2015
DOI: 10.1093/infdis/jiv387
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Identifying Hotspots of Multidrug-Resistant Tuberculosis Transmission Using Spatial and Molecular Genetic Data

Abstract: These findings 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.

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Cited by 66 publications
(73 citation statements)
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“…They therefore highlight the potential impact that novel rapid diagnostic tests that include rifampicin sensitivity testing such as Xpert MTB/RIF® could have on the MDR-TB epidemic. Our findings concur with the outcomes of recent studies demonstrating that primary transmission contributes more substantially to the MDR/RR-TB burden than drug resistance acquisition or amplification during treatment [17, 25]. Interestingly, the model also suggests that failure of second-line regimens may make a significant contribution to the burden of MDR/RR-TB at re-treatment, especially in settings such as Eastern Europe where MDR vigilance is high and patients are able to access MDR/RR-TB treatment.…”
Section: Discussionsupporting
confidence: 92%
“…They therefore highlight the potential impact that novel rapid diagnostic tests that include rifampicin sensitivity testing such as Xpert MTB/RIF® could have on the MDR-TB epidemic. Our findings concur with the outcomes of recent studies demonstrating that primary transmission contributes more substantially to the MDR/RR-TB burden than drug resistance acquisition or amplification during treatment [17, 25]. Interestingly, the model also suggests that failure of second-line regimens may make a significant contribution to the burden of MDR/RR-TB at re-treatment, especially in settings such as Eastern Europe where MDR vigilance is high and patients are able to access MDR/RR-TB treatment.…”
Section: Discussionsupporting
confidence: 92%
“…Thus, these three variables could be used in multivariate analysis (p value < 0,25). The BCG immunization status of the children was related to children's pulmonary TB incidence, 23 but one variable failed the candidate test (p value = 0,333 > 0,25). This variable was excluded in the multivariate analysis because the variance of the data was not balanced or almost all study samples already received BCG immunization (97%).…”
Section: Discussionmentioning
confidence: 96%
“…42,69,128 Indeed, some settings-from Estonia 129,130 to New York 131 -have seen steeper declines in the incidence of drug-resistant tuberculosis than in tuberculosis as a whole after adopting interventions to control the transmission of drug-resistant tuberculosis. Typically, these measures included universal DST, 132 individualised treatment, 133 access to tuberculosis care, 134 and sustained efforts to improve treatment completion, which is only achieved in two-thirds of cases, even in well functioning programmes.…”
Section: Clinical Implications Of the Findings Of Molecular Epidemiologymentioning
confidence: 99%
“…69 Targeting these hotspots might be highly effective for controlling drug-resistant tuberculosis. 128 However, as described by the routine strain typing service in the UK, the effect of molecular epidemiological data on patient care and public health response might not be useful if those data are not reported and acted upon quickly. 153 To achieve this, major technical and systems barriers must be overcome, including the strengthening of information technology systems to facilitate timely capture, export, and potentially automated analysis of complex data, such as in web-based systems; 148 linking molecular data to key epidemiological data (eg, geographical location); improving local scientific capacity; and providing decision makers with sufficient autonomy and resources to act in response to such data.…”
Section: Next-generation Molecular Epidemiologymentioning
confidence: 99%