Abstract
Molecular technology to identify relatedness between Mycobacterium tuberculosis complex isolates, representative of possible tuberculosis (TB) transmission between individuals, continues to evolve. At the same time, tools to utilise this information for public health action to improve TB control should also be implemented. Public Health England developed the Strain Typing Module (STM) as an integral part of the web-based surveillance system used in the United Kingdom following the roll-out of prospective 24 loci mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) strain typing. The creation of such a system required data integration and linkage, bringing together laboratory results and patient notification information. The STM facilitated widespread access to patient strain typing and clustering results for the public health community working in TB control. In addition, the system provided a log of cluster review and investigation decision making and results. Automated real-time data linkage between laboratory and notification data are essential to allow routine use of genotyping results in TB surveillance and control. Outputs must be accessible by those working in TB control at a local level to have any impact in ongoing public health activity.
Highlights
Tuberculosis (TB) incidence in the United Kingdom (UK) increased during the early 2000s from 12.3 per 100,000 in 2000 to 15.1 per 100,000 in 2005 [1]
In the UK, all Mycobacterium isolates cultured in local laboratories were sent to one of the reference laboratories for speciation, drug susceptibility testing (DST) and molecular typing (24 loci MIRU-VNTR strain typing between 2010 to 2016; strain typing in the UK is being gradually phased out starting from 2016 to be replaced with whole genome sequencing (WGS))
Between 2013 and 2015, the median time between specimen receipt in the reference laboratory and the MIRU-VNTR results being available to view in Enhanced Tuberculosis Surveillance System (ETS) was 2.3 months (70.9 days; interquartile range (IQR): 46.8–123.8)
Summary
Tuberculosis (TB) incidence in the United Kingdom (UK) increased during the early 2000s from 12.3 per 100,000 in 2000 to 15.1 per 100,000 in 2005 [1]. Recommendations for improvements in TB control were made in the Chief Medical Officer’s Action Plan for TB [2]. This included improved TB surveillance activity through the implementation of routine prospective molecular typing. In 2010, the National TB Strain Typing Service (TB STS) was established by Public Health England [3] to prospectively identify and, where necessary, investigate 24 loci mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) strain typing clusters [4]. The routine, prospective and universal use of molecular characterisation techniques, such as MIRU-VNTR strain typing, have multiple benefits in clinical care and public health as previously described [5]. This can, firstly, be achieved by confirming or refuting suspected transmission using MIRU-VNTR, secondly, by identifying MIRU-VNTR clusters where there had previously been no suspicion of transmission
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