Calderon, Rosa Yataco, Carmen Contreras, Justin Manjourides, Megan Murray, Jerome T Galea
Rok vydání: 2015
Předmět:
0301 basic medicine
congenital
hereditary
and neonatal diseases and abnormalities
medicine.medical_specialty
Tuberculosis
Genotype
030106 microbiology
Antitubercular Agents
law.invention
Cohort Studies
Mycobacterium tuberculosis
Major Articles and Brief Reports
03 medical and health sciences
fluids and secretions
0302 clinical medicine
law
Internal medicine
parasitic diseases
Peru
Tuberculosis
Multidrug-Resistant
Humans
Immunology and Allergy
Medicine
Prospective Studies
030212 general & internal medicine
Prospective cohort study
Molecular Epidemiology
biology
Molecular epidemiology
business.industry
Incidence
Incidence (epidemiology)
Odds ratio
medicine.disease
biology.organism_classification
Infectious Diseases
Transmission (mechanics)
population characteristics
business
geographic locations
Cohort study
Zdroj: Journal of Infectious Diseases. 213:287-294
ISSN: 1537-6613
0022-1899
Popis: Background We aimed to identify and determine the etiology of "hotspots" of concentrated multidrug-resistant tuberculosis (MDR-tuberculosis) risk in Lima, Peru. Methods From 2009 to 2012, we conducted a prospective cohort study among households of tuberculosis cases from 106 health center (HC) areas in Lima, Peru. All notified tuberculosis cases and their household contacts were followed for 1 year. Symptomatic individuals were screened by microscopy and culture; positive cultures were tested for drug susceptibility (DST) and genotyped by 24-loci mycobacterial interspersed repetitive units-variable-number tandem repeats (MIRU-VNTR). Results 3286 individuals with culture-confirmed disease, DST, and 24-loci MIRU-VNTR were included in our analysis. Our analysis reveals: (1) heterogeneity in annual per-capita incidence of tuberculosis and MDR-tuberculosis by HC, with a rate of MDR-tuberculosis 89 times greater (95% confidence interval [CI], 54,185) in the most-affected versus the least-affected HC; (2) high risk for MDR-tuberculosis in a region spanning several HCs (odds ratio = 3.19, 95% CI, 2.33, 4.36); and (3) spatial aggregation of MDR-tuberculosis genotypes, suggesting localized transmission. Conclusions These findings reveal that localized transmission is an important driver of the epidemic of MDR-tuberculosis in Lima. Efforts to interrupt transmission may be most effective if targeted to this area of the city.
Databáze: OpenAIRE
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