Abstract
International migrants are at heightened risk for tuberculosis (TB) disease. Intensified incarceration at international borders may compound population-wide TB risk. However, few studies have investigated the contributions of migration, local transmission, or prisons in driving incident TB at international borders. We conducted prospective population-based genomic surveillance in 3 cities along Brazil’s central western border from 2014–2017. Although most isolates (89/132; 67%) fell within genomic transmission clusters, genetically unique isolates disproportionately occurred among participants with recent international travel (17/42; 40.5%), suggesting that both local transmission and migration contribute to incident TB. Isolates from 40 participants with and 76 without an incarceration history clustered together throughout a maximum-likelihood phylogeny, indicating the close interrelatedness of prison and community epidemics. Our findings highlight the need for ongoing surveillance to control continued introductions of TB and reduce the disproportionate burden of TB in prisons at Brazil’s international borders.
Highlights
International migrants are at heightened risk for tuberculosis (TB) disease
In recent years, while TB incidence declined nationally in Brazil, TB notifications have increased in its Central West region border cities
We found that many genomic clusters involved persons with and without an incarceration history, evidence that prison and community epidemics of TB are closely interrelated in cities at Brazil’s Central West border
Summary
International migrants are at heightened risk for tuberculosis (TB) disease. Intensified incarceration at international borders may compound population-wide TB risk. Few studies have investigated the contributions of migration, local transmission, or prisons in driving incident TB at international borders. Most isolates (89/132; 67%) fell within genomic transmission clusters, genetically unique isolates disproportionately occurred among participants with recent international travel (17/42; 40.5%), suggesting that both local transmission and migration contribute to incident TB. Brazil’s national borders, settings characterized by frequent population movement and often overburdened health systems, have higher TB incidence than do nonborder areas [9,10,11]. TB notification rates have rapidly increased within prisons in Brazil [13], and TB is increasingly concentrated among incarcerated populations. In Mato Grosso do Sul, the state with the highest incarceration rate in Brazil (618/100,000 population) [14], 28.9% of notified TB. Whether prisons amplify drug-resistant TB in border cities is not known
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