PDF(Pubmed)
Abstract：
BACKGROUND: Tuberculosis (TB) has remained a tough problem in China. This study aims to identify the risk of tuberculosis transmission and to assess its characteristics.
METHODS: We performed a molecular epidemiological study for patients with culture-positive Mycobacterium tuberculosis (M. tuberculosis) in Shanghai, from 2009 to 2018. Demographic information was obtained from the Tuberculosis Information Management System. Whole-genome sequencing (WGS) was conducted with a threshold of 12 single-nucleotide polymorphisms (SNPs) to distinguish the genomic cluster. To analyze the characteristics of TB transmission, the contact investigation for clustered cases was performed.
RESULTS: In total, 94 (27.25%) of the 345 enrolled patients were grouped into 42 genomic clusters, indicating local transmission of M. tuberculosis strains. Compared to a health system delay <14 days, patients with a health system delay ≥14 days [adjusted odds ratios (AOR) = 2.57, 95% confidence interval (CI): 1.34-4.95] were more likely to be clustered. Patients under 65 years old (AOR = 3.11, 95% CI: 1.76-5.49), residents (AOR = 2.43, 95% CI: 1.18-4.99), and Beijing genotype strains (AOR = 3.35, 95% CI: 1.32-8.53) were associated with increased risk of clustering. Interestingly, patients with resistance to isoniazid (AOR = 2.36, 95% CI: 1.15-4.88) had a higher risk of transmission. Sixteen confirmed/probable epidemiological links were identified. Local transmission of imported cases and household transmission were prominent.
CONCLUSIONS: Health system delay is a crucial factor for TB transmission. Patients with resistance to isoniazid should be priority targets for contact investigation to reduce transmission.
METHODS: We performed a molecular epidemiological study for patients with culture-positive Mycobacterium tuberculosis (M. tuberculosis) in Shanghai, from 2009 to 2018. Demographic information was obtained from the Tuberculosis Information Management System. Whole-genome sequencing (WGS) was conducted with a threshold of 12 single-nucleotide polymorphisms (SNPs) to distinguish the genomic cluster. To analyze the characteristics of TB transmission, the contact investigation for clustered cases was performed.
RESULTS: In total, 94 (27.25%) of the 345 enrolled patients were grouped into 42 genomic clusters, indicating local transmission of M. tuberculosis strains. Compared to a health system delay <14 days, patients with a health system delay ≥14 days [adjusted odds ratios (AOR) = 2.57, 95% confidence interval (CI): 1.34-4.95] were more likely to be clustered. Patients under 65 years old (AOR = 3.11, 95% CI: 1.76-5.49), residents (AOR = 2.43, 95% CI: 1.18-4.99), and Beijing genotype strains (AOR = 3.35, 95% CI: 1.32-8.53) were associated with increased risk of clustering. Interestingly, patients with resistance to isoniazid (AOR = 2.36, 95% CI: 1.15-4.88) had a higher risk of transmission. Sixteen confirmed/probable epidemiological links were identified. Local transmission of imported cases and household transmission were prominent.
CONCLUSIONS: Health system delay is a crucial factor for TB transmission. Patients with resistance to isoniazid should be priority targets for contact investigation to reduce transmission.
摘要：
背景：结核病（TB）在中国仍然是一个棘手的问题。这项研究旨在确定结核病传播的风险并评估其特征。
方法：我们对培养阳性的结核分枝杆菌（M.结核病)在上海，从2009年到2018年。人口统计信息是从结核病信息管理系统获得的。使用12个单核苷酸多态性（SNP）的阈值进行全基因组测序（WGS）以区分基因组簇。分析结核病传播的特点,对聚集病例进行了接触调查.
结果：总计，345名患者中有94名（27.25%）被分为42个基因组簇，表明结核分枝杆菌菌株的局部传播。与卫生系统延迟<14天相比，卫生系统延迟≥14天[调整比值比(AOR)=2.57,95%置信区间(CI):1.34~4.95]的患者更有可能聚集.65岁以下患者(AOR=3.11,95%CI:1.76-5.49),居民(AOR=2.43，95%CI：1.18-4.99)，和北京基因型菌株（AOR=3.35，95％CI：1.32-8.53）与聚类风险增加相关。有趣的是,异烟肼耐药患者(AOR=2.36,95%CI:1.15~4.88)的传播风险较高.确定了16个确认/可能的流行病学联系。输入性病例的本地传播和家庭传播突出。
结论：卫生系统延迟是结核病传播的关键因素。对异烟肼耐药的患者应作为接触调查的优先目标，以减少传播。
方法：我们对培养阳性的结核分枝杆菌（M.结核病)在上海，从2009年到2018年。人口统计信息是从结核病信息管理系统获得的。使用12个单核苷酸多态性（SNP）的阈值进行全基因组测序（WGS）以区分基因组簇。分析结核病传播的特点,对聚集病例进行了接触调查.
结果：总计，345名患者中有94名（27.25%）被分为42个基因组簇，表明结核分枝杆菌菌株的局部传播。与卫生系统延迟<14天相比，卫生系统延迟≥14天[调整比值比(AOR)=2.57,95%置信区间(CI):1.34~4.95]的患者更有可能聚集.65岁以下患者(AOR=3.11,95%CI:1.76-5.49),居民(AOR=2.43，95%CI：1.18-4.99)，和北京基因型菌株（AOR=3.35，95％CI：1.32-8.53）与聚类风险增加相关。有趣的是,异烟肼耐药患者(AOR=2.36,95%CI:1.15~4.88)的传播风险较高.确定了16个确认/可能的流行病学联系。输入性病例的本地传播和家庭传播突出。
结论：卫生系统延迟是结核病传播的关键因素。对异烟肼耐药的患者应作为接触调查的优先目标，以减少传播。
