Assessment of tuberculosis spatial hotspot areas in Antananarivo, Madagascar, by combining spatial analysis and genotyping

BMC Infectious Diseases

Research Article

Guislaine Refrégier¹  Christophe Sola¹  Voahangy Rasolofo Razanamparany²  Solohery Lalaina Razafimahatratra²  Niaina Rakotosamimanana²  Noël Harijaona Ratovonirina³  Mamy Serge Raherison⁴  Fanjasoa Rakotomanana⁵ 

[1] Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Univ. Paris-Sud, Université Paris-Saclay, 91198, Gif-sur-Yvette cedex, France;Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar;Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar;Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Univ. Paris-Sud, Université Paris-Saclay, 91198, Gif-sur-Yvette cedex, France;Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar;Programme National de Lutte contre la Tuberculose (PNLT), Ministère de la Santé, Antananarivo, Madagascar;Unité d’Epidémiologie, Institut Pasteur de Madagascar, Antananarivo, Madagascar;

关键词: Mycobacterium tuberculosis;    Geographic Information System;    Genotyping;    Spatial cluster;    Antananarivo;   

DOI  :  10.1186/s12879-017-2653-9

 received in 2017-03-24, accepted in 2017-07-30,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundTuberculosis (TB) remains a public health problem in Madagascar. A crucial element of TB control is the development of an easy and rapid method for the orientation of TB control strategies in the country. Our main objective was to develop a TB spatial hotspot identification method by combining spatial analysis and TB genotyping method in Antananarivo.MethodsSputa of new pulmonary TB cases from 20 TB diagnosis and treatment centers (DTCs) in Antananarivo were collected from August 2013 to May 2014 for culture. Mycobacterium tuberculosis complex (MTBC) clinical isolates were typed by spoligotyping on a Luminex® 200 platform. All TB patients were respectively localized according to their neighborhood residence and the spatial distribution of all pulmonary TB patients and patients with genotypic clustered isolates were scanned respectively by the Kulldorff spatial scanning method for identification of significant spatial clustering. Areas exhibiting spatial clustering of patients with genotypic clustered isolates were considered as hotspot TB areas for transmission.ResultsOverall, 467 new cases were included in the study, and 394 spoligotypes were obtained (84.4%). New TB cases were distributed in 133 of the 192 Fokontany (administrative neighborhoods) of Antananarivo (1 to 15 clinical patients per Fokontany) and patients with genotypic clustered isolates were distributed in 127 of the 192 Fokontany (1 to 13 per Fokontany). A single spatial focal point of epidemics was detected when ignoring genotypic data (p = 0.039). One Fokontany of this focal point and three additional ones were detected to be spatially clustered when taking genotypes into account (p < 0.05). These four areas were declared potential TB transmission hotspots in Antananarivo and will be considered as priority targets for surveillance in the future.ConclusionThis method, combining spatial analysis and TB genotyping will now be used for further focused clinical and epidemiological studies in Madagascar and will allow better TB control strategies by public health authorities.

【 授权许可】

CC BY   
© The Author(s). 2017