Factors associated with primary transmission of multidrug-resistant tuberculosis compared with healthy controls in Henan Province, China

Infectious Diseases of Poverty

Xin-Xu Li¹  Ya-Hong Qu³  Zhen-Ya Ma³  Jin Xing²  Yan-Qiu Zhang²  Wei-Bin Li³ 

[1] National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, Changping District, PRC;Henan Center for Disease Control and Prevention, Zhengzhou 450016, PRC;Institute for Tuberculosis Control and Prevention of Kaifeng prefecture, Kaifeng 475000, Henan Province, People’s Republic of China

关键词: China;    Matched case–control;    Factors;    Primary MDR-TB;    Tuberculosis;   

Others  :  1144148
DOI  :  10.1186/s40249-015-0045-1

 received in 2014-12-16, accepted in 2015-03-10,  发布年份 2015

【 摘 要 】

Background

It is estimated that there are about 74,000 primary multidrug-resistant tuberculosis (MDR-TB) patients per year according to the prevalence of MDR-TB of 5.7% among new TB patients in China. Thus, the risks of primary transmission of MDR-TB require further attention. This study aimed to identify the factors associated with primary transmission of MDR-TB in Henan province, where the number of new TB patients is ranked second highest in China.

Methods

A 1:1 matched case–control study was conducted in Henan, China. Cases were primary MDR-TB patients who were individually matched with a healthy control without TB from the same neighborhood. The study was conducted from July 2013 to June 2014. Both case and control were matched by age (±5 years) and sex. Conditional logistic regression was used to compute adjusted odds ratios (AORs) with corresponding 95% confidence intervals (CIs) for risk factors associated with primary MDR-TB.

Results

For the study, 146 pairs of participants were recruited. The final multivariable logistic regression model disclosed that after adjusting for age and sex, primary MDR-TB cases were more likely to be single (AOR, 5.4; 95% CI, 1.4–20.7), earn an annual income of ≤ 12,000 yuan (RMB) (AOR, 9.9; 95% CI, 2.0–48.1), experience more life pressure/stress (AOR, 10.8; 95% CI, 2.8–41.5), not be medically insured (AOR, 50.1; 95% CI, 8.2–306.8), and suffer from diabetes, cardiovascular disease or other respiratory diseases, or cancer (AOR, 57.1; 95% CI, 8.6–424.2).

Conclusions

In order to control primary transmission of MDR-TB in China, we recommend that improving the social support, living standards and medical security of the lower social class become a priority.

【 授权许可】

   
2015 Li et al.; licensee BioMed Central.

【 参考文献 】

• [1]Faustini A, Hall AJ, Perucci CA: Risk factors for multidrug resistant tuberculosis in Europe: a systematic review. Thorax 2006, 61:158-163.
• [2]Diande S, Sangare L, Kouanda S, Dingtoumda BI, Mourfou A, Ouedraogo F, et al.: Risk factors for multidrug-resistant tuberculosis in four centers in Burkina Faso, West Africa. Microb Drug Resist 2009, 15:217-221.
• [3]Tanrikulu AC, Abakay A, Abakay O: Risk factors for multidrug-resistant tuberculosis in Diyarbakir, Turkey. Med Sci Monit 2010, 16:PH57-62.
• [4]Hu Y, Mathema B, Wang W, Hoffner S, Kreiswirth B, Xu B: Prevalence of multidrug-resistant pulmonary tuberculosis in counties with different duration of DOTS implementation in rural China. Microb Drug Resist 2008, 14:227-232.
• [5]Jain A, Mondal R, Prasad R, Singh K, Ahuja RC: Prevalence of multidrug resistant Mycobacterium tuberculosis in Lucknow, Uttar Pradesh. Indian J Med Res 2008, 128:300-306.
• [6]Sanchez-Padilla E, Dlamini T, Ascorra A, Rusch-Gerdes S, Tefera ZD, Calain P, et al.: High prevalence of multidrug-resistant tuberculosis, Swaziland, 2009–2010. Emerg Infect Dis 2012, 18:29-37.
• [7]World Health Organization: Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response. World Health Organization Press, Geneva, Switzerland; 2010.
• [8]World Health Organization: Global tuberculosis control: WHO report 2011. World Health Organization Press, Geneva, Switzerland; 2011.
• [9]Ridzon R, Kenyon T, Luskin-Hawk R, Schultz C, Valway S, Onorato IM: Nosocomial transmission of human immunodeficiency virus and subsequent transmission of multidrug-resistant tuberculosis in a healthcare worker. Infect Control Hosp Epidemiol 1997, 18:422-423.
• [10]Cobo J, Asensio A, Moreno S, Navas E, Pintado V, Oliva J, et al.: Risk factors for nosocomial transmission of multidrug-resistant tuberculosis due to Mycobacterium bovis among HIV-infected patients. Int J Tuberc Lung Dis 2001, 5:413-418.
• [11]Vella V, Racalbuto V, Guerra R, Marra C, Moll A, Mhlanga Z, et al.: Household contact investigation of multidrug-resistant and extensively drug-resistant tuberculosis in a high HIV prevalence setting. Int J Tuberc Lung Dis 2011, 15:1170-1175.
• [12]Gilpin CM, Simpson G, Vincent S, O'Brien TP, Knight TA, Globan M, et al.: Evidence of primary transmission of multidrug-resistant tuberculosis in the Western Province of Papua New Guinea. Med J Aust 2008, 188:148-152.
• [13]Vazquez-Gallardo R, Anibarro L, Fernandez-Villar A, Diaz-Cabanela D, Cruz-Ferro E, del Molino ML P, et al.: Multidrug-resistant tuberculosis in a low-incidence region shows a high rate of transmission. Int J Tuberc Lung Dis 2007, 11:429-435.
• [14]Zhao M, Li X, Xu P, Shen X, Gui X, Wang L, et al.: Transmission of MDR and XDR tuberculosis in Shanghai, China. PLoS One 2009, 4:e4370.
• [15]Hu Y, Hoffner S, Jiang W, Wang W, Xu B: Extensive transmission of isoniazid resistant M. tuberculosis and its association with increased multidrug-resistant TB in two rural counties of eastern China: a molecular epidemiological study. BMC Infect Dis 2010, 10:43. BioMed Central Full Text
• [16]Otero L, Krapp F, Tomatis C, Zamudio C, Matthys F, Gotuzzo E, et al.: High prevalence of primary multidrug resistant tuberculosis in persons with no known risk factors. PLoS One 2011, 6:e26276.
• [17]World Health Organization: Guidelines for surveillance of drug resistance in tuberculosis (Second Edition). World Health Organization Press, Geneva, Switzerland; 2003.
• [18]Disease Control Bureau of the Ministry of Health, Department of Medical Administration of the Ministry of Health, Chinese Center for Disease Control and Prevention: Guidelines for implementing the national tuberculosis control program in China (2008). Peking Union Medical College Press, Beijing, China; 2009.
• [19]Wang GJ, Sleigh A, Zhou G, Jackson S, Liu XL: Nonbiologic risk factors of pulmonary tuberculosis among adults in Henan: a case–control study. Zhonghua Liu Xing Bing Xue Za Zhi 2005, 26:92-96.
• [20]Pang PT, Leung CC, Lee SS: Neighbourhood risk factors for tuberculosis in Hong Kong. Int J Tuberc Lung Dis 2010, 14:585-592.
• [21]Tekkel M, Rahu M, Loit HM, Baburin A: Risk factors for pulmonary tuberculosis in Estonia. Int J Tuberc Lung Dis 2002, 6:887-894.
• [22]Valim AR, Possuelo LG, Cafrune PI, Borges M, Ribeiro MO, Rossetti ML, et al.: Evaluation and genotyping of multidrug-resistant cases of tuberculosis in southern Brazil. Microb Drug Resist 2006, 12:186-191.
• [23]Yang L, Wu DL, Guo HG, Liu JW: A study of the psychological and social factors in patients with pulmonary tuberculosis. Zhonghua Jie He He Hu Xi Za Zhi 2003, 26:704-707.
• [24]Suhadev M, Thomas BE, Raja Sakthivel M, Murugesan P, Chandrasekaran V, Charles N, et al.: Alcohol use disorders (AUD) among tuberculosis patients: a study from Chennai, South India. PLoS One 2011, 6:e19485.
• [25]Zhao P, Li XJ, Zhang SF, Wang XS, Liu CY: Social behaviour risk factors for drug resistant tuberculosis in Mainland China: a meta-analysis. J Int Med Res 2012, 40:436-445.
• [26]Kondo H, Morimoto K: Effects of mental arithmetic stress on blood cell counts and the immune system. Environ Health Prev Med 1996, 1:76-79.
• [27]Benschop RJ, Nieuwenhuis EE, Tromp EA, Godaert GL, Ballieux RE, van Doornen LJ: Effects of beta-adrenergic blockade on immunologic and cardiovascular changes induced by mental stress. Circulation 1994, 89:762-769.
• [28]McQuistion HL, Colson P, Yankowitz R, Susser E: Tuberculosis infection among people with severe mental illness. Psychiatr Serv 1997, 48:833-835.
• [29]Ballieux RE: Impact of mental stress on the immune response. J Clin Periodontol 1991, 18:427-430.
• [30]Xu B, Jiang QW, Xiu Y, Diwan VK: Diagnostic delays in access to tuberculosis care in counties with or without the National Tuberculosis Control Programme in rural China. Int J Tuberc Lung Dis 2005, 9:784-790.
• [31]Jianzhao H, van den Hof S, Lin X, Yubang Q, Jinglong H, van der Werf MJ: Risk factors for non-cure among new sputum smear positive tuberculosis patients treated in tuberculosis dispensaries in Yunnan, China. BMC Health Serv Res 2011, 11:97. BioMed Central Full Text
• [32]Faurholt-Jepsen D, Range N, Praygod G, Jeremiah K, Faurholt-Jepsen M, Aabye MG, et al.: Diabetes is a risk factor for pulmonary tuberculosis: a case–control study from Mwanza, Tanzania. PLoS One 2011, 6:e24215.
• [33]Kamboj M, Sepkowitz KA: The risk of tuberculosis in patients with cancer. Clin Infect Dis 2006, 42:1592-1595.
• [34]Kim HR, Hwang SS, Ro YK, Jeon CH, Ha DY, Park SJ, et al.: Solid-organ malignancy as a risk factor for tuberculosis. Respirology 2008, 13:413-419.
• [35]Fisher-Hoch SP, Whitney E, McCormick JB, Crespo G, Smith B, Rahbar MH, et al.: Type 2 diabetes and multidrug-resistant tuberculosis. Scand J Infect Dis 2008, 40:888-893.
• [36]Manjourides J, Lin HH, Shin S, Jeffery C, Contreras C, Cruz JS, et al.: Identifying multidrug resistant tuberculosis transmission hotspots using routinely collected data. Tuberculosis (Edinb) 2012, 92:273-279.