High proportion of tuberculosis transmission among social contacts in rural China: a 12-year prospective population-based genomic epidemiological study

作者：Meng Li, Mingcheng Guo, Ying Peng, Qi Jiang, Lan Xia, Sheng Zhong, Yong Qiu, Xin Su, Shu Zhang, Chongguang Yang, Peierdun Mijiti, Qizhi Mao, Howard Takiff, Fabin Li, Chuang Chen, Qian Gao · 发表于：Emerging Microbes & Infections · 年份：2022 · DOI：10.1080/22221751.2022.2112912 · 被引用次数：30 · 研究领域：Tuberculosis Research and Epidemiology、Mycobacterium research and diagnosis、Pneumocystis jirovecii pneumonia detection and treatment

Tuberculosis (TB) is more prevalent in rural than urban areas in China, and delineating TB transmission patterns in rural populations could improve TB control. We conducted a prospective population-based study of culture-positive pulmonary TB patients diagnosed between July 1, 2009 and December 31, 2020 in two rural counties in China. Genomic clusters were defined with a threshold distance of 12-single-nucleotide-polymorphisms, based on whole-genome sequencing. Risk factors for clustering were identified by logistic regression. Transmission links were sought through epidemiological investigation of genomic-clustered patients. Of 1517 and 751 culture-positive pulmonary TB patients in Wusheng and Wuchang counties, respectively, 1289 and 699 strains were sequenced. Overall, 624 (31.4%, 624/1988) patients were grouped into 225 genomic clusters. Epidemiological links were confirmed in 41.8% (196/469) of clustered isolates, including family (32.7%, 64/196) and social contacts (67.3%, 132/196). Social contacts were generally with relatives, within the community or in shared aggregated settings outside the community, but the proportion of clustered contacts in each category differed between the two sites. The time interval between diagnosis of student cases and contacts was significantly shorter than family and social contacts, probably due to enhanced student contact screening. Transmission of multidrug-resistant (MDR) strains was likely responsible for 81.4% (83/102) of MDR-TB case...