Multidrug-Resistant Tuberculosis, People’s Republic of China, 2007–2009

Guang Xue He,Yan Lin Zhao,Martien W Borgdorff,Susan Van Den Hof,Christopher P Tostado,Dick Van Soolingen,Jay K Varma,Zhi Min Liu,Xue Zheng Li,Hui Guo,Marieke J Van Der Werf,Hai Ying Wang

doi:10.3201/eid1710.110546

Abstract

We conducted a case-control study to investigate risk factors for multidrug-resistant tuberculosis (MDR TB) in the People's Republic of China. Genotyping analysis was used to estimate the percentage of cases from recent transmission among 100 MDR TB case-patients hospitalized during April 2007-July 2009. Molecular subtyping of isolates showed that 41% of MDR TB strains clustered. Beijing genotype was found in 94% of the MDR TB isolates and 79% of the pan-susceptible isolates. In multivariate analysis, MDR TB was independently associated with Beijing genotype, retreatment for TB, symptoms lasting >3 months before first evaluation at the hospital, lack of health insurance, and being a farmer (vs. being a student). MDR TB was associated with Beijing genotype and lower socioeconomic status. A large percentage of MDR TB cases seemed to result from recent transmission. Early detection, effective treatment, and infection control measures for MDR TB are needed to reduce transmission.

Highlights

The fourth report of the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance provides the latest data on the magnitude of drug resistance in 81 countries and 2 Special Administrative Regions (SARs) of China collected between 2002 and 2007, as well as the most up to date trends from 47 countries collected over a thirteen year period.The Global Project was initiated in 1994 in order to estimate the global burden of drug resistant TB worldwide using standardized methodologies so that data could be compared across and within regions
Of the 20 settings surveyed with the highest proportion of multi-drug resistant TB2 (MDR-TB) among new cases in the history of the project, 14 are located in countries of the former Soviet Union and four are in China
Magnitude of drug resistant TB The population weighted mean of MDR-TB among all TB cases from the 114 countries and 2 SARs of China that have reported to the global project is 5.3% (95% CLs, 3.9-6.6), but ranges from 0% in some western European countries to over 35% in some countries of the former Soviet Union

Summary

Introduction

The fourth report of the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance provides the latest data on the magnitude of drug resistance in 81 countries and 2 SARs of China collected between 2002 and 2007, as well as the most up to date trends from 47 countries collected over a thirteen year period.The Global Project was initiated in 1994 in order to estimate the global burden of drug resistant TB worldwide using standardized methodologies so that data could be compared across and within regions. The fourth report of the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance provides the latest data on the magnitude of drug resistance in 81 countries and 2 SARs of China collected between 2002 and 2007, as well as the most up to date trends from 47 countries collected over a thirteen year period. The report is published every three years as most countries require between 12 and 18 months to complete a drug resistance survey. Following the roll out and successful implementation of "DOTS-Plus" pilot projects for the management of drug resistant TB between 2000 and 2005, a new Stop TB Strategy was launched in 2006. Through the Global Fund and with the help of the Green Light Committee, most countries are initiating or scaling up the diagnosis and management of drug resistant TB. Until diagnosis of drug resistance is routine, surveys or surveillance systems will play an important role in determining the magnitude and trends in drug resistant TB

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