TRANSMISSION DYNAMICS OF TB ALONG THE U.S.-MEXICO BORDER

描述(改编自申请人的摘要)：设计出更有效的 为了减少结核病(TB)在美国的传播，关键是 了解耐药和敏感结核病的传播动态 在不同的社会经济环境中，包括小城市、农村地区和 外国出生的人进入美国解决这些问题的地点， 研究人员提出了一项基于人群的分子流行病学研究 美墨边境的结核病。 他们假设：(1)结核病在小城市和 农村地区与大城市地区不同；(2)分子的预期用途 流行病学将描绘出对药物敏感的和 耐药结核；(3)结核分枝杆菌RFLP快速分析方法 加强对结核病暴发的及时检测。我们的具体目标是-1。要确定 感染者之间的流行病学联系的性质 相同的结核分枝杆菌菌株，并确定结核病存在的地点和环境 传播，包括对美国-墨西哥传播的分析 边界。这将通过将详细的临床和 结核病人流行病学资料及结核分枝杆菌RFLP分析结果 分离株。2.表征药物的发展和传播动力学- 耐药结核病，包括结核分枝杆菌传播潜力的比较 带有或不带有katG突变的分离株。这将通过评估 药物敏感性模式、临床和流行病学数据、RFLP结果和 KatG基因的测序。3.为了评估SPOGO分型的效用，一个 快速RFLP分析方法，以识别意外的结核病暴发并指导 减少结核病传播的公共卫生干预措施。Spoligo类型化将是 适用于临床样本和早期分枝杆菌培养，然后 预期适用于所有结核分枝杆菌分离株。这项研究将为我们提供洞察 调查结核病在城乡混合地区的传播动态。会的 评估katG突变与传播潜力的关系， 为分枝杆菌毒力的潜在机制提供线索。最后， 它将确定快速RFLP方法是否有助于结核病控制工作。 所获得的知识将有助于改进结核病控制战略 美墨边境和拉丁美洲。

DESCRIPTION (Adapted from the Applicant's Abstract): To devise more effective means to reduce spread of tuberculosis (TB) in the U.S., it is critical to understand the transmission dynamics of drug-resistant and drug-susceptible TB in different socioeconomic settings, including small cities, rural areas and locations where foreign-born persons enter the U.S. To address these issues, the investigators propose a population-based molecular epidemiologic study of TB along the U.S.-Mexico border. They hypothesize that: (1) the transmission dynamics of TB in small cities and rural areas differ from those in large cities; (2) Prospective use of molecular epidemiology will delineate the transmission dynamics of drug- susceptible and drug-resistant TB; (3) A rapid method of RFLP analysis of M. tb isolates will enhance timely detection of TB outbreaks. Our specific aims are-1. To determine the nature of epidemiologic links between patients who are infected with the same M. tb strain, and to identify locations and settings where TB is transmitted, including an analysis of transmission across the U.S.-Mexico border. This will be achieved by correlating detailed clinical and epidemiologic data on TB patients with results of RFLP analysis of M. tb isolates. 2. To characterize the development and transmission dynamics of drug- resistant TB, including comparison of the transmission potential of M. tb isolates with or without katG mutations. This will be achieved by evaluation of drug susceptibility patterns, clinical and epidemiologic data, RFLP results and sequencing of the katG gene. 3. To evaluate the utility of spoligotyping, a rapid method of RFLP analysis, to identify unsuspected TB outbreaks and guide public health interventions to reduce TB transmission. Spoligotyping will be adapted for use in clinical samples and early mycobacterial cultures, then prospectively applied to all M. tb isolates. This study will provide insight into the transmission dynamics of TB in mixed urban/rural areas. It will evaluate the relationship between katG mutations and transmission potential, providing clues to the mechanisms underlying mycobacterial virulence. Finally, it will determine if rapid RFLP methods can contribute to TB control efforts. The knowledge gained will permit refinement of TB control strategies along the U.S.-Mexico border and in Latin America.