Fiebig Lena, Kohl Thomas A, Popovici Odette, Mühlenfeld Margarita, Indra Alexander, Homorodean Daniela, Chiotan Domnica, Richter Elvira, Rüsch-Gerdes Sabine, Schmidgruber Beatrix, Beckert Patrick, Hauer Barbara, Niemann Stefan, Allerberger Franz, Haas Walter
Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
These authors contributed equally to this work.
Euro Surveill. 2017 Jan 12;22(2). doi: 10.2807/1560-7917.ES.2017.22.2.30439.
Molecular surveillance of multidrug-resistant tuberculosis (MDR-TB) using 24-loci MIRU-VNTR in the European Union suggests the occurrence of international transmission. In early 2014, Austria detected a molecular MDR-TB cluster of five isolates. Links to Romania and Germany prompted the three countries to investigate possible cross-border MDR-TB transmission jointly. We searched genotyping databases, genotyped additional isolates from Romania, used whole genome sequencing (WGS) to infer putative transmission links, and investigated pairwise epidemiological links and patient mobility. Ten isolates from 10 patients shared the same 24-loci MIRU-VNTR pattern. Within this cluster, WGS defined two subgroups of four patients each. The first comprised an MDR-TB patient from Romania who had sought medical care in Austria and two patients from Austria. The second comprised patients, two of them epidemiologically linked, who lived in three different countries but had the same city of provenance in Romania. Our findings strongly suggested that the two cases in Austrian citizens resulted from a newly introduced MDR-TB strain, followed by domestic transmission. For the other cases, transmission probably occurred in the same city of provenance. To prevent further MDR-TB transmission, we need to ensure universal access to early and adequate therapy and collaborate closely in tuberculosis care beyond administrative borders.
在欧盟使用24位点MIRU-VNTR对耐多药结核病（MDR-TB）进行分子监测表明存在国际传播情况。2014年初，奥地利检测到一个由五株分离株组成的分子MDR-TB聚集性病例。与罗马尼亚和德国的关联促使这三个国家联合调查可能的跨境MDR-TB传播情况。我们搜索了基因分型数据库，对来自罗马尼亚的更多分离株进行基因分型，使用全基因组测序（WGS）推断可能的传播联系，并调查成对的流行病学联系和患者流动性。来自10名患者的10株分离株具有相同的24位点MIRU-VNTR模式。在这个聚集性病例中，WGS确定了两个亚组，每组有四名患者。第一组包括一名来自罗马尼亚、在奥地利就医的MDR-TB患者以及两名来自奥地利的患者。第二组包括一些患者，其中两名在流行病学上有关联，他们生活在三个不同国家，但在罗马尼亚有相同的来源城市。我们的研究结果强烈表明，奥地利公民中的两例病例是由新引入的MDR-TB菌株引起的，随后在国内传播。对于其他病例，传播可能发生在相同的来源城市。为防止MDR-TB进一步传播，我们需要确保普遍能够获得早期和充分的治疗，并在行政边界之外的结核病护理方面密切合作。
