Impact of genotyping of Mycobacterium tuberculosis on public health practice in Massachusetts

Massachusetts was one of seven sentinel surveillance sites in the National Tuberculosis Genotyping and Surveillance Network. From 1996 through 2000, isolates from new patients with tuberculosis (TB) underwent genotyping. We describe the impact that genotyping had on public health practice in Massachusetts and some limitations of the technique. Through genotyping, we explored the dynamics of TB outbreaks, investigated laboratory cross-contamination, and identified Mycobacterium tuberculosis strains, transmission sites, and accurate epidemiologic links. Genotyping should be used with epidemiologic follow-up to identify how resources can best be allocated to investigate genotypic findings.     

Transmission of Mycobacterium tuberculosis in a rural community,Arkansas, 1945-2000

A cluster of tuberculosis cases in a rural community in Arkansas persisted from 1991 to 1999. The cluster had 13 members, 11 linked epidemiologically. Old records identified 24 additional patients for 40 linked cases during a 54-year period. Residents of this neighborhood represent a population at high risk who should be considered for tuberculin testing and treatment for latent tuberculosis infection.     

The study recurrent tuberculosis and exogenous reinfection, Shanghai, China

Of 52 patients with recurrent tuberculosis in Shanghai, People's Republic of China, 32 (61.5%) had isolates in which genotype patterns of Mycobacterium tuberculosis differed between first and second episodes. This result indicates that exogenous reinfection is common in an area with a high incidence of tuberculosis.     

Spatial analysis of tuberculosis cases in migrants and permanent residents, Beijing, 2000-2006

To determine the role of the migrant population in the transmission of tuberculosis (TB), we investigated the distribution and magnitude of TB in permanent residents and migrant populations of Beijing, People's Republic of China, from 2000 through 2006. An exploratory spatial data analysis was applied to detect the "hot spots" of TB among the 2 populations. Results, using the data obtained from 2004-2006, showed that people who migrated from the western, middle, and eastern zones of China had a significantly higher risk of having TB than did permanent residents. These findings indicate that population fluctuations have affected the rate of TB prevalence in Beijing, and interventions to control TB should include the migrant population.     

Childbearing characteristics of U.S.- and foreign-born Hispanic mothers

This study compares maternal and infant health and sociodemographic characteristics of U.S.-born and foreign- or Puerto Rican-born Hispanic mothers and their babies, using data from the national vital statistics system and the 1980 National Natality Survey. While nearly half of all Hispanic mothers and Mexican and Puerto Rican mothers were born in the United States, less than 10 percent of Cuban and other Hispanic mothers were U.S. born. Compared with foreign- or Puerto Rican-born Hispanic mothers, U.S.-born mothers tended to be younger, to have had fewer high-order births, to be less likely to receive delayed or no prenatal care, to have higher educational attainment, and to be more likely to be unmarried. The incidence of low birth weight among infants born to Hispanic mothers, particularly Mexican and Cuban women, was relatively low. When the proportions of low birth weight were examined by nativity status, infants born to foreign- or Puerto Rican-born women were consistently less likely to be of low birth weight. In an effort to account for these findings, the mother's smoking status before and during pregnancy is examined. Compared with non-Hispanic mothers, Hispanic mothers were much less likely to have smoked before or during pregnancy. These data are examined to see if they account for the better outcome as measured by birth weight for Hispanic births, especially those to foreign- or Puerto Rican-born women.     

Quality assessment of Mycobacterium tuberculosis genotyping in a large laboratory network

Quality assessment exercises were conducted to evaluate the reproducibility of IS6110 DNA fingerprinting performed by eight laboratories in the National Tuberculosis Genotyping and Surveillance Network. Three panels, each with 8 to 16 isolates, were typed at all laboratories, resulting in 280 images. When the pattern obtained by the majority for each isolate was used as the standard, exact matches were obtained for 73% of patterns; 90% and 97% of patterns matched within one- and two-band differences, respectively. A second approach involved retyping of randomly selected isolates at the Centers for Disease Control and Prevention. Retyping was done for 8-19 isolates per laboratory (76 total). Paired images matched exactly for 54% of isolates and within one and two band differences, 78% and 93%, respectively. We evaluated reasons for mismatching. We also evaluated the reproducibility of spoligotyping using a test panel of 13 isolates; a discrepancy of 1 in 91 results was noted.     

2008 — 2015年贵州省学生肺结核疫情特征分析

  目的  了解贵州省2009 — 2018年儿童结核病流行特征,为儿童结核病防控工作提供参考依据。  方法  收集结核病管理信息系统登记的贵州省2009 — 2018年 ≤ 14岁儿童肺结核病例资料进行流行特征分析。  结果  2009 — 2018年贵州省共登记治疗儿童肺结核5 775例,年均登记率为7.39/10万,占全人群肺结核的平均比例为1.46 %,经趋势卡方检验,差异有统计学意义（χ² = 460.852,P < 0.05）。10年贵州省儿童肺结核患者总体呈下降趋势,2015 — 2018年出现缓慢上升趋势。每季度均有病例,主要集中在第一季度和第二季度;毕节市登记治疗的儿童肺结核患者最多,占全省儿童病例总数的37.44 %;男生占51.39 %,女生占48.61 %,男女比例为1.10 : 1;年龄分布均以10～14岁年龄组最多,男生组为2 258例,女生组为2 281例。发现方式主要是以因症就诊和转诊为主,初复治比为75 : 1,新涂阳儿童肺结核患者治疗成功率为91.02 %,复治涂阳治疗成功率为82.69 %。  结论  2009 — 2018年贵州省儿童结核病呈下降趋势,应针对10～14岁、男生、毕节市等三间分布特征采取针对措施。     

DNA fingerprinting of Mycobacterium tuberculosis isolates from epidemiologically linked case pairs

DNA fingerprinting was used to evaluate epidemiologically linked case pairs found during routine tuberculosis (TB) contact investigations in seven sentinel sites from 1996 to 2000. Transmission was confirmed when the DNA fingerprints of source and secondary cases matched. Of 538 case pairs identified, 156 (29%) did not have matching fingerprints. Case pairs from the same household were no more likely to have confirmed transmission than those linked elsewhere. Case pairs with unconfirmed transmission were more likely to include a smear-negative source case (odds ratio [OR] 2.0) or a foreign-born secondary case (OR 3.4) and less likely to include a secondary case <15 years old (OR 0.3). Our study suggests that contact investigations should focus not only on the household but also on all settings frequented by an index case. Foreign-born persons with TB may have been infected previously in high-prevalence countries; screening and preventive measures recommended by the Institute of Medicine could prevent TB reactivation in these cases.     

天津市2006-2013年学生肺结核发病情况及流行病学特征

目的 了解天津市学生人群肺结核发病情况及特征,为学校结核病防治提供依据。方法 对天津市2006-2013年结核专报网中的学生肺结核患者资料进行描述性研究,采用SAS 9.13软件进行统计分析。结果 2006-2013年,天津市报告学生活动性肺结核及涂阳肺结核例数分别占总报告数的8.45%（2 676/31 662）和5.19%（604/11 645）,所占比例的趋势无统计学意义（P=0.65,P=0.50）;报告发病率分别为21.00/10万和4.74/10万,趋势检验无统计学意义（P=0.31,P=0.31）。学生患者年龄中位数19岁（17,21）,以大学和高中学生为主,分别占54.52%（1 459/2 676）和28.74%（769/2 676）;男女比例为1.51：1;患者来源以因症就诊和转诊为主,分别占24.96%（668/2 676）和56.95%（1 524/2 676）,健康检查占16.33%（437/2 676）;病人发现的高峰为4月和10月。临床特征上,学生患者涂阳比例、复治比例、胸片空洞比例和合并症比例均低于非学生人群（均P<0.01）,但合并其他结核与非学生人群差异无统计学意义（P=0.87）。结论 高中和大学学生是天津市学校结核病防治的重点人群,需继续做好学生人群的健康体检和学校医务室的转诊、推荐工作。     

Predominance of ancestral lineages of Mycobacterium tuberculosis in India

Although India has the highest prevalence of tuberculosis (TB) worldwide, the genetic diversity of Mycobacterium tuberculosis in India is largely unknown. A collection of 91 isolates originating from 12 different regions spread across the country were analyzed by genotyping using 21 loci with variable-number tandem repeats (VNTRs), by spoligotyping, by principal genetic grouping (PGG), and by deletion analysis of M. tuberculosis-specific deletion region 1. The isolates showed highly diverse VNTR genotypes. Nevertheless, highly congruent groupings identified by using the 4 independent sets of markers permitted a clear definition of 3 prevalent PGG1 lineages, which corresponded to the "ancestral" East African-Indian, the Delhi, and the Beijing/W genogroups. A few isolates from PGG2 lineages and a single representative of the presumably most recent PGG3 were identified. These observations suggest a predominance of ancestral M. tuberculosis genotypes in the Indian subcontinent, which supports the hypothesis that India is an ancient endemic focus of TB.     

大连2010-2015年高校学生结核病疫情特征分析

目的 观察辽宁省大连市高校学生结核病发病特征及趋势变化,了解高校结核病流行现状及特点,为学校结核病防治策略调整提供依据。方法 回顾性收集2010-2015年大连市结核病医院资料室和国家结核病管理信息系统登记的学生结核病疫情资料,并进行统计和分析。结果 2010-2015年大连市高校结核病报告发病率为48.19/10万,2010-2015各年份结核病发病率分别为54.93/10万、55.14/10万、43.15/10万、41.94/10万、44.74/10万和50.33/10万,趋势变化无统计学意义（χ²=2.456,P>0.05）。结核菌痰涂片报告涂阳发病率为6.19/10万,患者中涂阳率为12.85%。病例年龄介于16~30岁,平均年龄为21.09岁;男女比例2.61：1,季节发病率以第二季度最高。学生新发活动性肺结核以初治为主（97.18%）;涂阴患者最多（74.52%）。高校肺结核聚集性疫情每年均有发生,呈增多趋势。2010-2015年散发患者发病率分别为49.9/10万、47.3/10万、41.8/10万、35.6/10万、34.6/10万和38.67/10万,趋势变化有统计学意义（χ²=10.318,P<0.05）;聚集性续发患者发病率分别为5.0/10万、7.9/10万、1.3/10万、6.4/10万、10.1/10万和11.7/10万,趋势性变化亦有统计学意义（χ²=13.097,P<0.05）。结论 2010-2015年大连市高校学生肺结核发病疫情形势变化不明显,但学校肺结核聚集性疫情呈逐年增多趋势,提示防控需注意聚集性疫情,创新策略,并重视学校结核病健康教育工作,预防结核病发生。     

2010-2015年南昌市肺结核病流行特征分析

目的 了解南昌市肺结核病疫情现状及流行病学特征,为制定全市结核病防治策略提供参考依据。 方法 利用《结核病信息管理系统》收集南昌市2010-2015年结核病数据信息,进行处理分析。 结果 2010-2015年南昌市共登记肺结核病例28 543例;2010-2015年南昌市结核病疫情呈逐年下降趋势;以春季登记肺结核患者人数最高,主要集中于3-5月份;男性发病多于女性,男女性别比为2.58:1.00,发病年龄集中在中老年人,农民是肺结核发病最多的人群;新建区、南昌县、进贤县三个农村县区发病数较高。 结论 南昌市结核病防治工作应抓住“重点地区”和“关键人群”,把防治工作重点放在农村,将农村中老年男性人口作为重点防治对象。     

2008-2012年扬州市初治涂阳肺结核疫情流行病学分析

目的了解扬州市初治涂阳肺结核患者流行病学特点,为结核病控制工作提供科学依据。方法根据扬州市各类结核病工作报表和全国结核病管理信息系统数据,对初治涂阳病例资料进行分类统计分析。结果 2008-2012年扬州市共登记初治涂阳肺结核病例5 950例,年均登记率为25.9/10万。每月均有病例;男性年均登记率高于女性,差异有统计学意义(P0.05),男女比为3.33∶1;男女发病年龄分别以65~74岁和55~64岁所占比例最大;农民/民工发病最多,占71.98%;城区和郊县初治涂阳登记率差异有统计学意义(P0.05);79.6%的患者来源于转诊和追踪;治愈率稳步提升,年均治愈率为94.49%。结论扬州市初治涂阳病例登记率呈下降趋势。应加强农村地区老年人群的结核病防治工作,采用现代结核病防治策略,控制结核病疫情。     

淮北市1998～2004年肺结核病流行趋势分析

目的分析淮北市肺结核病的流行趋势,为制定防治对策提供依据。方法对淮北市1998～2004年结核病疫情报表中肺结核病疫情资料进行收集整理,回顾性分析7年间结核病人的发现情况及新发涂阳肺结核病人的构成和转归。结果1998～2004年累计报告肺结核病人5916例,新发涂阳肺结核病人1655例。年平均报告肺结核发病率为42.86/10万,新发涂阳发病率为11.99/10万。新发涂阳病人男女之比为2.28∶1,66.82%的病人在15～54岁组内。治愈率平均为89.73%。结论淮北市新发涂阳肺结核发现率低,病人主要集中在青壮年。必须加强结核病归口管理,继续利用结核病控制项目,采用现代肺结核病控制技术,控制肺结核病疫情。     

Physical and mental health characteristics of U.S.- and foreign-born adults: United States, 1998-2003

OBJECTIVE: This report presents national prevalence estimates of selected measures of physical health status and limitations, health care access and utilization, and mental health status among the civilian noninstitutionalized population of U.S.- and foreign-born adults aged 18 years and over in four race-ethnicity groups in the United States. METHODS: The estimates in this report were derived from the Family Core and Sample Adult components of the 1998-2003 National Health Interview Surveys, conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Estimates were generated and comparisons conducted using the SUDAAN statistical package to account for the complex survey sample design. Data were age adjusted to the 2000 U.S. standard population. RESULTS: In general, the foreign-born population was younger, less likely to have a high school diploma, more likely to be poor, heavily concentrated in the central cities of metropolitan areas, and more likely to live in large families, compared with their U.S.-born counterparts. Hispanic immigrants were the least likely to have health insurance or to have a usual source of health care compared with other immigrant groups. Non-Hispanic black and Hispanic adults, regardless of nativity, were more likely to be obese than non-Hispanic white and non-Hispanic Asian adults. However, non-Hispanic black and Hispanic immigrant adults were significantly less likely to be obese than their U.S.-born counterparts. Hispanic immigrants were more likely to be obese the longer they lived in the United States. Foreign-born nonHispanic black and Hispanic immigrant adults experienced fewer symptoms of serious psychological distress compared with their U.S.-born counterparts. CONCLUSIONS: There are significant differences in physical health status and mental health status among U.S.-born and foreign-born adults. Foreign-born adults enjoy considerable advantages over their U.S.-born counterparts for many health measures despite limited access to health care and unfavorable sociodemographic characteristics. Differences in the impact of length of stay in the United States on immigrant health suggest that the role of acculturation in understanding immigrant health is complex and may differ for various race/ethnicity groups.     

宜昌地区结核分枝杆菌北京基因型菌株的鉴定及VNTR分型

 目的 研究宜昌地区结核分枝杆菌北京基因型菌株的多态性和流行特征,揭示该地区结核病的分子流行病学特征,为结核病防治提供科学依据。方法 选择2018年1月-2019年12月具有完整病例信息的结核分枝杆菌298株,进行人型结核分枝杆菌的鉴定,用扩增RD105缺失片段的多重PCR (DTM-PCR)鉴定北京基因型菌株;应用优化的9位点数目可变串联重复序列技术(VNTR)分析北京基因型菌株的多态性。结果 298株结核分枝杆菌中,260株为人型结核分枝杆菌,DTM-PCR鉴定发现北京基因型菌株140株(53.85%),非北京基因型菌株120株(46.15%)。北京基因型菌株耐药率(32.14%)高于非北京基因型菌株耐药率(10.83%),差异有统计学意义(P<0.05)。VNTR-9位点对北京基因型菌株的分辨率为0.998 5,成簇率为12.15%。结论 北京基因型菌株在宜昌地区呈较高流行趋势,且北京基因型菌株耐药率更高。VNTR-9位点基因分型方法用于该地区结核分枝杆菌北京基因型菌株的鉴别,能准确反映宜昌地区结核分枝杆菌的分子流行病学特征。     

Bayesian modelling of tuberculosis clustering from DNA fingerprint data

A combination of continuous and categorical tests, none of which is a gold standard, is often available for classification of subject status in epidemiologic studies. For example, tuberculosis (TB) molecular epidemiology uses select mycobacterial DNA sequences to provide clues about which cases of active TB are likely clustered, implying recent transmission between these cases, versus reactivation of previously acquired infection. The proportion of recently transmitted cases is important to public health, as different control methods are implemented as transmission rates increase. Standard typing methods include IS6110 restriction fragment length polymorphism (IS6110 RFLP), but recently developed polymerase chain reaction based genotyping modalities, including mycobacterial interspersed repetitive unit-variable-number tandem repeat and spoligotyping provide quicker results. In addition, it has recently been suggested that results from IS6110 RFLP can be used to create a continuous measure of genetic relatedness, called the nearest genetic distance. Whichever method is used, estimation of cluster rates is rendered difficult by the lack of a gold standard method for classifying cases as clustered or not. Since many of these methods are relatively new, their properties have not been extensively investigated. Misclassification errors subsequently lead to sub-optimal estimation of risk factors for clustering. Here we show how Bayesian latent class models can be used in such situations, for example to simultaneously analyse Mycobacterium tuberculosis DNA data from all three of the above methods. Using the data collected at the Public Health Unit in Montreal, we estimate the proportion of clustered cases and the operating characteristics of each method using information from all three methods combined, including both continuous and dichotomous measures from IS6110 RFLP. A misclassification-adjusted regression model provides estimates of the effects of risk factors on the clustering probabilities. We also discuss how one must carefully interpret any inferences that arise from a combination of continuous and dichotomous tests.     

聚合酶链反应扩增指纹多态性快速分型技术在部队结核病分子流行病学研究中的应用

目的 探讨南方部队结核病的分子流行病学规律。方法 设计一对特异性IS6110外向性引物，应用聚合酶链反应(PCR)建立检测结核分支杆菌DNA指纹多态性的方法，分析结核分支杆菌DNA多态性与流行病学的关系。结果 共检测分析了154株结核分支杆菌DNA的指纹多态性。根据这些菌株的指纹多态性特征共分为8个类型，以Ⅰ型(36．4％)、Ⅱ型(31．8％)和Ⅲ型(21．4％)为主，其余各型均少于4％。以20—29岁和30—39岁组在这三型中所占比例最大，分别为31．8％和27．9％。驻城镇部队与驻乡村部队以及结核病患者有无卡介苗接种史，在这三型的分布差异无显著统计学意义(P＞0．05)。但初治与复治患者分离菌株的PCR扩增指纹类型的分布差异有显著统计学意义(P＜0．05)。所检测菌株是否具有耐药性，在这三型中的分布差异也有显著统计学意义(P＜0．05)。菌株耐药主要为单耐异烟肼和利福平，耐药菌株在Ⅰ、Ⅱ、Ⅲ型中所占比例分别是44．4％、29．6％和14．8％。结论 PCR扩增指纹多态性分型技术是一种简便、快速、敏感、特异和重复性好的分型方法，可用于结核病的分子流行病学研究。南方部队结核分支杆菌的传播以Ⅰ、Ⅱ、Ⅲ型为主，应加强此三型菌株流行的监控。     

浙江省2010-2012年耐多药结核病患者空间分布特征分析

目的 分析2010-2012年浙江省耐多药结核病患者的空间分布特征。方法 运用ArcGIS 10.0软件空间分析方法,对浙江省耐多药结核病患者登记报告的数据进行空间显示和统计分析。结果 浙江省2010-2012年耐多药结核存在高发区和低发区,并存在空间聚集特征;局部Moran''s I自相关分析结果表明,吴兴区、德清县、余杭区、拱墅区、江干区、萧山区、越城区、绍兴县、嵊州市、常山县、柯城区为高高值聚集,海曙区为低低值聚集;局部G统计量热点分析结果显示,存在29个"热点"区域,18个"正热点"区域为吴兴区、南浔区、德清县、余杭区、上城区、下城区、拱墅区、江干区、滨江区、萧山区、西湖区、海宁市、越城区、绍兴县、诸暨市、嵊州市、柯城区、遂昌县,11个"负热点"区域为南湖区、海盐县、慈溪市、定海区、镇海区、江北区、江东区、北仑区、鄞州区、奉化市、乐清市。结论 浙江省耐多药结核发病具有明显的地域分布,存在较高程度的空间聚集性,且人口聚集的"正热点"区域的范围呈现出逐渐扩大的趋势。     

结核病传播动力学模型研究进展

结核病给全球带来了严重的疾病负担,结核病防控意义重大。近年来,新冠肺炎大流行严重破坏了全球结核病防治进程,再度引发对结核病防治工作的担忧。传播动力学模型能够较好地从宏观和微观角度揭示结核病传播规律及流行动态,并评估不同干预措施的防控效果,在结核病研究中发挥了重要作用。本文介绍五种结核病传播动力学模型：“仓室”模型、集合种群模型、智能体模型、网络模型和系统动力学模型,从而为结核病的防控和进一步研究提供参考和支持。