Genotypic and spatial analysis of transmission dynamics of tuberculosis in Shanghai, China: a 10-year prospective population-based surveillance study

Li, Meng; Lu, Liping; Jing, Qi; Jiang, Yuan; Yang, Chongguang; Li, Jing; Zhang, Yangyi; Zou, Jinyan; Li, Y.-J.; Dai, Wayne Wei-Ming; Hong, Jianjun; Takiff, Howard; Shen, Xin; X, Guo; Yuan, Zhengan; Gao, Qian

doi:10.1016/j.lanwpc.2023.100833

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…Particularly, Songjiang has a population of 1.76 million, of which internal migrants account for 61.4%, and Minhang has a population of 2.53 million, with 50.2% internal migrants ( 30 ). Interestingly, previous studies in Songjiang have highlighted the importance of recent local transmission and the impact of internal migrants on the TB burden ( 31 , 32 ). And previous research has unmasked the association between high cluster areas and local transmission ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

Spatial pattern of isoniazid-resistant tuberculosis and its associated factors among a population with migrants in China: a retrospective population-based study

Zhang,

Sun,

et al. 2024

Front. Public Health

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BackgroundIsoniazid-resistant, rifampicin-susceptible tuberculosis (Hr-TB) globally exhibits a high prevalence and serves as a potential precursor to multidrug-resistant tuberculosis (MDR-TB). Recognizing the spatial distribution of Hr-TB and identifying associated factors can provide strategic entry points for interventions aimed at early detection of Hr-TB and prevention of its progression to MDR-TB. This study aims to analyze spatial patterns and identify socioeconomic, demographic, and healthcare factors associated with Hr-TB in Shanghai at the county level.MethodWe conducted a retrospective study utilizing data from TB patients with available Drug Susceptible Test (DST) results in Shanghai from 2010 to 2016. Spatial autocorrelation was explored using Global Moran’s I and Getis-Ord Gi∗ statistics. A Bayesian hierarchical model with spatial effects was developed using the INLA package in R software to identify potential factors associated with Hr-TB at the county level.ResultsA total of 8,865 TB patients with DST were included in this analysis. Among 758 Hr-TB patients, 622 (82.06%) were new cases without any previous treatment history. The drug-resistant rate of Hr-TB among new TB cases in Shanghai stood at 7.20% (622/8014), while for previously treated cases, the rate was 15.98% (136/851). Hotspot areas of Hr-TB were predominantly situated in southwestern Shanghai. Factors positively associated with Hr-TB included the percentage of older adult individuals (RR = 3.93, 95% Crl:1.93–8.03), the percentage of internal migrants (RR = 1.35, 95% Crl:1.15–1.35), and the number of healthcare institutions per 100 population (RR = 1.17, 95% Crl:1.02–1.34).ConclusionWe observed a spatial heterogeneity of Hr-TB in Shanghai, with hotspots in the Songjiang and Minhang districts. Based on the results of the models, the internal migrant population and older adult individuals in Shanghai may be contributing factors to the emergence of areas with high Hr-TB notification rates. Given these insights, we advocate for targeted interventions, especially in identified high-risk hotspots and high-risk areas.

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Section: Discussionmentioning

confidence: 99%

Spatial pattern of isoniazid-resistant tuberculosis and its associated factors among a population with migrants in China: a retrospective population-based study

Zhang,

Sun,

et al. 2024

Front. Public Health

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“…As a highly successful pathogen, MTBC exhibits remarkable adaptation to its human host, in uencing between-host selection of the bacterial population and population-level epidemiologic dynamics (6), (7). This in uence is primarily determined by spatial proximity and the likelihood of contact between hosts, with transmission probability decreasing as the distance between hosts increases (8), (9), (10).…”

Section: Introductionmentioning

confidence: 99%

Mapping the threads: Geospatial Exploration of Shared Modifiable Tuberculosis Disease Risks in a clinic-based population

Asare-Baah,

Luong,

Afriyie-Mensah

et al. 2024

Preprint

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Background In emerging economies experiencing rapid sociodemographic transitions and historically high tuberculosis (TB) prevalence, effective TB control requires acknowledging the evolving socio-behavioral characteristics of diverse patient populations shaping community-level TB risk. This study aimed to explore the spatial distribution and clustering of shared modifiable clinical and social risk factors for TB in a clinic-based population in Accra, Ghana.Methods We prospectively enrolled new and previously treated TB patients between June 2022 and July 2023. At diagnosis, patients provided informed consent to collect their residential coordinates and completed a questionnaire assessing their demographic and modifiable clinical and social risks for TB. We used geospatial scan statistics to describe the spatial distribution of cases and PERMANOVA to examine the correlation between spatial proximity and shared socio-behavioral risks, with a 1.5 square kilometer threshold defining significant residential proximity.Results The study population (N = 150) was predominantly male (68.0%) and of working age (80.0% aged 25–64 years), with half the sample engaged in unskilled labor (51.3%). Approximately one-third reported heavy alcohol (36.0%) and recreational drug use (26.7%) in the past year. Fifteen percent were HIV-positive, of whom more than 80% were diagnosed at the time of TB diagnosis. Local Moran's I statistics revealed spatial clusters of TB cases in separate sections of the study area. Unskilled labor, recreational drug use, and a history of cough in patients’ social contacts were significantly associated with residential proximity, explaining 1.26% of the variance in our model (F = 1.89, R^2 = 1.3%, p = 0.004).Conclusions Shared modifiable risks, including unskilled labor, recreational drug use, and close contact with TB, exhibited spatial clustering, suggesting their potential to enhance TB disease progression and transmission in this setting. Targeted interventions addressing these socio-behavioral risks within identified hotspots may improve TB control efforts.

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“… 21 , 22 We previously established population-based epidemiological study sites in Songjiang District, an urban area in Shanghai, and Wusheng County, a rural area in Sichuan Province, and obtained WGS data from the clinical M. tuberculosis strains isolated in both sites over periods of at least 10 years. 23 , 24 Here, we report our analysis of this WGS data to identify trends in TB drug resistance in both Songjiang and Wusheng.…”

Section: Introductionmentioning

confidence: 99%

Trends of Drug-Resistant Tuberculosis in an Urban and a Rural Area in China: A 10-Year Population-Based Molecular Epidemiological Study

Xu,

Li,

Jiang

et al. 2024

IDR

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Objective Drug resistance is the critical determinant for appropriate tuberculosis (TB) treatment regimens and an important indicator of the local TB burden. We aimed to investigate and compare trends in TB drug resistance in the urban Songjiang District of Shanghai from 2011 to 2020, and the rural Wusheng County of Sichuan Province from 2009 to 2020, to assess the effectiveness of local TB control and treatment programs. Methods Whole-genome sequencing data of Mycobacterium tuberculosis were used to predict drug-resistance profiles and identify genomic clusters. Clustered, retreated cases of drug-resistant TB with identical resistance mutations, as well as all new resistant cases, were defined as transmitted resistance. The Cochran-Armitage trend test was used to identify trends in the proportions. Differences between groups were tested using the Wilcoxon rank sum or chi-square tests. Results The annual proportions of rifampicin-resistant (RR), isoniazid-resistant (INH-R) and multidrug-resistant (MDR) TB cases did not change significantly in Songjiang. In Wusheng, however, the percentage of total TB cases that were RR decreased from 13.2% in 2009 to 3.7% in 2020, the INH-R cases decreased from 16.5% to 7.3%, and the MDR cases decreased from 10.7% to 3.7%. In retreated cases, the percentage of drug resistance decreased in both Songjiang and Wusheng, suggesting improved treatment programs. Transmitted resistance accounted for more than two thirds of drug-resistant cases over the entire study periods, and in recent years this proportion has increased significantly in Songjiang. Conclusion In both urban Songjiang and rural Wusheng, drug-resistant TB is mostly the result of transmission of drug resistant strains and the percentage of transmitted resistance will likely increase with on-going improvements in the TB treatment programs. Reducing the prevalence of drug resistance depends principally upon decreasing transmission through the prompt diagnosis and effective treatment of drug-resistant TB cases.

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Genotypic and spatial analysis of transmission dynamics of tuberculosis in Shanghai, China: a 10-year prospective population-based surveillance study

Cited by 5 publications

References 27 publications

Spatial pattern of isoniazid-resistant tuberculosis and its associated factors among a population with migrants in China: a retrospective population-based study

Spatial pattern of isoniazid-resistant tuberculosis and its associated factors among a population with migrants in China: a retrospective population-based study

Mapping the threads: Geospatial Exploration of Shared Modifiable Tuberculosis Disease Risks in a clinic-based population

Trends of Drug-Resistant Tuberculosis in an Urban and a Rural Area in China: A 10-Year Population-Based Molecular Epidemiological Study

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