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

Author(s): Zelner, Jonathan L.; Murray, Megan B.; Becerra, Mercedes C.; Galea, Jerome; Lecca, Leonid; et al

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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-conrmed 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 ndings 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.
Publication Date: 15-Jan-2016
Electronic Publication Date: 14-Jul-2015
Citation: Zelner, Jonathan L., Murray, Megan B., Becerra, Mercedes C., Galea, Jerome, Lecca, Leonid, Calderon, Roger, Yataco, Rosa, Contreras, Carmen, Zhang, Zibiao, Manjourides, Justin, Grenfell, Bryan T., Cohen, Ted. (2016). Identifying Hotspots of Multidrug-Resistant Tuberculosis Transmission Using Spatial and Molecular Genetic Data. Journal of Infectious Diseases, 213 (2), 287 - 294. doi:10.1093/infdis/jiv387
DOI: doi:10.1093/infdis/jiv387
ISSN: 0022-1899
EISSN: 1537-6613
Pages: 287 - 294
Type of Material: Journal Article
Journal/Proceeding Title: Journal of Infectious Diseases
Version: Final published version. This is an open access article.



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