Abstract
BackgroundIncreasing multidrug-resistant tuberculosis (MDR-TB) incidence is a major threat against TB eradication worldwide. We aim to conduct a detailed MDR-TB study in Portugal, an European country with endemic TB, combining genetic analysis and epidemiological data, in order to assess the efficiency of public health containment of MRD-TB in the country.MethodsWe used published MIRU-VNTR data, that we reanalysed using a phylogenetic analysis to better describe MDR-TB cases transmission occurring in Portugal from 2014 to 2017, further enriched with epidemiological data of these cases.ResultsWe show an MDR-TB transmission scenario, where MDR strains likely arose and are transmitted within local chains. 63% of strains were clustered, suggesting high primary transmission (estimated as 50% using MIRU-VNTR data and 15% considering epidemiological links). These values are higher than those observed across Europe and even for sensitive strains in Portugal using similar methodologies. MDR-TB cases are associated with individuals born in Portugal and evolutionary analysis suggests a local evolution of strains. Consistently the sublineage LAM, the most common in sensitive strains in Europe, is the more frequent in Portugal in contrast with the remaining European MDR-TB picture where immigrant-associated Beijing strains are more common.ConclusionsDespite efforts to track and contain MDR-TB strains in Portugal, their transmission patterns are still as uncontrolled as that of sensitive strains, stressing the need to reinforce surveillance and containment strategies.
Highlights
Increasing multidrug-resistant tuberculosis (MDR-TB) incidence is a major threat against TB eradication worldwide
We aim to assess the dynamics of MDR-TB emergence and transmission, including the identification of associated risk factors, and last to establish the rate of probable recent transmissions against newly developed resistant strains
Statistical analysis Data were summarized by descriptive statistics according to the nature of the variables
Summary
Increasing multidrug-resistant tuberculosis (MDR-TB) incidence is a major threat against TB eradication worldwide. Tuberculosis (TB) remains a high burden disease worldwide with persistent areas where elimination is still a distant goal. Despite declining incidence of TB in the last decades, multidrug-resistant TB (MDR-TB) poses a major threat for WHO’s 2035 goal of TB elimination [1]. WHO estimated a worldwide incidence of around 560, 000 cases of MDR/RR-TB per year and a rate of 7.4 cases per 100,000 individuals [3]. In Europe, MDR/RR-TB incidence rate was 12.0 per 100,000 individuals, the highest among the regions considered by WHO [3], but results. MDR-TB notification rate in Portugal has been increasing since 2012 at a rate of 0.8 and 3.7% among new cases and previously treated patients, respectively [4]
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