Molecular, ethno-spatial epidemiology of leprosy in China: novel insights for tracing leprosy in endemic and non endemic provinces.
Molecular, ethno-spatial epidemiology of leprosy in China: novel insights for tracing leprosy in endemic and non endemic provinces.
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中国麻风病的分子、民族空间流行病学：追踪麻风病流行省份和非流行省份的新见解。
DOI：
10.1016/j.meegid.2012.12.009
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Vissa,Varalakshmi
中科院分区：
文献类型：
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作者：
Weng,Xiaoman;Xing,Yan;Liu,Jian;Wang,Yonghong;Ning,Yong;Li,Ming;Wu,Wenbin;Zhang,Lianhua;Li,Wei;VanderHeiden,Jason;Vissa,Varalakshmi
即使有既定的控制方案，麻风病在中国的检出率仍然接近稳定，需要新的知识和替代方法来阻断传播。对190例麻风病人进行了分子流行病学调查，以确定麻风分枝杆菌菌株类型，并在流行区和非流行区进行了遗传关系和聚类分析。研究结果支持多位点可变数目串联重复序列（VNTR）分析作为一个有用的工具，在中国的多民族和不同的地理景观揭示特征模式。从乡镇到省到区域各级的麻风聚集性的几种情况得到了承认，而最近的职业或远程迁移表明某些菌株的地理分离。首先，先前的研究表明，四个主要的M。根据单核苷酸多态性（SNP）定义的麻风亚型，只有3型存在于中国，据称通过丝绸之路从欧洲/西亚/中亚进入。然而，这项研究发现，在中国南方的广东，福建和广西的VNTR连锁菌株是1型。第二，VNTR可区分的3型菌株的子集在这些省份中共存。第三，在东部的江苏和安徽以及与西藏接壤的四川西部发现了在日本和韩国检测到的rpoT VNTR等位基因为4的3型菌株。第四，从总体遗传多样性来看，云南丘北、贵州兴义、西南四川等地的流行县菌株之间存在一定的亲缘关系。然而，更仔细的检查显示出不同的地方菌株和集群。总而言之，这些主要来自VNTR分型的见解揭示了麻风病在中国境内和境外传播的多条被忽视的途径，并引起了对中国南海和东海历史海上路线的关注。更重要的是，引入了从县到国家一级的前瞻性病例发现和麻风追踪的新概念和方法。
Leprosy continues to be detected at near stable rates in China even with established control programs, necessitating new knowledge and alternative methods to interrupt transmission. A molecular epidemiology investigation of 190 patients was undertaken to define Mycobacterium leprae strain types and discern genetic relationships and clusters in endemic and non-endemic regions spanning seventeen provinces and two autonomous regions. The findings support multiple locus variable number of tandem repeat (VNTR) analysis as a useful tool in uncovering characteristic patterns across the multiethnic and divergent geographic landscape of China. Several scenarios of clustering of leprosy from township to provincial to regional levels were recognized, while recent occupational or remote migration showed geographical separation of certain strains. First, prior studies indicated that of the four major M. leprae subtypes defined by single nucleotide polymorphisms (SNPs), only type 3 was present in China, purportedly entering from Europe/West/Central Asia via the Silk Road. However, this study revealed VNTR linked strains that are of type 1 in Guangdong, Fujian and Guangxi in southern China. Second, a subset of VNTR distinguishable strains of type 3, co-exist in these provinces. Third, type 3 strains with rpoT VNTR allele of 4, detected in Japan and Korea were discovered in Jiangsu and Anhui in the east and in western Sichuan bordering Tibet. Fourth, considering the overall genetic diversity, strains of endemic counties of Qiubei, Yunnan; Xing Yi, Guizhou; and across Sichuan in southwest were related. However, closer inspection showed distinct local strains and clusters. Altogether, these insights, primarily derived from VNTR typing, reveal multiple and overlooked paths for spread of leprosy into, within and out of China and invoke attention to historic maritime routes in the South and East China Sea. More importantly, new concepts and approaches for prospective case finding and tracking of leprosy from county to national level have been introduced.