BMC Infectious Diseases
Volume 19, Issue 1, 2019

Mycobacterium tuberculosis transmission in an ethnically-diverse high incidence region in England, 2007-11 11 Medical and Health Sciences 1117 Public Health and Health Services (Review) (Open Access)

Vynnycky E.* , Keen A.R. , Evans J.T. , Khanom S. , Hawkey P.M. , White R.G. , Abubakar I.
  • a Statistics Modelling and Economics Department, 61 Colindale Avenue, Colindale, London, NW9 5HT, United Kingdom, TB Modelling Group, Centre for Mathematical Modelling of Infectious Diseases, TB Centre and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • b Statistics Modelling and Economics Department, 61 Colindale Avenue, Colindale, London, NW9 5HT, United Kingdom, TB Modelling Group, Centre for Mathematical Modelling of Infectious Diseases, TB Centre and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • c PHE West Midlands Public Health Laboratory, Heart of England NHS Foundation Trust, Birmingham, United Kingdom, Public Health Wales Microbiology Cardiff, Llandough Hospital, Penlan Road, Penarth, CF64 2XX, United Kingdom
  • d PHE West Midlands Public Health Laboratory, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
  • e Queen Elizabeth Hospital, Birmingham, B15 2TH, United Kingdom
  • f TB Modelling Group, Centre for Mathematical Modelling of Infectious Diseases, TB Centre and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • g Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, Research Department of Infection and Population Health, University College London, London, United Kingdom

Abstract

Background: Transmission patterns in high tuberculosis incidence areas in England are poorly understood but need elucidating to focus contact tracing. We study transmission within and between age, ethnic and immigrant groups using molecular data from the high incidence West Midlands region. Methods: Isolates from culture-confirmed tuberculosis cases during 2007-2011 were typed using 24-locus Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeats (MIRU-VNTR). We estimated the proportion of disease attributable to recent transmission, calculated the proportion of isolates matching those from the two preceding years ("retrospectively clustered"), and identified risk factors for retrospective clustering using multivariate analyses. We calculated the ratio (RCR) between the observed and expected proportion clustered retrospectively within or between age, ethnic and immigrant groups. Results: Of the 2159 available genotypes (79% of culture-confirmed cases), 34% were attributed to recent transmission. The percentage retrospectively clustered decreased from 50 to 24% for 0-14 and ≥ 65 year olds respectively (p = 0.01) and was significantly lower for immigrants than the UK-born. Higher than expected clustering occurred within 15-24 year olds (RCR: 1.4 (95% CI: 1.1-1.8)), several ethnic groups, and between UK-born or long-term immigrants with the UK-born (RCR: 1.8 (95% CI: 1.1-2.4) and 1.6 (95% CI: 1.2-1.9) respectively). Conclusions: This study is the first to consider "who clusters with whom" in a high incidence area in England, laying the foundation for future whole-genome sequencing work. The higher than expected clustering seen here suggests that preferential mixing between some age, ethnic and immigrant groups occurs; prioritising contact tracing to groups with which cases are most likely to cluster retrospectively could improve TB control. © 2019 The Author(s).

Author Keywords

transmission Contact patterns West Midlands tuberculosis England Clustering MIRU-VNTR

Index Keywords

genetics genotype immigrant transmission molecular epidemiology human trend study middle aged Ethnic Groups ethnic group variable number of tandem repeat Mycobacterium tuberculosis Aged ethnology cluster analysis Humans migrant Adolescent Infant, Newborn male Emigrants and Immigrants preschool child England tuberculosis risk factor Infant Risk Factors Child, Preschool Multivariate Analysis newborn female Review isolation and purification Incidence disease transmission infection control Minisatellite Repeats major clinical study adult age case study microbiology bacterium isolate retrospective study bacterium culture whole genome sequencing Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85059744946&doi=10.1186%2fs12879-018-3585-8&partnerID=40&md5=e355a622d77ba5c256d8914f10e50095
DOI: 10.1186/s12879-018-3585-8
ISSN: 14712334
Original Language: English