Transmission of multidrug-resistant tuberculosis in the UK: a cross-sectional molecular and epidemiological study of clustering and contact tracing

Anderson, Laura; Tamne, Surinder; Brown, Timothy J.; Watson, John; Mullarkey, Catherine; Zenner, Dominik; Abubakar, Ibrahim

doi:10.1016/s1473-3099(14)70022-2

Cited by 67 publications

(65 citation statements)

References 26 publications

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“…Helping them understand their risk will sensitize them to cardiovascular prevention. This method is called contact tracing, which is used in infectious disease control [93]. …”

Section: Discussionmentioning

confidence: 99%

Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review

et al. 2017

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Background: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. Aims and Objectives: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care. Methods: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included. Results: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. Conclusion: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.

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“…Helping them understand their risk will sensitize them to cardiovascular prevention. This method is called contact tracing, which is used in infectious disease control [93]. …”

Section: Discussionmentioning

confidence: 99%

Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review

et al. 2017

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“…1 However, the high risk of MDR-TB among patients with previous treatment history has resulted in a common brief that most MDR-TB cases were due to the acquisition of resistance, and led to the allocation of resources to improve treatment. Although previous studies suggested that many MDR-TB cases resulted from the transmission of MDR strains, 10-13 few studies present data that provide direct evidence of MDR-TB transmission at the population level. Thus, we hypothesized that the transmission of MDR strains plays a major role in the high prevalence of MDR-TB in China.…”

Section: Introductionmentioning

confidence: 96%

Transmission of multidrug-resistant Mycobacterium tuberculosis in Shanghai, China: a retrospective observational study using whole-genome sequencing and epidemiological investigation

Yang

Luò

Shen

et al. 2017

The Lancet Infectious Diseases

213

221

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Summary Background Multidrug-resistant tuberculosis (MDR-TB) is a significant threat to tuberculosis elimination worldwide. Understanding the transmission pattern is crucial for its control. We used a genomic epidemiological approach to assess the recent transmission of MDR-TB and potential risk factors for transmission. Methods In a population-based retrospective study, we performed variable-number-of-tandem-repeat (VNTR) genotyping, followed by whole-genome sequencing (WGS) of isolates from all MDR-TB patients in Shanghai, China, 2009-2012. We measured strain diversity within and between genomically clustered patients. Genomic and epidemiologic data were combined to construct transmission networks. Findings 367 (5%) of 7982 patients with tuberculosis had MDR tuberculosis and 324 (88%) of these had isolates available for genomic analysis. 103 (32%) of the 324 MDR strains were in 38 genomic clusters that differed by 12 or fewer single nucleotide polymorphisms (SNPs), indicating recent transmission of MDR strains. Patients who had delayed diagnosis or were older than 45 years had high risk of recent transmission. 235 (73%) patients with MDR tuberculosis probably had transmission of MDR strains. Transmission network analysis showed that 33 (87%) of the 38 clusters accumulated additional drug-resistance mutations through emergence or fixation of mutations during transmission. 68 (66%) of 103 clustered MDR strains had compensatory mutations of rifampicin resistance. Interpretation Recent transmission of MDR strains, with increasing drug-resistance, helps drive the MDR-TB epidemic in Shanghai, China. WGS provides a measure of the heterogeneity of drug-resistant mutations within and between hosts and enhances our ability to determine the transmission patterns of MDR-TB. Funding National Science and Technology Major Project, National Natural Science Foundation of China, and US National Insitutes of Health.

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“…For example, TB models might find that the comparative impact of Xpert scale-up strategies depends strongly on the amount of ongoing TB transmission in a community, which in many places may not be known. 6 These results could motivate further data-gathering activities (e.g., molecular epidemiological characterization of acommunity, 39,40 or synthesis of existing programmatic data on TB incidence 41 ) that could help to improve decision-making related to Xpert scale-up in the future. For the spread of rubella, modelling has already led to the collection of new missing data.…”

Section: Linking Model Results To Public Health Policy Around Infementioning

confidence: 99%

Bridging the gap between evidence and policy for infectious diseases: How models can aid public health decision-making

Knight

Dharan

Fox

et al. 2016

International Journal of Infectious Diseases

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SUMMARYThe dominant approach to decision-making in public health policy for infectious diseases relies heavily on expert opinion, which often applies empirical evidence to policy questions in a manner that is neither systematic nor transparent. Although systematic reviews are frequently commissioned to inform specific components of policy (such as efficacy), the same process is rarely applied to the full decision-making process. Mathematical models provide a mechanism through which empirical evidence can be methodically and transparently integrated to address such questions. However, such models are often considered difficult to interpret. In addition, models provide estimates that need to be iteratively reevaluated as new data or considerations arise. Using the case study of a novel diagnostic for tuberculosis, a framework for improved collaboration between public health decision-makers and mathematical modellers that could lead to more transparent and evidence-driven policy decisions for infectious diseases in the future is proposed. The framework proposes that policymakers should establish long-term collaborations with modellers to address key questions, and that modellers should strive to provide clear explanations of the uncertainty of model structure and outputs. Doing so will improve the applicability of models and clarify their limitations when used to inform real-world public health policy decisions.

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Transmission of multidrug-resistant tuberculosis in the UK: a cross-sectional molecular and epidemiological study of clustering and contact tracing

Abstract: Public Health England.

Cited by 67 publications

References 26 publications

Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review

Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review

Transmission of multidrug-resistant Mycobacterium tuberculosis in Shanghai, China: a retrospective observational study using whole-genome sequencing and epidemiological investigation

Bridging the gap between evidence and policy for infectious diseases: How models can aid public health decision-making

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