Transmission characteristics in Tuberculosis by WGS: nationwide cross-sectional surveillance in China

Dongxin Liu; Fei Huang; Yaru Li; Lingfeng Mao; Wencong He; Sihao Wu; Hui Xia; Ping He; Huiwen Zheng; Yang Zhou; Bing Zhao; Xichao Ou; Yuanyuan Song; Zexuan Song; Li Mei; Li Liu; Guoliang Zhang; Qiang Wei; Yanlin Zhao

doi:10.1080/22221751.2024.2348505

Emerging Microbes and Infections (Dec 2024)

Transmission characteristics in Tuberculosis by WGS: nationwide cross-sectional surveillance in China

Dongxin Liu,
Fei Huang,
Yaru Li,
Lingfeng Mao,
Wencong He,
Sihao Wu,
Hui Xia,
Ping He,
Huiwen Zheng,
Yang Zhou,
Bing Zhao,
Xichao Ou,
Yuanyuan Song,
Zexuan Song,
Li Mei,
Li Liu,
Guoliang Zhang,
Qiang Wei,
Yanlin Zhao

Affiliations

Dongxin Liu: National Pathogen Resource Center, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Fei Huang: National Tuberculosis Reference Laboratory, National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Yaru Li: Department of Nutrition, Beijing Friendship Hospital, Capital Medical University
Lingfeng Mao: Joint Research Center for Molecular Diagnosis of Severe Infection in Children, Binjiang Institute of Zhejiang University, Hangzhou, People’s Republic of China
Wencong He: National Tuberculosis Reference Laboratory, National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Sihao Wu: Joint Research Center for Molecular Diagnosis of Severe Infection in Children, Binjiang Institute of Zhejiang University, Hangzhou, People’s Republic of China
Hui Xia: National Tuberculosis Reference Laboratory, National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Ping He: National Tuberculosis Reference Laboratory, National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Huiwen Zheng: Laboratory of Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Center for Children’s Health, Beijing, People’s Republic of China
Yang Zhou: National Tuberculosis Reference Laboratory, National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Bing Zhao: National Tuberculosis Reference Laboratory, National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Xichao Ou: National Tuberculosis Reference Laboratory, National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Yuanyuan Song: National Tuberculosis Reference Laboratory, National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Zexuan Song: National Tuberculosis Reference Laboratory, National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Li Mei: National Pathogen Resource Center, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Li Liu: National Pathogen Resource Center, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Guoliang Zhang: National Clinical Research Center for Infectious Diseases, Guangdong Clinical Research Center for Tuberculosis, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
Qiang Wei: National Pathogen Resource Center, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
Yanlin Zhao: National Tuberculosis Reference Laboratory, National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China

DOI: https://doi.org/10.1080/22221751.2024.2348505
Journal volume & issue: Vol. 13, no. 1

Abstract

Read online

ABSTRACTChina, with the third largest share of global tuberculosis cases, faces a substantial challenge in its healthcare system as a result of the high burden of multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB). This study employs a genomic epidemiological approach to assess recent tuberculosis transmissions between individuals, identifying potential risk factors and discerning the role of transmitted resistant isolates in the emergence of drug-resistant tuberculosis in China. We conducted a population-based retrospective study on 5052 Mycobacterium tuberculosis (MTB) isolates from 70 surveillance sites using whole genome sequencing (WGS). Minimum spanning tree analysis identified resistance mutations, while epidemiological data analysis pinpointed transmission risk factors. Of the 5052 isolates, 23% (1160) formed 452 genomic clusters, with 85.6% (387) of the transmissions occurring within the same counties. Individuals with younger age, larger family size, new cases, smear positive, and MDR/RR were at higher odds for recent transmission, while higher education (university and above) and occupation as a non-physical workers emerged as protective factors. At least 61.4% (251/409) of MDR/RR-TB were likely a result of recent transmission of MDR/RR isolates, with previous treatment (crude OR = 2.77), smear-positive (cOR = 2.07) and larger family population (cOR = 1.13) established as risk factors. Our findings highlight that local transmission remains the predominant form of TB transmission in China. Correspondingly, drug-resistant tuberculosis is primarily driven by the transmission of resistant tuberculosis isolates. Targeted interventions for high-risk populations to interrupt transmission within the country will likely provide an opportunity to reduce the prevalence of both tuberculosis and drug-resistant tuberculosis.

Published in Emerging Microbes and Infections

ISSN: 2222-1751 (Online)
Publisher: Taylor & Francis Group
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Infectious and parasitic diseases; Science: Microbiology
Website: https://www.tandfonline.com/journals/temi

About the journal

Abstract

Keywords