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J Infect Dis. 2016 Jan 15;213(2):287-94. doi: 10.1093/infdis/jiv387. Epub 2015 Jul 14.

Identifying Hotspots of Multidrug-Resistant Tuberculosis Transmission Using Spatial and Molecular Genetic Data.

Author information

1
Robert Wood Johnson Foundation Health and Society Scholars Program, Interdisciplinary Center for Innovative Theory and Empirics (INCITE) & Mailman School of Public Health, Columbia University, New York, New York.
2
Department of Global Health and Social Medicine, Harvard Medical School, Department of Epidemiology, Harvard School of Public Health.
3
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
4
Socios En Salud, Lima, Peru.
5
Division of Global Health Equity, Brigham and Women's Hospital.
6
Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts.
7
Department of Ecology and Evolutionary Biology, Princeton University, New Jersey Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
8
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.

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.

KEYWORDS:

MDR-tuberculosis; drug resistance; spatial analysis; tuberculosis

PMID:
26175455
PMCID:
PMC4690150
DOI:
10.1093/infdis/jiv387
[Indexed for MEDLINE]
Free PMC Article

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