To determine if local transmission was responsible for rising tuberculosis incidence in a recently dispersed migrant community in Birmingham, UK, during 2004–2013, we conducted enhanced epidemiologic investigation of molecular clusters. This technique identified exact locations of social mixing and chains of apparent recent transmission, which can be helpful for directing resources.
BackgroundTransmission 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.MethodsIsolates 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.ResultsOf 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).ConclusionsThis 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.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3585-8) contains supplementary material, which is available to authorized users.
time of TB diagnosis. Values at the two time points were compared using Student's paired t-tests. Results Thirty-one participants were followed up between August 2012 and February 2013. Serum 25(OH)D concentrations were significantly higher post-recovery than at diagnosis (mean 29.7 vs. 12.2 nmol/L, p < 0.0001). Participants also had higher mean serum concentrations of PTH, corrected calcium and 24,25(OH) 2 D post-recovery than at diagnosis (PTH, 4 Strain typing of tuberculosis (TB) isolates by 24 loci mycobacterial interspersed repetitive unit-variable number tandem repeats (MIRU-VNTRs) is now a routine laboratory tool for TB control, but its utility in informing contact tracing and public health action has not been well reported in the United Kingdom. Since November 2011 we have routinely held typing meetings and undertaken cluster investigation. Over 18 months, 68 clusters were discussed. Fifty-five (81%) clusters were small (2-5 patients), 7 (10%) were medium (6-14 patients) and 6 (9%) were large (>15 patients, median = 42, IQR = 26-52). Enhanced epidemiological investigation was undertaken in 27/68 (40%) clusters. Typing meetings alone readily identified 20 definite epidemiological links between 46/458 (10%) cases. In 15 cases, 9 definite or probable links were not supported by genotyping, leading to expanded screening in one workplace. 112 extended interviews were done. A further 23 definite links between 77 (17%) cases, 2 probable links between 5 (1%) cases and 24 possible links between 72 (16%) cases were found. Expanded screening as a direct result of strain typing and cluster investigation occurred in 4/6 settings where non-household transmission was identified (a factory, 2 places of worship, a hospital, a hostel and a pub). An additional 124 contacts were identified. 65 attended screening, 21 latent TB cases were treated and 1 active TB case was found. Routine incorporation of strain typing data in contact tracing improves diagnosis of latent and active infection but requires investment in data management systems and human resource for enhanced epidemiological investigation. Background Miliary tuberculosis (mTB), a severe manifestation of TB is classically associated with a high mortality. Modern data on the management and outcomes of mTB in developed world settings are lacking. We reviewed clinico-bacteriological features of mTB cases presenting to a teaching hospital in Leicester, UK serving an ethnically diverse population. Methods Retrospective descriptive case-series of all notified mTB cases admitted between 2007 and 2012. Results 41 cases were identified; median age 47 years (IQR:29-65 years), 61% were male and 80.5% patients were of IndianSubcontinent origin. 92.5% of patients were foreign-born and median time between UK arrival and diagnosis was 4 years (IQR:1-10 years). 37(90.2%) patients had an HIV test; 4 were positive (median CD4 count 60;IQR 30-140). Weight loss (87.2%) and fevers (82.9%) were the most common presenting symptoms. 30 patients (73.2%) had abnormal examination findings; pr...
Introduction and Objectives Multi-drug resistant tuberculosis (MDR-TB) is a growing concern 1. Cost of treatment is ten times that of fully sensitive TB. Treatment regimens are complex and prolonged with risk of serious adverse drug reactions (ADRs). Previously no single guidance in the UK has been available to inform clinicians on what baseline testing should be performed and how to monitor for ADRs 2. We would like to introduce the first UK guideline for adverse-effect monitoring in MDR-TB. Methods This document has been written using the best available evidence and, where this is limited, expert consensus. Our multidisciplinary guideline group held regular teleconferences and corresponded by email. When evidence was sparse, expert consensus was sought from the British Thoracic Society TB Special Advisory Group (SAG) and UK MDR-TB Advisory Service. When other specialty input was needed this was sought from experts in that field. Once the guideline was developed it was submitted to the TB SAG for peer review. Results 'MDR-TB: A guideline for treatment monitoring' includes direction on baseline and generic monitoring throughout treatment and individual drug monographs for all drugs currently used to treat MDR-TB in the UK. At the time of writing it is due to be published online, later this month, and will be available on the BTS website (www.brit-thoracic.org.uk). Conclusions We hope that by introducing a guideline to aid ADR monitoring in MDR-TB treatment we can improve morbidity and mortality and reduce treatment costs. By the time of the BTS Winter Meeting we will have nearly six months experience of this guideline being used in practice and will present any feedback received. In due course we plan to audit its use and publish our experiences.
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