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Lancet Infec Dis:中国上海结核病的内部迁移和传播动态:流行病学,空间,基因组分析

发布日期:2018-06-11来源:Lancet Infec Dis发布人:感控雏鹰

中国上海结核病的内部迁移和传播动态:流行病学,空间,基因组分析


背景

从农村到城市的大规模内部迁移为中国结核病控制带来了新的挑战。我们旨在结合基因组,空间和流行病学数据来描述具有大量移民的城市环境中的结核病动态。

方法

我们在上海松江进行了一项基于人群的培养阳性结核分枝杆菌菌株的研究。我们使用全基因组测序来区分具有相同可变数量串联重复(VNTR)模式的结核分枝杆菌的明显遗传簇,并分析了居住地附近与基因组聚集的结核分枝杆菌风险之间的关系。最后,我们使用基因组,空间和流行病学数据来估计移民和居民感染和传播的时间。

结果

在2009年1月1日至2015年12月31日期间,共记录1620例培养阳性肺结核病例,其中1211例(75%)发生在国内流动人口中。在218个共享相同VNTR模式的人中有150个(69%)在至少一个其他菌株的10个单核苷酸多态性(SNP)内具有分离物,这与最近传播的结核分枝杆菌。从居住在距离较近的个体中收集到的菌株对比从远处居住的个体更可能与基因相似 - 对于患者家中每增加一公里的距离,基因型匹配的菌株在彼此的10个SNP内的几率减少了约10%(OR=0.89 [95%CI 0.87-0.91]; p <0.0001)。我们推断居民向移民的传播与移民向居民的传播一样普遍,我们估计移民后三分之二以上的基因组群移民在本地受到感染。

解释

推动城市中心结核病局部发病的主要机制是移民与居民之间的本地传播。流行病学,基因组学和空间数据的综合分析有助于对当地传播动力学有更深入的了解,并应该为设计更有效的干预措施提供信息。

Internal migration and transmission dynamics of tuberculosis in Shanghai, China: an epidemiological, spatial, genomic analysis

Background

Massive internal migration from rural to urban areas poses new challenges for tuberculosis control in China. We aimed to combine genomic, spatial, and epidemiological data to describe the dynamics of tuberculosis in an urban setting with large numbers of migrants.

Methods

We did a population-based study of culture-positive Mycobacterium tuberculosis isolates in Songjiang, Shanghai. We used whole-genome sequencing to discriminate apparent genetic clusters of M tuberculosis sharing identical variable-number-tandem-repeat (VNTR) patterns, and analysed the relations between proximity of residence and the risk of genomically clustered M tuberculosis. Finally, we used genomic, spatial, and epidemiological data to estimate time of infection and transmission links among migrants and residents.

Findings

Between Jan 1, 2009, and Dec 31, 2015, 1620 cases of culture-positive tuberculosis were recorded, 1211 (75%) of which occurred among internal migrants. 150 (69%) of 218 people sharing identical VNTR patterns had isolates within ten single-nucleotide polymorphisms (SNPs) of at least one other strain, consistent with recent transmission of M tuberculosis. Pairs of strains collected from individuals living in close proximity were more likely to be genetically similar than those from individuals who lived far away—for every additional km of distance between patients' homes, the odds that genotypically matched strains were within ten SNPs of each other decreased by about 10% (OR 0·89 [95% CI 0·87–0·91]; p<0·0001). We inferred that transmission from residents to migrants occurs as commonly as transmission from migrants to residents, and we estimated that more than two-thirds of migrants in genomic clusters were infected locally after migration.

Interpretation

The primary mechanism driving local incidence of tuberculosis in urban centres is local transmission between both migrants and residents. Combined analysis of epidemiological, genomic, and spatial data contributes to a richer understanding of local transmission dynamics and should inform the design of more effective interventions.

简译人:感控雏鹰