PDF(Pubmed)
Abstract：
BACKGROUND: The war in Ukraine has led to significant migration to neighboring countries, raising public health concerns. Notable tuberculosis (TB) incidence rates in Ukraine emphasize the immediate requirement to prioritize approaches that interrupt the spread and prevent new infections.
METHODS: We conducted a prospective genomic surveillance study to assess migration\'s impact on TB epidemiology in the Czech Republic and Slovakia. Mycobacterium tuberculosis isolates from Ukrainian war refugees and migrants, collected from September 2021 to December 2022 were analyzed alongside 1574 isolates obtained from Ukraine, the Czech Republic, and Slovakia.
RESULTS: Our study revealed alarming results, with historically the highest number of Ukrainian tuberculosis patients detected in the host countries. The increasing number of cases of multidrug-resistant TB, significantly linked with Beijing lineage 2.2.1 (p < 0.0001), also presents substantial obstacles to control endeavors. The genomic analysis identified the three highly related genomic clusters, indicating the recent TB transmission among migrant populations. The largest clusters comprised war refugees diagnosed in the Czech Republic, TB patients from various regions of Ukraine, and incarcerated individuals diagnosed with pulmonary TB specialized facility in the Kharkiv region, Ukraine, pointing to a national transmission sequence that has persisted for over 14 years.
CONCLUSIONS: The data showed that most infections were likely the result of reactivation of latent disease or exposure to TB before migration rather than recent transmission occurring within the host country. However, close monitoring, appropriate treatment, careful surveillance, and social support are crucial in mitigating future risks, though there is currently no evidence of local transmission in EU countries.
METHODS: We conducted a prospective genomic surveillance study to assess migration\'s impact on TB epidemiology in the Czech Republic and Slovakia. Mycobacterium tuberculosis isolates from Ukrainian war refugees and migrants, collected from September 2021 to December 2022 were analyzed alongside 1574 isolates obtained from Ukraine, the Czech Republic, and Slovakia.
RESULTS: Our study revealed alarming results, with historically the highest number of Ukrainian tuberculosis patients detected in the host countries. The increasing number of cases of multidrug-resistant TB, significantly linked with Beijing lineage 2.2.1 (p < 0.0001), also presents substantial obstacles to control endeavors. The genomic analysis identified the three highly related genomic clusters, indicating the recent TB transmission among migrant populations. The largest clusters comprised war refugees diagnosed in the Czech Republic, TB patients from various regions of Ukraine, and incarcerated individuals diagnosed with pulmonary TB specialized facility in the Kharkiv region, Ukraine, pointing to a national transmission sequence that has persisted for over 14 years.
CONCLUSIONS: The data showed that most infections were likely the result of reactivation of latent disease or exposure to TB before migration rather than recent transmission occurring within the host country. However, close monitoring, appropriate treatment, careful surveillance, and social support are crucial in mitigating future risks, though there is currently no evidence of local transmission in EU countries.
摘要：
背景：乌克兰战争导致大量移民到邻国，引发公众健康担忧。乌克兰著名的结核病（TB）发病率强调迫切需要优先考虑中断传播和预防新感染的方法。
方法：我们在捷克共和国和斯洛伐克进行了一项前瞻性基因组监测研究，以评估迁移对结核病流行病学的影响。来自乌克兰战争难民和移民的结核分枝杆菌，从2021年9月至2022年12月收集的样本与从乌克兰获得的1574个分离株进行了分析，捷克共和国,斯洛伐克。
结果：我们的研究揭示了令人震惊的结果，历史上在东道国发现的乌克兰结核病患者人数最多。耐多药结核病病例的增加，与北京血统2.2.1显著相关(p<0.0001)，也给控制工作带来了巨大的障碍。基因组分析确定了三个高度相关的基因组簇，表明最近在移民人群中的结核病传播。最大的集群包括在捷克共和国诊断的战争难民，来自乌克兰不同地区的结核病患者，以及在哈尔科夫地区被诊断患有肺结核专业设施的被监禁者，乌克兰,指向一个持续了14年以上的国家传播序列。
结论：数据表明，大多数感染可能是潜伏疾病的重新激活或在迁移之前暴露于结核病的结果，而不是在东道国境内发生的近期传播。然而,密切监测,适当的治疗,仔细监视,社会支持对减轻未来风险至关重要，尽管目前没有证据表明欧盟国家有本地传播。
方法：我们在捷克共和国和斯洛伐克进行了一项前瞻性基因组监测研究，以评估迁移对结核病流行病学的影响。来自乌克兰战争难民和移民的结核分枝杆菌，从2021年9月至2022年12月收集的样本与从乌克兰获得的1574个分离株进行了分析，捷克共和国,斯洛伐克。
结果：我们的研究揭示了令人震惊的结果，历史上在东道国发现的乌克兰结核病患者人数最多。耐多药结核病病例的增加，与北京血统2.2.1显著相关(p<0.0001)，也给控制工作带来了巨大的障碍。基因组分析确定了三个高度相关的基因组簇，表明最近在移民人群中的结核病传播。最大的集群包括在捷克共和国诊断的战争难民，来自乌克兰不同地区的结核病患者，以及在哈尔科夫地区被诊断患有肺结核专业设施的被监禁者，乌克兰,指向一个持续了14年以上的国家传播序列。
结论：数据表明，大多数感染可能是潜伏疾病的重新激活或在迁移之前暴露于结核病的结果，而不是在东道国境内发生的近期传播。然而,密切监测,适当的治疗,仔细监视,社会支持对减轻未来风险至关重要，尽管目前没有证据表明欧盟国家有本地传播。
