Title
Identifying hotspots of multidrug-resistant tuberculosis transmission using spatial and molecular genetic data
Date Issued
15 January 2016
Access level
open access
Resource Type
journal article
Author(s)
Zelner J.L.
Murray M.B.
Becerra M.C.
Galea J.
Contreras C.
Zhang Z.
Manjourides J.
Grenfell B.T.
Cohen T.
Publisher(s)
Oxford University Press
Abstract
Background. We aimed to identify and determine the etiology of "hotspots" of concentrated multidrug-resistant tuberculosis (MDR-tuberculosis) risk in Lima, Peru. Methods. From 2009 to 2012, we conducted a prospective cohort study among households of tuberculosis cases from 106 health center (HC) areas in Lima, Peru. All notified tuberculosis cases and their household contacts were followed for 1 year. Symptomatic individuals were screened by microscopy and culture; positive cultures were tested for drug susceptibility (DST) and genotyped by 24-loci mycobacterial interspersed repetitive units-variable-number tandem repeats (MIRU-VNTR). Results. 3286 individuals with culture-confirmed disease, DST, and 24-loci MIRU-VNTR were included in our analysis. Our analysis reveals: (1) heterogeneity in annual per-capita incidence of tuberculosis and MDR-tuberculosis by HC, with a rate of MDR-tuberculosis 89 times greater (95% confidence interval [CI], 54,185) in the most-affected versus the least-affected HC; (2) high risk for MDR-tuberculosis in a region spanning several HCs (odds ratio = 3.19, 95% CI, 2.33, 4.36); and (3) spatial aggregation of MDR-tuberculosis genotypes, suggesting localized transmission. Conclusions. These findings reveal that localized transmission is an important driver of the epidemic of MDR-tuberculosis in Lima. Efforts to interrupt transmission may be most effective if targeted to this area of the city.
Start page
287
End page
294
Volume
213
Issue
2
Language
English
OCDE Knowledge area
Enfermedades infecciosas
Sistema respiratorio
Genética humana
Subjects
Scopus EID
2-s2.0-84957696805
PubMed ID
Source
Journal of Infectious Diseases
ISSN of the container
00221899
Sponsor(s)
This work was supported by the Research and Policy for Infectious Disease Dynamics program of the Science and Technology Directorate, Department of Homeland Security, and the Fogarty International Center, National Institutes of Health (NIH) (J. L. Z. and B. T. G.). J. L. Z. was supported by the Robert Wood Johnson Foundation Health and Society Scholars program. B. T. G. was funded by the Bill and Melinda Gates Foundation. M. B. M., M. C. B., J. G., L. L., R. C., R. Y., C. C., Z. Z., and T. C. as well as collection of all data presented were funded by the NIH (grant U19 A1076217). M. C. B., L. L., J. G., C. C., R. Y., R. C., Z. Z., and M. B. M. were also funded by grant U01 AI057786 from the NIH.
Sources of information:
Directorio de Producción Científica
Scopus