Article: article from journal or magazin.
Mycobacterium tuberculosis transmission in a country with low tuberculosis incidence: role of immigration and HIV infection.
Journal of Clinical Microbiology
Swiss HIV Cohort Study Group, Molecular Epidemiology of Tuberculosis Study Group
Fenner L., Egger M., Gagneux S., Tanner M., Furrer H., Böttger EC., Frei R., Bodmer T., Ninet B., Schrenzel J., Jaton K., Telenti A., Siegrist H., Pfyffer GE., Bruderer T., Dolina M., Dubuis O., Janssens JP., Stalder JM., Helbling P., Altpeter E., Rieder HL., Barth J., Battegay M., Bernasconi E., Böni J., Bucher H., Burton-Jeangros C., Calmy A., Cavassini M., Cellerai C., Egger M., Elzi L., Fehr J., Fellay J., Flepp M., Francioli P., Furrer H., Fux C., Gorgievski M., Günthard H., Haerry D., Hasse B., Hirschel B., Hirsch H., Hirschel B., Hoffmann M., Hösli I., Kahlert C., Kaiser L., Keiser O., Kind C., Klimkait T., Kovari H., Ledergerber B., Lugano A., Martinetti G., Martinez de Tejada B., Metzner K., Müller N., Nadal D., Pantaleo G., Rauch A., Regenass S., Rickenbach M., Rudin C., Schmid P., Schultze D., Schöni-Affolter F., Schüpbach J., Speck R., Taffé P., Tarr P., Telenti A., Trkola A., Vernazza P., Weber R., Yerly S.
Publication types: Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Immigrants from high-burden countries and HIV-coinfected individuals are risk groups for tuberculosis (TB) in countries with low TB incidence. Therefore, we studied their role in transmission of Mycobacterium tuberculosis in Switzerland. We included all TB patients from the Swiss HIV Cohort and a sample of patients from the national TB registry. We identified molecular clusters by spoligotyping and mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) analysis and used weighted logistic regression adjusted for age and sex to identify risk factors for clustering, taking sampling proportions into account. In total, we analyzed 520 TB cases diagnosed between 2000 and 2008; 401 were foreign born, and 113 were HIV coinfected. The Euro-American M. tuberculosis lineage dominated throughout the study period (378 strains; 72.7%), with no evidence for another lineage, such as the Beijing genotype, emerging. We identified 35 molecular clusters with 90 patients, indicating recent transmission; 31 clusters involved foreign-born patients, and 15 involved HIV-infected patients. Birth origin was not associated with clustering (adjusted odds ratio [aOR], 1.58; 95% confidence interval [CI], 0.73 to 3.43; P = 0.25, comparing Swiss-born with foreign-born patients), but clustering was reduced in HIV-infected patients (aOR, 0.49; 95% CI, 0.26 to 0.93; P = 0.030). Cavitary disease, male sex, and younger age were all associated with molecular clustering. In conclusion, most TB patients in Switzerland were foreign born, but transmission of M. tuberculosis was not more common among immigrants and was reduced in HIV-infected patients followed up in the national HIV cohort study. Continued access to health services and clinical follow-up will be essential to control TB in this population.
Adult, Bacterial Typing Techniques, Cluster Analysis, Cohort Studies, Emigration and Immigration, Female, HIV Infections/complications, Humans, Incidence, Male, Middle Aged, Molecular Epidemiology, Molecular Typing, Mycobacterium tuberculosis/classification, Mycobacterium tuberculosis/genetics, Switzerland/epidemiology, Tuberculosis/complications, Tuberculosis/epidemiology
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