Transmission of Mycobacterium tuberculosis in China: A Population-Based Molecular Epidemiologic Study

Chongguang Yang, Xin Shen, Ying Peng, Rushu Lan, Yuling Zhao, Bo Long, Tao Luo, Guomei Sun, Xia Li, Ke Qiao, Xiaohong Gui, Jie Wu, Jiying Xu, Fabin Li, Dingyue Li, Feiying Liu, Mei Shen, Jianjun Hong, Jian Mei, Kathryn DeriemerQian Gao

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Abstract

Background. Understanding the transmission of Mycobacterium tuberculosis is essential for the development of efficient tuberculosis control strategies. China has the second-largest tuberculosis burden in the world. Recent transmission and infection with M. tuberculosis, particularly drug-resistant strains, may account for many new tuberculosis cases. Methods. We performed a population-based molecular epidemiologic study of pulmonary tuberculosis in China during 1 July 2009 to 30 June 2012. We defined clusters as cases with identical variable number tandem repeat genotype patterns and identified the risk factors associated with clustering, by logistic regression. Relative transmission rates were estimated by the sputum smear status and drug susceptibility status of tuberculosis patients. Results. Among 2274 culture-positive tuberculosis patients with genotyped isolates, there were 705 (31.0%) tuberculosis patients in 287 clusters. Multidrug-resistant (MDR) tuberculosis (adjusted odds ratio [aOR], 1.86∗95% confidence interval [CI], 1.25-2.63) and infection with a Beijing family strain (aOR, 1.56∗95% CI, 1.23-2.96) were associated with clustering. Eighty-four of 280 (30.0%) clusters had a putative source case that was sputum smear negative, and 30.6% of their secondary cases were attributed to transmission by sputum smear-negative patients. The relative transmission rate for sputum smear negative compared with sputum smear-positive patients was 0.89 (95% CI,. 68-1.10), and was 1.51 (95% CI, 1.00-2.24) for MDR tuberculosis vs drug-susceptible tuberculosis. Conclusions. Recent transmission of M. tuberculosis, including MDR strains, contributes substantially to tuberculosis disease in China. Sputum smear-negative cases were responsible for at least 30% of the secondary cases. Interventions to reduce the transmission of M. tuberculosis should be implemented in China.

Original languageEnglish (US)
Pages (from-to)219-227
Number of pages9
JournalClinical Infectious Diseases
Volume61
Issue number2
DOIs
StatePublished - Jul 15 2015

Fingerprint

Mycobacterium tuberculosis
Epidemiologic Studies
China
Tuberculosis
Sputum
Multidrug-Resistant Tuberculosis
Population
Confidence Intervals
Cluster Analysis
Odds Ratio
Pharmaceutical Preparations
Minisatellite Repeats
Infectious Disease Transmission
Pulmonary Tuberculosis
Logistic Models
Genotype
Infection

Keywords

  • molecular epidemiology
  • recent transmission; China
  • tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Transmission of Mycobacterium tuberculosis in China : A Population-Based Molecular Epidemiologic Study. / Yang, Chongguang; Shen, Xin; Peng, Ying; Lan, Rushu; Zhao, Yuling; Long, Bo; Luo, Tao; Sun, Guomei; Li, Xia; Qiao, Ke; Gui, Xiaohong; Wu, Jie; Xu, Jiying; Li, Fabin; Li, Dingyue; Liu, Feiying; Shen, Mei; Hong, Jianjun; Mei, Jian; Deriemer, Kathryn; Gao, Qian.

In: Clinical Infectious Diseases, Vol. 61, No. 2, 15.07.2015, p. 219-227.

Research output: Contribution to journalArticle

Yang, C, Shen, X, Peng, Y, Lan, R, Zhao, Y, Long, B, Luo, T, Sun, G, Li, X, Qiao, K, Gui, X, Wu, J, Xu, J, Li, F, Li, D, Liu, F, Shen, M, Hong, J, Mei, J, Deriemer, K & Gao, Q 2015, 'Transmission of Mycobacterium tuberculosis in China: A Population-Based Molecular Epidemiologic Study', Clinical Infectious Diseases, vol. 61, no. 2, pp. 219-227. https://doi.org/10.1093/cid/civ255
Yang, Chongguang ; Shen, Xin ; Peng, Ying ; Lan, Rushu ; Zhao, Yuling ; Long, Bo ; Luo, Tao ; Sun, Guomei ; Li, Xia ; Qiao, Ke ; Gui, Xiaohong ; Wu, Jie ; Xu, Jiying ; Li, Fabin ; Li, Dingyue ; Liu, Feiying ; Shen, Mei ; Hong, Jianjun ; Mei, Jian ; Deriemer, Kathryn ; Gao, Qian. / Transmission of Mycobacterium tuberculosis in China : A Population-Based Molecular Epidemiologic Study. In: Clinical Infectious Diseases. 2015 ; Vol. 61, No. 2. pp. 219-227.
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abstract = "Background. Understanding the transmission of Mycobacterium tuberculosis is essential for the development of efficient tuberculosis control strategies. China has the second-largest tuberculosis burden in the world. Recent transmission and infection with M. tuberculosis, particularly drug-resistant strains, may account for many new tuberculosis cases. Methods. We performed a population-based molecular epidemiologic study of pulmonary tuberculosis in China during 1 July 2009 to 30 June 2012. We defined clusters as cases with identical variable number tandem repeat genotype patterns and identified the risk factors associated with clustering, by logistic regression. Relative transmission rates were estimated by the sputum smear status and drug susceptibility status of tuberculosis patients. Results. Among 2274 culture-positive tuberculosis patients with genotyped isolates, there were 705 (31.0{\%}) tuberculosis patients in 287 clusters. Multidrug-resistant (MDR) tuberculosis (adjusted odds ratio [aOR], 1.86∗95{\%} confidence interval [CI], 1.25-2.63) and infection with a Beijing family strain (aOR, 1.56∗95{\%} CI, 1.23-2.96) were associated with clustering. Eighty-four of 280 (30.0{\%}) clusters had a putative source case that was sputum smear negative, and 30.6{\%} of their secondary cases were attributed to transmission by sputum smear-negative patients. The relative transmission rate for sputum smear negative compared with sputum smear-positive patients was 0.89 (95{\%} CI,. 68-1.10), and was 1.51 (95{\%} CI, 1.00-2.24) for MDR tuberculosis vs drug-susceptible tuberculosis. Conclusions. Recent transmission of M. tuberculosis, including MDR strains, contributes substantially to tuberculosis disease in China. Sputum smear-negative cases were responsible for at least 30{\%} of the secondary cases. Interventions to reduce the transmission of M. tuberculosis should be implemented in China.",
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T2 - A Population-Based Molecular Epidemiologic Study

AU - Yang, Chongguang

AU - Shen, Xin

AU - Peng, Ying

AU - Lan, Rushu

AU - Zhao, Yuling

AU - Long, Bo

AU - Luo, Tao

AU - Sun, Guomei

AU - Li, Xia

AU - Qiao, Ke

AU - Gui, Xiaohong

AU - Wu, Jie

AU - Xu, Jiying

AU - Li, Fabin

AU - Li, Dingyue

AU - Liu, Feiying

AU - Shen, Mei

AU - Hong, Jianjun

AU - Mei, Jian

AU - Deriemer, Kathryn

AU - Gao, Qian

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N2 - Background. Understanding the transmission of Mycobacterium tuberculosis is essential for the development of efficient tuberculosis control strategies. China has the second-largest tuberculosis burden in the world. Recent transmission and infection with M. tuberculosis, particularly drug-resistant strains, may account for many new tuberculosis cases. Methods. We performed a population-based molecular epidemiologic study of pulmonary tuberculosis in China during 1 July 2009 to 30 June 2012. We defined clusters as cases with identical variable number tandem repeat genotype patterns and identified the risk factors associated with clustering, by logistic regression. Relative transmission rates were estimated by the sputum smear status and drug susceptibility status of tuberculosis patients. Results. Among 2274 culture-positive tuberculosis patients with genotyped isolates, there were 705 (31.0%) tuberculosis patients in 287 clusters. Multidrug-resistant (MDR) tuberculosis (adjusted odds ratio [aOR], 1.86∗95% confidence interval [CI], 1.25-2.63) and infection with a Beijing family strain (aOR, 1.56∗95% CI, 1.23-2.96) were associated with clustering. Eighty-four of 280 (30.0%) clusters had a putative source case that was sputum smear negative, and 30.6% of their secondary cases were attributed to transmission by sputum smear-negative patients. The relative transmission rate for sputum smear negative compared with sputum smear-positive patients was 0.89 (95% CI,. 68-1.10), and was 1.51 (95% CI, 1.00-2.24) for MDR tuberculosis vs drug-susceptible tuberculosis. Conclusions. Recent transmission of M. tuberculosis, including MDR strains, contributes substantially to tuberculosis disease in China. Sputum smear-negative cases were responsible for at least 30% of the secondary cases. Interventions to reduce the transmission of M. tuberculosis should be implemented in China.

AB - Background. Understanding the transmission of Mycobacterium tuberculosis is essential for the development of efficient tuberculosis control strategies. China has the second-largest tuberculosis burden in the world. Recent transmission and infection with M. tuberculosis, particularly drug-resistant strains, may account for many new tuberculosis cases. Methods. We performed a population-based molecular epidemiologic study of pulmonary tuberculosis in China during 1 July 2009 to 30 June 2012. We defined clusters as cases with identical variable number tandem repeat genotype patterns and identified the risk factors associated with clustering, by logistic regression. Relative transmission rates were estimated by the sputum smear status and drug susceptibility status of tuberculosis patients. Results. Among 2274 culture-positive tuberculosis patients with genotyped isolates, there were 705 (31.0%) tuberculosis patients in 287 clusters. Multidrug-resistant (MDR) tuberculosis (adjusted odds ratio [aOR], 1.86∗95% confidence interval [CI], 1.25-2.63) and infection with a Beijing family strain (aOR, 1.56∗95% CI, 1.23-2.96) were associated with clustering. Eighty-four of 280 (30.0%) clusters had a putative source case that was sputum smear negative, and 30.6% of their secondary cases were attributed to transmission by sputum smear-negative patients. The relative transmission rate for sputum smear negative compared with sputum smear-positive patients was 0.89 (95% CI,. 68-1.10), and was 1.51 (95% CI, 1.00-2.24) for MDR tuberculosis vs drug-susceptible tuberculosis. Conclusions. Recent transmission of M. tuberculosis, including MDR strains, contributes substantially to tuberculosis disease in China. Sputum smear-negative cases were responsible for at least 30% of the secondary cases. Interventions to reduce the transmission of M. tuberculosis should be implemented in China.

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KW - recent transmission; China

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