Advanced survey of tuberculosis transmission in a complex socioepidemiologic scenario with a high proportion of cases in immigrants
Advanced survey of tuberculosis transmission in a complex socioepidemiologic scenario with a high proportion of cases in immigrants
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DOI：
10.1086/588785
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发表时间：
2008-07-01
影响因子：
11.8
通讯作者：
Garcia de Viedma, Dario
中科院分区：
文献类型：
--
作者：
Martinez-Lirola, Miguel;Alonso-Rodriguez, Noelia;Garcia de Viedma, Dario
背景移民中结核病（TB）发病率的增加改变了西班牙的社会流行病学情况。一般认为移民中的结核病是输入性感染的结果，但很少考虑最近传播的作用。标准的接触者追踪不适合在这个复杂的地区进行传播调查。在研究期间（2003-2006年），我们对来自阿尔梅里亚（西班牙移民中结核病病例比例最高的省份）的394例经微生物证实的结核病患者的356株（90.4%）进行了基因分型。结核病传播的流行病学调查是通过对结核病患者进行标准化访谈和随后对聚集患者（根据其分离株的限制性片段长度多态性类型进行聚集）进行访谈以确定传播位置（由聚集患者的名义和/或照片识别支持）来进行的。在所有356个基因型分离株中，131个（36.8%）呈聚集性，表明最近传播。移民（32.8%）和本地患者（41.6%）的聚类率之间的差异无统计学意义（P= 0.087）;在45个聚类中，15个（33.3%）仅涉及移民，17个（37.8%）仅涉及本地患者，13个（28.9%）同时涉及移民和本地患者。先进的系统，以调查集群的患者成功地检测到10的12个集群，涉及14名患者的链接，而传统的方法，基于接触者追踪，只能检测到2个集群的链接。发现了移民间的近期传播和移民与本地人群之间的传播渗透性，需要结合联合收割机通用基因分型和聚集性患者的精细调查的流行病学策略来调查复杂情况下的传播模式。
Background. An increase in the incidence of tuberculosis (TB) in immigrants has changed the socioepidemiologic scenario in Spain. It is generally assumed that TB in immigrants is the result of importation of infection, but the role of recent transmission is rarely considered. Standard contact tracing is not suitable for the survey of transmission in this complex scenario.Methods. During the study period (2003-2006), we genotyped 356 (90.4%) of 394 isolates from patients with microbiologically confirmed TB in Almeria, the province with the highest percentage of TB cases among immigrants in Spain. The epidemiologic survey of TB transmission was performed by active data collection using standardized interviews of the patients with TB and subsequent interviews of the clustered patients (who were clustered on the basis of the restriction fragment-length polymorphism types of their isolates) to identify transmission locations (supported by nominal and/or photographic recognition by the clustered patients).Results. Of all 356 genotyped isolates, 131 (36.8%) were clustered, suggesting recent transmission. The difference between the clustering rate for immigrants (32.8%) and that for native patients (41.6%) was not statistically significant (P=.087); of the 45 clusters, 15 (33.3%) involved only immigrants, 17 (37.8%) involved only autochthonous patients, and 13 (28.9%) involved both immigrants and autochthonous patients. The advanced system to investigate the clustered patients succeeded in detecting links in 10 of the 12 clusters that involved 14 patients, whereas the conventional approach, based on contact tracing, could detect links in only 2 clusters.Conclusions. Recent transmission among immigrants and transmission permeability between the immigrant and autochthonous populations were found. Epidemiologic strategies that combine universal genotyping and refined surveys of the clustered patients are needed to investigate transmission patterns in complex scenarios.