Abstract
BackgroundThe implementation of an integrated molecular surveillance (IMS) of tuberculosis (TB) is of high priority for TB control. IMS is defined as the systematic inclusion of molecular typing results in the national TB surveillance system. Although not standardized, an IMS of TB is already implemented in several low TB incidence countries. Germany is in the process of implementing a nationwide IMS of TB. This requires close collaboration between national and local health authorities. We conducted an online survey to understand the current use of molecular typing results for TB surveillance among the local public health offices (PHO)s in Germany, and to collect their perception and expectations towards the implementation of a nationwide IMS of TB.MethodsThe online survey was developed using the software Voxco and included 31 questions. The survey was sent to all the 377 local PHOs in Germany in April 2017. Responses were collected until June 2017.ResultsA total of 174/377 (46.2%) local PHOs participated in our survey, and 88/377 (23.3%) used molecular typing results in their routine TB surveillance work. The PHOs used molecular typing results especially as support for epidemiological contact tracing (62/88, 70.4%). We found statistically significant differences between answers of PHOs that did not use molecular typing results (n = 86) vs. PHOs that did use molecular typing results (n = 88): the latter perceived the use of molecular typing results as more beneficial for their work compared to the former (65.9% vs. 34.9%, p < 0.05). Moreover, the PHOs using molecular typing results expect for the future more support and coordination from regional and national public health institutes, especially regarding the identification and analysis of molecular clusters.ConclusionsOur study is a step forward in the broader goal of implementing an IMS of TB in Germany. The local PHOs currently using the molecular typing results highlighted their positive attitude towards the implementation of an IMS, but also their needs of more support. Similar assessments might serve as an example for other countries which are on the way to implement a nationwide IMS of TB.
Highlights
The implementation of an integrated molecular surveillance (IMS) of tuberculosis (TB) is of high priority for TB control
The questionnaire was divided into four parts: 1) general information on each public health offices (PHO); 2) information regarding the use of the molecular typing result up to 2016; 3) information on the performance of contact tracing and 4) expectations for the implementation of a nationwide IMS of TB
Number of TB cases and contact tracings per PHO A total of 174/377 (46.2%) of PHOs participated in our online survey
Summary
The implementation of an integrated molecular surveillance (IMS) of tuberculosis (TB) is of high priority for TB control. Several studies have been done in Germany in the context of molecular surveillance of TB All these studies have been conducted at the local level (for example in one or two German federal states), were restricted in time and used different molecular typing methods. In a study conducted in 2003–2005 in the federal state of Baden-Württemberg, molecular typing results (obtained using IS6110 DNA fingerprinting and spoligotyping) and the conventional contact tracing information were used to estimate TB transmission in Germany between people with and without a migration background. In another study conducted in 2006– 2010 in the federal state of Schleswig-Holstein, the authors compared the discriminatory power of three different molecular typing methods for TB, such as IS6110 DNA fingerprinting, spoligotyping and 24-loci mycobacterial interspersed repetitive units (MIRU). Ten isolates were included in one cluster according to the MIRU typing method, the WGS further divided these 10 isolates into 2 subgroups, suggesting the presence of two distinct transmission events [22]
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