Transregional movement of multidrug-resistant tuberculosis in north China: an underlying threat to tuberculosis control.

Jun An,Hairong Huang,Mengqiu Gao,Liang Li,Naihui Chu,Yu Pang

doi:10.1038/srep29727

Abstract

Due to unbalanced distribution of health care resource in China, tuberculosis patients, especially multidrug-resistant tuberculosis (MDR-TB), prefer to suffer transregional movement for seeking better health care service in the first-tier cities. Here, we performed a study on the current status of transregional movement of tuberculosis in northern China by reviewing the medical record of TB patients hospitalized in Beijing Chest Hospital from 2011 to 2015. From 2011 to 2015, the proportion of non-Beijing in-patients had increased from 55.0% (996/1810) to 67.2% (1860/2769). In addition, we found that the rate of re-treated among non-Beijing group was significantly higher than that among Beijing-group. Compared with the proportion of pulmonary TB patients from non-Beijing, there were more extra-pulmonary TB patients from non-Beijing. In addition, 10.5% (164/1568) of Beijing in-patients and 26.5% (491/1858) of non-Beijing in-patients had MDR tuberculosis, and statistical analysis revealed that there was significantly higher proportion of MDR cases among non-Beijing group than Beijing group. In conclusion, our data demonstrate that an increasing proportion of TB patients from northern China seek health care in Beijing. In view of higher prevalence of MDR-TB cases among these patients, the transregional movement of MDR-TB will lead to ongoing MDR TB transmission in the community.

Highlights

In recent years, as a result of rapid socioeconomic growth, patients, including TB patients, are able to enjoy a better quality of health care in China[9], whereas the distribution of health care service is unbalanced between different regions[10]
We firstly described a large-scale transregional movement of multidrug-resistant tuberculosis in north China, which provide several important hints for national tuberculosis programmes
A proportion of TB patients with unfavorable clinical outcome in the local hospitals are prone to seek health service in Beijing, which may be responsible for higher proportion of re-treated and multidrug-resistant TB (MDR-TB) cases in non-Beijing group

Summary

Introduction

As a result of rapid socioeconomic growth, patients, including TB patients, are able to enjoy a better quality of health care in China[9], whereas the distribution of health care service is unbalanced between different regions[10]. The TB patients from resource-limited setting in China, especially drug-resistant patients, may not timely access to rapid case detection and appropriate treatment, thereby leading to the unsatisfactory treatment outcome[12]. These patients with poor clinical outcome prefer to carry out transregional movement for seeking better health care service in the first-tier cities. The transmission of MDR-TB patients will cause the community transmission in China This is a serious obstacle associated with TB control and prevention, there is no systematic report on the current status of transregional movement of tuberculosis and MDR-TB in China

Objectives

Methods

Results

Conclusion