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

描述（改编自申请人的摘要）：为了设计更有效的 减少结核病在美国传播的手段，至关重要 了解耐药和药敏结核病的传播动态 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的地点。为了解决这些问题， 研究人员提出了一项基于人群的分子流行病学研究， 结核病沿着美国-墨西哥边境。 他们假设：（1）结核病在小城市的传播动态， 农村地区与大城市不同;（2）分子生物学的前瞻性使用 流行病学将描述药物敏感和 （3）建立了耐药结核分枝杆菌的RFLP快速分析方法。结核病分离株将 加强及时发现结核病疫情。我们的目标是：1。以确定 感染结核病的患者之间流行病学联系的性质 相同的作案结核菌株，并确定结核病流行的地点和环境， 传播，包括对美国各地传播的分析-墨西哥 边境这将通过将详细的临床和 结核病人的流行病学资料及M. TB 分离株2.描述药物的发展和传播动力学- 耐药结核病，包括比较M. TB 具有或不具有katG突变的分离物。这将通过评价 药物敏感模式、临床和流行病学数据、RFLP结果和 katG基因的测序。3.为了评估spoligotyping的效用， RFLP分析的快速方法，以确定未被怀疑的结核病爆发，并指导 采取公共卫生干预措施，减少结核病传播。Spoligotyping将是 适用于临床样本和早期分枝杆菌培养， 适用于所有M。结核分离株。这项研究将提供洞察力 结核病在城乡混合地区的传播动态。它将 评估katG突变与传播潜力之间的关系， 为分枝杆菌毒力机制提供线索。最后， 它将确定快速RFLP方法是否有助于结核病控制工作。 所获得的知识将使结核病控制战略沿着 美国--墨西哥边境和拉丁美洲。

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.