Field Epidemiology Training Programme, Public Health England, Liverpool, UK Field Epidemiology Services, Public Health England, Liverpool, UK European Programme for Intervention Epidemiology Training, European Centre for Diseases Prevention and Control, Stockholm, Sweden.
Greater Manchester Public Health England Centre, Public Health England, Manchester, UK Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
Thorax. 2016 Aug;71(8):742-8. doi: 10.1136/thoraxjnl-2014-206416. Epub 2015 Apr 28.
Information on geographical variation in localised transmission of TB can inform targeting of disease control activities. The aim of this study was to estimate the proportion of TB attributable to localised transmission for the period 2010-2012 in northern England and to identify case characteristics associated with spatiotemporal-genotypical clusters.
We combined genotyping data with spatiotemporal scan statistics to define an indicator of localised TB transmission and identified factors associated with localised TB transmission thus defined in a multivariable logistics regression model.
The estimated proportion of TB cases in northern England attributable to localised transmission was 10% (95% CI 9% to 12%). Clustered cases (cases which were spatiotemporally clustered with others of identical genotype) were on average younger than non-clustered cases (mean age 34 years vs 43 years; p value <0.05). Being UK born (adjusted OR (aOR) 3.6, 95% CI 2.9 to 6.0), presenting with pulmonary disease (aOR 2.2, 95% CI 1.3 to 3.6) and history of homelessness (aOR 2.8, 95% CI 1.2 to 6.8) or incarceration (aOR 2.6, 95% CI 1.2 to 5.9) were independently associated with being part of a spatiotemporal-genotypical cluster in a multivariable model. Belonging to an ethnic group other than white or mixed/other was also significantly associated with localised transmission. We identified localised transmission in 103/1958 middle super output areas mostly in urban areas.
Incorporating highly discriminatory genotyping data into spatiotemporal analysis of TB incidence is feasible as part of routine surveillance and can provide valuable information on groups at greater risk and areas with localised transmission of TB, which could be used to inform control measures, such as intensified contact tracing.
有关局部传播结核病的地理变异信息可用于指导疾病控制活动的重点。本研究的目的是估计 2010-2012 年在英格兰北部局部传播的结核病比例，并确定与时空基因聚类相关的病例特征。
我们将基因分型数据与时空扫描统计相结合，定义了一个局部结核病传播的指标，并在多变量逻辑回归模型中确定了与由此定义的局部结核病传播相关的因素。
英格兰北部局部传播的结核病病例比例估计为 10%（95%CI 9%至 12%）。聚类病例（与其他相同基因型的病例在时空上聚类的病例）的平均年龄小于非聚类病例（平均年龄 34 岁比 43 岁；p 值<0.05）。在英国出生（调整后的比值比（aOR）3.6，95%CI 2.9 至 6.0）、患有肺部疾病（aOR 2.2，95%CI 1.3 至 3.6）、无家可归史（aOR 2.8，95%CI 1.2 至 6.8）或监禁史（aOR 2.6，95%CI 1.2 至 5.9）与时空基因聚类中的病例部分相关在多变量模型中。属于白种人或混合/其他以外的其他族裔也与局部传播显著相关。我们在 1958 个中超级输出区中的 103 个（主要在城市地区）发现了局部传播。
将高度区分性的基因分型数据纳入结核病发病率的时空分析是可行的，作为常规监测的一部分，可以提供有关高危人群和结核病局部传播地区的有价值信息，这可以用于指导控制措施，例如强化接触者追踪。
