Prospective Molecular Epidemiological Study on Transmission of Pulmonary Tuberculosis and Migration (MuT Study)

Summary

Introduction: In Western Europe prevalence and incidence of tuberculosis in the indigenous population is declining and TB in migrants from high prevalence countries is becoming a major issue of TB control. Resulting changes in transmission patterns need to be investigated to adapt control strategies. The MuT (Migration and Tuberculosis) study a co-operation among federal and local public health services (ÖDG), the National Surveillance Center (RKI) and the University has been established in Baden-Wuerttemberg to address these issues.

Objectives: The goal of this ongoing study is to determine the transmission dynamics of TB in Baden-Wuerttemberg. Here, we present the first set of data on TB cases and their contacts and discuss strategies to overcome arising difficulties.

Methods: Prospective data collection of culture positive pulmonary tuberculosis cases and their contacts. Analysis of (1) routine data, (2) spatial data, (3) social interaction data, (4) molecular typing data, and (5) observational data of the implementation phase.

Results: The study demonstrates the capability of the study consortium to identify clusters. It provides valuable insights into current case detection and case management procedures and shows ways to improve. A set of factors has been identified that (a) facilitate and (b) discourage study participation.

Conclusion: Collaboration among federal and local public health services (ÖGD), National Surveillance Center (RKI) and the University is a promising approach to investigate and improve TB control. This model has potentials for other infectious disease control.

Keywords

Tuberculosis - public health services - migration - molecular epidemiology - clustering

• References

• 1 WHO report 2003. http://www.who.int/gtb/publications/globrep/download.html accessed 15.3.04
• 2 RKI report. Zum Welttuberkulosetag 2004: Jeder Atemzug zählt- Stoppt TB jetzt! Epidemiologisches Bulletin. 2004; 12: 95-7.
• 3 Euro Surveillance. Tuberculosis in Europe: another step forward for international surveillance. Europ Comm Dis Bull 1998; 3: 1-5.
• 4 LGA report. Tuberkulose in Baden-Württemberg. July 2003
• 5 Menzies D. Tuberculosis crosses borders. Int J Tuberc Lung Dis 2000; 4 (12) S153-S159.
• 6 Rieder HL, Zellweger J-P, Raviglione MC, Keizer ST, Migliori GB. Tuberculosis control in Europe and international migration. Eur Respir J 1994; 7: 1545-53.
• 7 Bloom BR. Tuberculosis-the global view. NEJM 2002; 346 (19) 1434-5.
• 8 Broekmans JF, Migliori GB, Rieder HL, Leese J, Rutu P, Loddenkemper R. et al. European framework for effective tuberculosis control and elimination in countries with a low incidence of tuberculosis. Eur Respir J 2002; 19: 765-75.
• 9 Lillebaek T, Andersen AB, Dirksen A, Smith E, Skovgaard LT, Kok-Jensen A. Persistent high incidence of tuberculosis in immigrants in low-incidence country. Emerg Infect Dis 2002; 8 (07) 679-84.
• 10 Alland D, Kalkut GE, Moss AR, McAdam RA, Hahn JA, Bosworth W, Drucker E, Bloom BR. Transmission of tuberculosis in New York City. NEJM 1994; 330: 1710-6.
• 11 Bishai WR, Graham NMH, Harrington S, Pope DS, Hooper N, Astemborski J, Sheely L, Vlahov D, Glass GE, Chiasson RE. Molecular and geographic patterns of tuberculosis transmission after 15 years of directly observed therapy. JAMA 1998; 280 (19) 1679-84.
• 12 Borgdorff MW, Nagelkerke N, van Soolingen D, de Haas PEW, Veen J, van Embden JDA. Analysis of tuberculosis transmission between nationalities in the Netherlands in the period 1993 – 1995 using DNA fingerprinting. AJE 1998; 147 (02) 187-95.
• 13 Borgdorff MW, Behr MA, Nagelkerke NJ, Hopewell PC, Small PM. Transmission of tuberculosis in San Francisco and its association with immigration and ethnicity. Int J Tuberc Lung Dis 2000; 4 (04) 287-94.
• 14 Lillebaek T, Andersen AB, Bauer J, Dirksen A, Glismann S, de Haas P, Kok-Jensen A. Risk of mycobacterium tuberculosis transmission in a lowincidence country due to immigration from highincidence areas. J Clin Microbiol 2001; 39 (03) 855-61.
• 15 Mitnick C, Furin J, Henry C, Ross J. Tuberculosis among the foreign born in Massachusetts, 1982–1994: a reflection of social and economic disadvantage. Int J Tuberc Lung Dis 1998; 2 (09) S32-S40.
• 16 Small PM, Hopewell PC, Singh SP, Paz A, Parsonnet J, Ruston DC, Schecter GF, Daley CL, Schoolmik GK. The epidemiology of tuberculosis in San Francisco. NEJM 1994; 330 (24) 1703-9.
• 17 RKI: Falldefinitionen des Robert Koch Institutes, 2002
• 18 DZK. Richtlinien für die Umgebungsuntersuchung bei Tuberkulose. Nachdruck 1997 aus: Gesundheitswesen 1996; 58: 657-65.
• 19 van Embden JD, Cave MD, Crawford JT, Dale JW, Eisenach KD, Gicquel B, Hermans P, Martin C, McAdams R, Shinnick TM. Strain identification of mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol 1993; 31: 406-9.
• 20 Hayward AC, Coker RJ. Could a tuberculosis epidemic occur in London as it did in New York?. Em Inf Dis 2000; 6 (01) 12-6.
• 21 McNabb SJN, Braden CR, Navin TR. DNA fingerprinting of Mycobacterium tuberculosis: Lessons learned and implications for the future. Emerg Infect Dis 2002; 8: 11
• 22 Murray M, Nardell E. Molecular epidemiology of tuberculosis: achievements and challenges to current knowledge. Bull WHO 2002; 80 (06) 477-82.