The emerging threat of pre-extensively drug-resistant tuberculosis in West Africa: preparing for large-scale tuberculosis research and drug resistance surveillance

BMC Medicine

Research Article

Adama Sanou¹  Zingue Dezemon¹  Aderemi O. Kehinde²  Ifedayo Adetifa³  Umberto D’Alessandro⁴  Richard A. Adegbola⁵  Samba Ceesay⁶  Samrat Kumar⁷  Bouke C. de Jong⁷  Samuel Kudzawu⁸  Aissatou Gaye-Diallo⁹  Awa Ba-Diallo⁹  Souleymane Mboup⁹  Essosimna A. Kadanga^1,10  Anoumou Dagnra^1,10  Kodjo Dissé^1,10  Mark J. Pallen^1,11  Paulo Rabna^1,12  Morto Mane^1,12  Mamadou Jallow^1,13  Ignatius Baldeh^1,13  Aisha Jallow^1,13  Adama Jallow^1,14  Nneka Onyejepu^1,15  Emmanuel Oni Idigbe^1,15  Catherine Onubogu^1,15  Bassirou Diarra^1,16  Moumine Sanogo^1,16  Kayode Salako^1,17  Oludele Adebiyi^1,17  Audrey Forson^1,18  Edward Demba^1,19  Jacob Otu^1,19  Tumani Corrah^1,19  Assan Jaye^1,19  Lindsay Kendall^1,19  Tutty Faal-Jawara^1,19  Leopold D. Tientcheu^2,20  Beate Kampmann^2,21  Brenda A. Kwambana-Adams^2,22  Florian Gehre^2,23  Madikay Senghore^2,24  Martin Antonio^2,25  Awewura Kwara^2,26 

[1] Centre Muraz and the National TB Program, Ouagadougou, Burkina Faso;College of Medicine, University of Ibadan, Ibadan, Nigeria;University College Hospital, 23402, Ibadan, Oyo, Nigeria;Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK;Disease Control and Elimination, Medical Research Council Unit, Serrekunda, The Gambia;Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;Disease Control and Elimination, Medical Research Council Unit, Serrekunda, The Gambia;Institute of Tropical Medicine, Antwerp, Belgium;GSK Vaccines, Wavre, Belgium;Health Services, Ministry of Health and Social Welfare, Banjul, The Gambia;Institute of Tropical Medicine, Antwerp, Belgium;Korle-Bu Teaching Hospital, Accra, Ghana;Laboratoire Bactériologie Virologie Aristide Le Dantec Sénégal, Dakar, Senegal;Laboratoire National de Reference Mycobacteria, Lome, Togo;Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK;National Institute of Public Health, Bissau, Guinea-Bissau;National Public Health Laboratory Services, Banjul, The Gambia;National Tuberculosis/Leprosy Control Program, Banjul, The Gambia;Nigerian Institute of Medical Research, Lagos, Nigeria;SEREFO Program, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali;University College Hospital, 23402, Ibadan, Oyo, Nigeria;University of Ghana Medical School, Accra, Ghana;Korle-Bu Teaching Hospital, Accra, Ghana;Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia;Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia;Department of Biochemistry, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon;Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia;Department of Paediatrics, Imperial College London, London, UK;Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia;Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia;Institute of Tropical Medicine, Antwerp, Belgium;Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia;Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK;Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia;Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK;Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK;Warren Alpert Medical School of Brown University, Providence, RI, USA;The Miriam Hospital, Providence, RI, USA;

关键词: Tuberculosis;    Extensively drug-resistant tuberculosis;    West Africa;    Drug-resistance surveillance;    Capacity building;   

DOI  :  10.1186/s12916-016-0704-5

 received in 2016-08-06, accepted in 2016-09-28,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundDrug-resistant tuberculosis (TB) is a global public health problem. Adequate management requires baseline drug-resistance prevalence data. In West Africa, due to a poor laboratory infrastructure and inadequate capacity, such data are scarce. Therefore, the true extent of drug-resistant TB was hitherto undetermined. In 2008, a new research network, the West African Network of Excellence for Tuberculosis, AIDS and Malaria (WANETAM), was founded, comprising nine study sites from eight West African countries (Burkina Faso, The Gambia, Ghana, Guinea-Bissau, Mali, Nigeria, Senegal and Togo). The goal was to establish Good Clinical Laboratory Practice (GCLP) principles and build capacity in standardised smear microscopy and mycobacterial culture across partnering laboratories to generate the first comprehensive West African drug-resistance data.MethodsFollowing GCLP and laboratory training sessions, TB isolates were collected at sentinel referral sites between 2009–2013 and tested for first- and second-line drug resistance.ResultsFrom the analysis of 974 isolates, an unexpectedly high prevalence of multi-drug-resistant (MDR) strains was found in new (6 %) and retreatment patients (35 %) across all sentinel sites, with the highest prevalence amongst retreatment patients in Bamako, Mali (59 %) and the two Nigerian sites in Ibadan and Lagos (39 % and 66 %). In Lagos, MDR is already spreading actively amongst 32 % of new patients. Pre-extensively drug-resistant (pre-XDR) isolates are present in all sites, with Ghana showing the highest proportion (35 % of MDR). In Ghana and Togo, pre-XDR isolates are circulating amongst new patients.ConclusionsWest African drug-resistance prevalence poses a previously underestimated, yet serious public health threat, and our estimates obtained differ significantly from previous World Health Organisation (WHO) estimates. Therefore, our data are reshaping current concepts and are essential in informing WHO and public health strategists to implement urgently needed surveillance and control interventions in West Africa.

【 授权许可】

CC BY   
© The Author(s). 2016