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

BMC Infectious Diseases

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[1] 0000 0001 1503 7226, grid.5808.5, EPIUnit, Instituto de Saúde Pública, Universidade do Porto, 4050-600, Porto, Portugal;0000 0001 1503 7226, grid.5808.5, Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319, Porto, Portugal;0000 0000 8902 4519, grid.418336.b, Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, 4400-129, Vila Nova de Gaia, Portugal;0000 0001 2159 175X, grid.10328.38, Population Health Research Domain, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Gualtar Campus, 4710-057, Braga, Portugal;0000 0001 2159 175X, grid.10328.38, ICVS/3B, PT Government Associate Laboratory, 4710-057 Braga, 4805-017, Guimarães, Portugal;0000 0001 2159 175X, grid.10328.38, Population Health Research Domain, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Gualtar Campus, 4710-057, Braga, Portugal;0000 0001 2159 175X, grid.10328.38, ICVS/3B, PT Government Associate Laboratory, 4710-057 Braga, 4805-017, Guimarães, Portugal;0000 0001 1503 7226, grid.5808.5, EPIUnit, Instituto de Saúde Pública, Universidade do Porto, 4050-600, Porto, Portugal;Department of Mathematics, Faculty of Sciences, Porto, Portugal;0000 0001 1503 7226, grid.5808.5, Centre of Mathematics, University of Porto, Porto, Portugal;Department of Public Health, Northern Regional Health Administration, 4000-078, Porto, Portugal;0000 0001 1503 7226, grid.5808.5, Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-013, Porto, Portugal;

关键词: Multidrug-resistant tuberculosis;    Epidemiology;    Transmission;    Risk factor;   

DOI  :  10.1186/s12879-019-4189-7

来源: publisher

【 摘 要 】

BackgroundIncreasing 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.MethodsWe 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.ResultsWe 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.ConclusionsDespite 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.

【 授权许可】

CC BY