Andrés Marta, Göhring-Zwacka Elke, Fiebig Lena, Priwitzer Martin, Richter Elvira, Rüsch-Gerdes Sabine, Haas Walter, Niemann Stefan, Brodhun Bonita
Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
State Health Department (Landesgesundheitsamt) Baden-Württemberg, Stuttgart, Germany.
PLoS One. 2017 Nov 22;12(11):e0188356. doi: 10.1371/journal.pone.0188356. eCollection 2017.
An integrated molecular surveillance for tuberculosis (TB) improves the understanding of ongoing TB transmission by combining molecular typing and epidemiological data. However, the implementation of an integrated molecular surveillance for TB is complex and requires thoughtful consideration of feasibility, demand, public health benefits and legal issues. We aimed to pilot the integration of molecular typing results between 2008 and 2010 in the German Federal State of Baden-Württemberg (population 10.88 Million) as preparation for a nationwide implementation. Culture positive TB cases were typed by IS6110 DNA fingerprinting and results were integrated into routine notification data. Demographic and clinical characteristics of cases and clusters were described and new epidemiological links detected after integrating typing data were calculated. Furthermore, a cross-sectional survey was performed among local public health offices to evaluate their perception and experiences. Overall, typing results were available for 83% of notified culture positive TB cases, out of which 25% were clustered. Age <15 years (OR = 4.96, 95% CI: 1.69-14.55) and being born in Germany (OR = 2.01, 95% CI: 1.44-2.80) were associated with clustering. At cluster level, molecular typing information allowed the identification of previously unknown epidemiological links in 11% of the clusters. In 59% of the clusters it was not possible to identify any epidemiological link. Clusters extending over different counties were less likely to have epidemiological links identified among their cases (OR = 11.53, 95% CI: 3.48-98.23). The majority of local public health offices found molecular typing useful for their work. Our study illustrates the feasibility of integrating typing data into the German TB notification system and depicts its added public health value as complementary strategy in TB surveillance, especially to uncover transmission events among geographically separated TB patients. It also emphasizes that special efforts are required to strengthen the communication between local public health offices in different counties to enhance TB control.
结核病（TB）的综合分子监测通过整合分子分型和流行病学数据，提高了对正在进行的结核病传播的认识。然而，实施结核病综合分子监测很复杂，需要对可行性、需求、公共卫生效益和法律问题进行深思熟虑。我们的目标是在2008年至2010年期间，在德国巴登-符腾堡州（人口1088万）试点整合分子分型结果，为全国范围内的实施做准备。对培养阳性的结核病病例进行IS6110 DNA指纹分型，并将结果整合到常规报告数据中。描述了病例和聚集性病例的人口统计学和临床特征，并计算了整合分型数据后检测到的新的流行病学关联。此外，还对当地公共卫生办公室进行了横断面调查，以评估他们的看法和经验。总体而言，83%的报告培养阳性结核病病例有分型结果，其中25%为聚集性病例。年龄<15岁（OR = 4.96，95%CI：1.69-14.55）和出生在德国（OR = 2.01，95%CI：1.44-2.80）与聚集性病例相关。在聚集性病例层面，分子分型信息使11%的聚集性病例中发现了先前未知的流行病学关联。在59%的聚集性病例中，无法确定任何流行病学关联。跨越不同县的聚集性病例中，其病例之间发现流行病学关联的可能性较小（OR = 11.53，95%CI：3.48-98.23）。大多数当地公共卫生办公室认为分子分型对他们的工作有用。我们的研究说明了将分型数据整合到德国结核病报告系统中的可行性，并描述了其作为结核病监测补充策略的额外公共卫生价值，特别是在发现地理上分散的结核病患者之间的传播事件方面。它还强调，需要做出特别努力，加强不同县的当地公共卫生办公室之间的沟通，以加强结核病控制。
