Abstract
A hundred years ago the prevalence of tuberculosis (TB) in Sweden was one of the highest in the world. In this study we conducted a population-based search for distinct strains of Mycobacterium tuberculosis complex isolated from patients born in Sweden before 1945. Many of these isolates represent the M. tuberculosis complex population that fueled the TB epidemic in Sweden during the first half of the 20th century.MethodsGenetic relationships between strains that caused the epidemic and present day strains were studied by spoligotyping and restriction fragment length polymorphism.ResultsThe majority of the isolates from the elderly population were evolutionary recent Principal Genetic Group (PGG)2/3 strains (363/409 or 88.8%), and only a low proportion were ancient PGG1 strains (24/409 or 5.9%). Twenty-two were undefined. The isolates demonstrated a population where the Euro-American superlineage dominated; in particular with Haarlem (41.1%) and T (37.7%) spoligotypes and only 21.2% belonged to other spoligotype families. Isolates from the elderly population clustered much less frequently than did isolates from a young control group population.ConclusionsA closely knit pool of PGG2/3 strains restricted to Sweden and its immediate neighbours appears to have played a role in the epidemic, while PGG1 strains are usually linked to migrants in todaýs Sweden. Further studies of these outbreak strains may give indications of why the epidemic waned.
Highlights
Tuberculosis (TB) is globally a major cause of morbidity and mortality, with a majority of cases occurring in low income countries
As estimated by the WHO currently one third of the worlds population is infected with bacteria of the Mycobacterium tuberculosis complex, and ten million cases of active TB disease occur each year, resulting in almost two million deaths annually
A specific strain of M. tuberculosis has emerged rapidly in Denmark [1], another outbreak has been recorded in Norway [2] and one of the largest outbreaks ever recorded in a low endemic country is ongoing in Sweden [3,4,5]
Summary
Tuberculosis (TB) is globally a major cause of morbidity and mortality, with a majority of cases occurring in low income countries. As estimated by the WHO currently one third of the worlds population is infected with bacteria of the Mycobacterium tuberculosis complex, and ten million cases of active TB disease occur each year, resulting in almost two million deaths annually. In the Nordic countries there are outbreaks of specific strains of M. tuberculosis. A specific strain of M. tuberculosis has emerged rapidly in Denmark [1], another outbreak has been recorded in Norway [2] and one of the largest outbreaks ever recorded in a low endemic country is ongoing in Sweden [3,4,5]. It does appear that this bacterial population has been successfully reduced from representing the major public health problem to its current level of near elimination
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