Trends of multidrug-resistant tuberculosis clustering in Portugal

Macedo, Rita; Duarte, Raquel

doi:10.1183/23120541.00151-2018

Cited by 2 publications

(4 citation statements)

References 4 publications

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“…The majority of clusters identified in our study belonged to L4. This is consistent with previous studies carried out in our geographical area 9,21 , however, the largest cluster was caused by an animal linage strain, coming from an existent outbreak during the nineties 22,23 .…”

Section: Discussionsupporting

confidence: 93%

“…A higher proportion of foreign-born was found in cluster, in contrast with data obtained by other European countries 5,21,28 . Related to the Foreign-Clusters, MDR transmission could be occurring outside Spain.…”

Section: Discussioncontrasting

confidence: 93%

“…Other shorter studies realized in Switzerland and Germany showed 24.4% and 49% of clustering, respectively, in seven years of follow-up 20 . On the other hand, a recent 4-year follow-up study in Portugal showed the highest clustering rate of 63.4% 21 . These differences in clustering and the persistence of some patterns should take us to reconsider the four-year time-frame as the most appropriate follow-up time to complement the molecular epidemiological studies 13 .…”

Section: Discussionmentioning

confidence: 88%

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The value of the continuous genotyping of multi-drug resistant tuberculosis over 20 years in Spain

Iglesias

Ibarz

Cebollada

et al. 2020

Sci Rep

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Molecular epidemiology of circulating clinical isolates is crucial to improve prevention strategies. The Spanish Working Group on multidrug resistant tuberculosis (MDR-TB) is a network that monitors the MDR-TB isolates in Spain since 1998. The aim of this study was to present the study of the MDR-TB and extensively drug-resistant tuberculosis (XDR-TB) patterns in Spain using the different recommended genotyping methods over time by a national coordinated system. Based on the proposed genotyping methods in the European Union until 2018, the preservation of one method, MIRU-VNTR, applied to selected clustered strains permitted to maintain our study open for 20 years. The distribution of demographic, clinical and epidemiological characteristics of clustered and non-clustered cases of MDR/XDR tuberculosis with proportion differences as assessed by Pearson’s chi-squared or Fisher’s exact test was compared. The differences in the quantitative variables using the Student's-t test and the Mann–Whitney U test were evaluated. The results obtained showed a total of 48.4% of the cases grouped in 77 clusters. Younger age groups, having a known TB case contact (10.2% vs 4.7%) and XDR-TB (16.5% vs 1.8%) were significantly associated with clustering. The largest cluster corresponded to a Mycobacterium bovis strain mainly spread during the nineties. A total of 68.4% of the clusters detected were distributed among the different Spanish regions and six clusters involving 104 cases were grouped in 17 and 18 years. Comparison of the genotypes obtained with those European genotypes included in The European Surveillance System (TESSy) showed that 87 cases had become part of 20 European clusters. The continuity of MDR strain genotyping in time has offered a widespread picture of the situation that allows better management of this public health problem. It also shows the advantage of maintaining one genotyping method over time, which allowed the comparison between ancient, present and future samples.

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Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 93%

Section: Discussionmentioning

confidence: 88%

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The value of the continuous genotyping of multi-drug resistant tuberculosis over 20 years in Spain

Iglesias

Ibarz

Cebollada

et al. 2020

Sci Rep

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“…We estimated recent transmission to 52.2% using MIRU-VNTR data and 14.9 after adjustment for epidemiological data. While MIRU-VNTR data largely overestimates recent transmission estimates [16, 35], the epidemiological data likely underestimates direct transmission given the difficulty in assessing all relevant epidemiological information using only conventional contact tracing data in complex transmission chains [18]. Nevertheless, these 14.9% were still twice as high as what was reported in UK [19] and Switzerland [34] using similar approaches.…”

Section: Discussionmentioning

confidence: 99%

A nationwide study of multidrug-resistant tuberculosis in Portugal 2014–2017 using epidemiological and molecular clustering analyses

et al. 2019

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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. Electronic supplementary material The online version of this article (10.1186/s12879-019-4189-7) contains supplementary material, which is available to authorized users.

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Trends of multidrug-resistant tuberculosis clustering in Portugal

Cited by 2 publications

References 4 publications

The value of the continuous genotyping of multi-drug resistant tuberculosis over 20 years in Spain

The value of the continuous genotyping of multi-drug resistant tuberculosis over 20 years in Spain

A nationwide study of multidrug-resistant tuberculosis in Portugal 2014–2017 using epidemiological and molecular clustering analyses

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