Recent TB transmission, clustering and predictors of large clusters in London, 2010-2012: results from first 3 years of universal MIRU-VNTR strain typing.
Recent TB transmission, clustering and predictors of large clusters in London, 2010-2012: results from first 3 years of universal MIRU-VNTR strain typing.
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DOI：
10.1136/thoraxjnl-2014-206608
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发表时间：
2016-08
期刊：
影响因子：
10
通讯作者：
Public Health England Strain Typing Project Board
中科院分区：
文献类型：
--
作者：
Hamblion EL;Le Menach A;Anderson LF;Lalor MK;Brown T;Abubakar I;Anderson C;Maguire H;Anderson SR;Public Health England Strain Typing Project Board
在过去的20 年里，伦敦的结核病发病率翻了一番。需要更好地了解风险群体最近的传播情况，才能有效地针对干预措施。我们调查了结核病病例的分子流行病学特征，以估计由于最近的传播而导致的病例比例，并确定属于一个聚集性的预测因素。研究人群包括2010年1月至2012年12月期间通报的伦敦居民中所有培养阳性的结核病病例，使用24个座位的多个散布重复单元-可变数量串联重复进行菌株分型。根据前两个病例的特点，采用多变量Logistic回归分析，根据病例的社会人口学和临床特征来评估聚集性的危险因素，并评估聚集性的大小。共检出10株 ，其中培养阳性5 72 8株(5 7%)，分型4 790株(84%)。2194例(46%)聚集在570个聚集群中，估计可归因于最近传播的比例为34%。聚集性病例更有可能是在英国出生的，有肺结核病，有过诊断，有药物滥用或酗酒和监禁的病史，是白人、印度人、非洲黑人或加勒比海人。在大型集群中，前两个病例的通知间隔时间更可能是<；90 天。伦敦多达三分之一的结核病病例可能是由最近的传播引起的。应将资源用于及时调查具有风险因素的病例群组，特别是前两个病例之间时间较短的病例，以阻断结核病的继续传播。
The incidence of TB has doubled in the last 20 years in London. A better understanding of risk groups for recent transmission is required to effectively target interventions. We investigated the molecular epidemiological characteristics of TB cases to estimate the proportion of cases due to recent transmission, and identify predictors for belonging to a cluster. The study population included all culture-positive TB cases in London residents, notified between January 2010 and December 2012, strain typed using 24-loci multiple interspersed repetitive units-variable number tandem repeats. Multivariable logistic regression analysis was performed to assess the risk factors for clustering using sociodemographic and clinical characteristics of cases and for cluster size based on the characteristics of the first two cases. There were 10 147 cases of which 5728 (57%) were culture confirmed and 4790 isolates (84%) were typed. 2194 (46%) were clustered in 570 clusters, and the estimated proportion attributable to recent transmission was 34%. Clustered cases were more likely to be UK born, have pulmonary TB, a previous diagnosis, a history of substance abuse or alcohol abuse and imprisonment, be of white, Indian, black-African or Caribbean ethnicity. The time between notification of the first two cases was more likely to be <90 days in large clusters. Up to a third of TB cases in London may be due to recent transmission. Resources should be directed to the timely investigation of clusters involving cases with risk factors, particularly those with a short period between the first two cases, to interrupt onward transmission of TB.