Spatial Patterns of Extensively Drug-Resistant Tuberculosis Transmission in KwaZulu-Natal, South Africa. (28th June 2018)

• Record Type: Journal Article
• Authors: Nelson, Kristin N; Shah, N Sarita; Mathema, Barun; Ismail, Nazir; Brust, James C M; Brown, Tyler S; Auld, Sara C; Omar, Shaheed Vally; Morris, Natashia; Campbell, Angie; Allana, Salim; Moodley, Pravi; Mlisana, Koleka; Gandhi, Neel R
• Is Part Of: Journal of infectious diseases. Volume 218:Number 12(2018)
• Page Start: 1964
• Page End: 1973
• Publication Date: 2018-06-28
• Subjects: tuberculosis -- drug resistance -- molecular epidemiology -- whole-genome sequencing -- transmission; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiy394
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract : We identified 67 posttreatment HIV controllers with sustained HIV remission after antiretroviral treatment interruption. Posttreatment control was more commonly identified amongst early treated individuals, frequently characterized by early transient viral rebound and heterogeneous durability of HIV remission. Abstract: Background: Transmission is driving the global drug-resistant tuberculosis (TB) epidemic; nearly three-quarters of drug-resistant TB cases are attributable to transmission. Geographic patterns of disease incidence, combined with information on probable transmission links, can define the spatial scale of transmission and generate hypotheses about factors driving transmission patterns. Methods: We combined whole-genome sequencing data with home Global Positioning System coordinates from 344 participants with extensively drug-resistant (XDR) TB in KwaZulu-Natal, South Africa, diagnosed from 2011 to 2014. We aimed to determine if genomically linked (difference of ≤5 single-nucleotide polymorphisms) cases lived close to one another, which would suggest a role for local community settings in transmission. Results: One hundred eighty-two study participants were genomically linked, comprising 1084 case-pairs. The median distance between case-pairs' homes was 108 km (interquartile range, 64–162 km). Between-district, as compared to within-district, links accounted for the majority (912/1084 [84%]) of genomic links. Half (526 [49%]) of genomic links involved a case from Durban, the urban center of KwaZulu-Natal. Conclusions: The high proportions of between-district links with Durban provide insight into possible drivers of province-wide XDR-TB transmission, including urban–rural migration. Further research should focus on characterizing the contribution of these drivers to overall XDR-TB transmission in KwaZulu-Natal to inform design of targeted strategies to curb the drug-resistant TB epidemic.