BMC Infectious Diseases
Volume 19, Issue 1, 2019

A nationwide study of multidrug-resistant tuberculosis in Portugal 2014-2017 using epidemiological and molecular clustering analyses (Article) (Open Access)

Oliveira O. , Gaio R. , Carvalho C. , Correia-Neves M. , Duarte R. , Rito T.*
  • a Population Health Research Domain, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Gualtar Campus, Braga, 4710-057, Portugal, ICVS/3B, PT Government Assocs Laboratory, 4710-057 Braga, Guimarães, 4805-017, Portugal, EPIUnit, Instituto de Saúde Pública, Universidade Do Porto, Porto, 4050-600, Portugal
  • b Department of Mathematics, Faculty of Sciences, Porto, Portugal, Centre of Mathematics, University of Porto, Porto, Portugal
  • c Department of Public Health, Northern Regional Health Administration, Porto, 4000-078, Portugal, Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, 4050-013, Portugal
  • d Population Health Research Domain, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Gualtar Campus, Braga, 4710-057, Portugal, ICVS/3B, PT Government Assocs Laboratory, 4710-057 Braga, Guimarães, 4805-017, Portugal
  • e EPIUnit, Instituto de Saúde Pública, Universidade Do Porto, Porto, 4050-600, Portugal, Departamento de Ciencias da Saude Publica e Forenses e Educacao Medica, Faculdade de Medicina, Universidade Do Porto, Porto, 4200-319, Portugal, Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, 4400-129, Portugal
  • f Population Health Research Domain, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Gualtar Campus, Braga, 4710-057, Portugal, ICVS/3B, PT Government Assocs Laboratory, 4710-057 Braga, Guimarães, 4805-017, Portugal

Abstract

Background: Increasing multidrug-resistant tuberculosis (MDR-TB) incidence is a major threat against TB eradication worldwide. We aim to conduct a detailed MDR-TB study in Portugal, an European country with endemic TB, combining genetic analysis and epidemiological data, in order to assess the efficiency of public health containment of MRD-TB in the country. Methods: We used published MIRU-VNTR data, that we reanalysed using a phylogenetic analysis to better describe MDR-TB cases transmission occurring in Portugal from 2014 to 2017, further enriched with epidemiological data of these cases. Results: We show an MDR-TB transmission scenario, where MDR strains likely arose and are transmitted within local chains. 63% of strains were clustered, suggesting high primary transmission (estimated as 50% using MIRU-VNTR data and 15% considering epidemiological links). These values are higher than those observed across Europe and even for sensitive strains in Portugal using similar methodologies. MDR-TB cases are associated with individuals born in Portugal and evolutionary analysis suggests a local evolution of strains. Consistently the sublineage LAM, the most common in sensitive strains in Europe, is the more frequent in Portugal in contrast with the remaining European MDR-TB picture where immigrant-associated Beijing strains are more common. Conclusions: Despite efforts to track and contain MDR-TB strains in Portugal, their transmission patterns are still as uncontrolled as that of sensitive strains, stressing the need to reinforce surveillance and containment strategies. © 2019 The Author(s).

Author Keywords

Multidrug-resistant tuberculosis transmission Epidemiology Risk factor

Index Keywords

genetics genotype China extrapulmonary tuberculosis immigrant bacterial transmission Portugal Europe human middle aged controlled study multidrug resistant tuberculosis Mycobacterium tuberculosis variable number of tandem repeat Tuberculosis, Multidrug-Resistant Aged cluster analysis Humans lung tuberculosis male female risk factor Beijing Risk Factors prevalence Article Minisatellite Repeats genetic analysis major clinical study Phylogeny adult migration tuberculosis control microbiology Transients and Migrants drug effect bacterial strain
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85068503739&doi=10.1186%2fs12879-019-4189-7&partnerID=40&md5=8b257c7abd3c9b86fcabb623bd0f43ef
DOI: 10.1186/s12879-019-4189-7
ISSN: 14712334
Original Language: English