EMERGING MDR TUBERCULOSIS ACROSS THE US/MEXICO BORDER

描述：（由申请人提供）我们的申请将创建动态数据库，以分析和生成结核病（TB），特别是耐多药结核病（MDR-TB）在德克萨斯州南部和墨西哥东北部传播的精确模式的初步数据。这将通过一个两国联盟来实现，该联盟将分享来自各自地区的结核病病例的社会、人口和地理数据。该联盟的目标是：1)整合目前由联盟成员单独持有的现有社会人口学、耐药性和分子指纹数据库；2)合并、地理编码和分析聚合数据库；3)建立耐药性测试、结核分枝杆菌DNA提取和分离株分子表征的通用协议和程序；4)评估社会网络分析作为改进耐多药结核病传播追踪的方法。这些分析将3-5年的个别病例与分子指纹图谱、药物敏感性模式、社会人口特征和地理位置联系起来，从而使区域能够了解耐多药和耐多药结核病跨境传播的分布和动态。这些数据将用于改进控制技术，并成为假设的基础，这些假设将在未来更详细的研究应用中得到检验。这些应用将包括流行病学和转译研究，使用新兴疾病特别是耐多药结核病的双边项目的共同方案。该财团的地理区域包括从墨西哥湾到拉雷多的下里约热内卢格兰德山谷（LRGV）的5个县，以及墨西哥边境的塔毛利帕斯州和新莱昂州。该联盟将由位于布朗斯维尔的德克萨斯大学公共卫生学院地区校区的院长和教职员工领导，该校区距离边境不到一英里，在分子微生物学、流行病学、生物统计学、社会网络研究和时空分析方面提供专业知识。休斯敦、圣安东尼奥和蒙特雷的主要结核病研究人员将在加强研究地区开展耐多药结核病专业公共卫生、流行病学和分子研究的能力方面发挥关键作用。边境联盟的参与者来自两国负责消除结核病的所有公共卫生调查机构。生物恐怖主义引入耐多药的一个重要防御措施是，了解这些生物体的传播可能与非耐药结核病（如果有的话）有何不同，以及对耐多药本地菌株的详细了解，从而能够快速区分已知的耐多药结核病流行菌株和新引入的菌株。这个应用程序将有助于解决所有这些问题。

DESCRIPTION: (provided by applicant) Our application will create dynamic databases to analyze and generate preliminary data on the precise patterns of transmission of tuberculosis (TB), especially multidrug resistant tuberculosis (MDR-TB), across South Texas and North Eastern Mexico. This will be achieved through a binational consortium that will share social, demographic, and geographic data on tuberculosis cases from each of their respective areas. The aims of the consortium are 1) aggregate existing sociodemographic, drug resistance and molecular fingerprinting databases currently held separately by consortium members 2) merge, geocode and analyze the aggregated database 3) establish common protocols and procedures for testing of drug resistance, extraction of M. tuberculosis DNA, and molecular characterization of isolates 4) evaluate social network analysis as a method for improving the tracking of MDR-TB transmission. These analyses link individual cases over 3-5 years with molecular fingerprints, drug susceptibility patterns, sociodemographic characteristics and geographic location, allowing regional understanding of the distribution and dynamics of DR and MDR-TB transmission across the border. These data will be used to improve control techniques and become the basis of hypotheses that will be tested in future, more elaborate research applications. These applications will include epidemiologic and translational research studies using common protocols for binational projects in emerging diseases, specifically MDR-TB. The geographic area of the consortium encompasses 5 counties of the Lower Rio Grande Valley (LRGV) from the Gulf of Mexico to Laredo, and the Mexican border states of Tamaulipas and Nuevo Leon. The consortium will be led by the Dean and faculty of the University of Texas School of Public Health Regional Campus at Brownsville, less than a mile from the border and contributing expertise in molecular microbiology, epidemiology, biostatistics, social network studies and spatial-temporal analyses. Leading tuberculosis researchers in Houston, San Antonio and Monterrey will play key roles in strengthening the capacity to conduct specialized public health, epidemiologic, and molecular based research on MDR-TB in the study area. Border consortium participants are from all the public health investigatorities responsible for TB elimination in both countries. An important defense of MDR introduction by bioterrorism is understanding how transmission of these organisms may differ from non resistant TB (if at all) and detailed knowledge of local strains of MDR that will allow quick distinction between known circulating strains of MDR TB and newly introduced strains. This application will be instrumental in addressing all of these issues.