Citywide Transmission of Multidrug-resistant Tuberculosis Under China's Rapid Urbanization: A Retrospective Population-based Genomic Spatial Epidemiological Study
Citywide Transmission of Multidrug-resistant Tuberculosis Under China's Rapid Urbanization: A Retrospective Population-based Genomic Spatial Epidemiological Study
复制标题
中国快速城市化背景下耐多药结核病的城市传播：基于人群的回顾性基因组空间流行病学研究。
DOI：
10.1093/cid/ciz790
复制
发表时间：
2020-07-01
影响因子：
11.8
通讯作者：
Gao, Qian
中科院分区：
文献类型：
--
作者：
Jiang, Qi;Liu, Qingyun;Gao, Qian
背景
人口流动可能会扩大耐多药结核病(MDR-TB)的传播，并使其全球流行复杂化。我们试图确定深圳耐多药结核病传播的高危人群和地理位置，深圳是中国最常见的国内流动人口目的地。
方法
我们对深圳市2013-2017年间被诊断为耐多药结核病的患者进行了一项以人群为基础的回顾性研究。根据临床分离株的全基因组测序，以12SNP距离为阈值定义基因组簇，计算聚集率以评估近期传播水平。多变量Logistic回归分析确定耐多药结核病传播的危险因素。为了进一步描述流行病学联系，我们邀请了基因组聚集的患者进行深入的社会网络调查。
结果
总体而言，在417名登记的耐多药结核病患者中，有105人(25.2%)被归入40个基因组簇，这表明最近发生了耐多药菌株的传播。调整后，学生患上聚集性菌株的风险是其他患者的4.05倍(95%可信区间[CI]，1.06-17.0)。大多数(70%，28/40)的基因组簇涉及居住在不同地区的患者，居住地点平均相隔8.76公里。除家庭成员外，还在同学和工作场所同事之间确认了流行病学联系。
结论
这些发现表明，耐多药结核病的本地传播在深圳市是一个严重的问题。虽然大多数传播发生在住得很远的人之间，但有明确的证据表明，传播发生在学校和工作场所，这些地方应该被列为积极病例发现的目标地点。
BACKGROUND
Population movement could extend multidrug-resistant tuberculosis (MDR-TB) transmission and complicate its global prevalence. We sought to identify the high-risk populations and geographic sites of MDR-TB transmission in Shenzhen, the most common destination for internal migrants in China.
METHODS
We performed a population-based, retrospective study of patients who were diagnosed with MDR-TB in Shenzhen during 2013-2017. By defining genomic clusters with a threshold of 12 SNP distance based on whole-genome sequencing their clinical strains, the clustering rate was calculated to evaluate the level of recent transmission. Risk factors for MDR-TB transmission were identified by multivariable logistic regression. To further delineate the epidemiological links, we invited the genomic-clustered patients to an in-depth social network investigation.
RESULTS
In total, 105 (25.2%) of the 417 enrolled MDR-TB patients were grouped into 40 genome clusters, suggesting recent transmission of MDR strains. The adjusted risk for students to have a clustered strain was 4.05 (95% confidential intervals [CI], 1.06-17.0) times greater than other patients. The majority (70%, 28/40) of the genomic clusters involved patients who lived in different districts, with residences separated by an average of 8.76 kilometers. Other than household members, confirmed epidemiological links were also identified among classmates and workplace colleagues.
CONCLUSIONS
These findings demonstrate that local transmission of MDR-TB is a serious problem in Shenzhen city. While most transmission occurred between people who lived distant from each other, there was clear evidence that transmission occurred in schools and workplaces, which should be included as targeted sites for active case finding.