Tuberculosis (TB) incidence is decreasing worldwide and eradication is becoming plausible. In low-incidence countries, intervention on migrant populations is considered one of the most important strategies for elimination. However, such measures are inappropriate in European areas where TB is largely endemic, such as Porto in Portugal. We aim to understand transmission chains in Porto through a genetic characterization of Mycobacterium tuberculosis strains and through a detailed epidemiological evaluation of cases.This work was developed under the scope of the project NORTE-01-0145-FEDER-000013, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER), and supported by contributions from Iceland, Liechtenstein and Norway through the European Economic Area Grants under the Public Health Initiative programme, (PT06, Project 000138DT1). TR is supported by the Portuguese Foundation for Science and Technology (FCT) through a post-doctoral grant (SFRH/BPD/108126/2015)info:eu-repo/semantics/publishedVersio

A Roetzer

AR Moss

C Nunes

Carlos Carvalho

Carlos Matos

Catarina L. Santos

Clara Morais

Eduarda Ferreira

EL Hamblion

Gabriela Rodrigues

Helena Ramos

Henrique Machado

HJ Bandelt

HN Bastos

I Comas

I Franco

J Paulino

Jorge Gonçalves

João Tiago Guimarães

JS Lopes

K Lönnroth

L D’Ambrosio

L Fallico

L Yuan

Lurdes Maio

M Dias

M Kato-Maeda

Margarida Correia-Neves

MC Oelemann

Olena Oliveira

P Supply

PF Barnes

Raquel Duarte

S Gagneux

SJ Salipante

Teresa Rito

TM Walker

U Gurjav

V Vadwai

BMC Infectious Diseases

English

Background: Tuberculosis (TB) incidence is decreasing worldwide and eradication is becoming plausible. In low-incidence countries, intervention on migrant populations is considered one of the most important strategies for elimination. However, such measures are inappropriate in European areas where TB is largely endemic, such as Porto in Portugal. We aim to understand transmission chains in Porto through a genetic characterization of Mycobacterium tuberculosis strains and through a detailed epidemiological evaluation of cases.
Methods: We genotyped the M. tuberculosis strains using the MIRU-VNTR system. We performed an evolutionary reconstruction of the genotypes with median networks, used in this context for the first time. TB cases from a period of two years were evaluated combining genetic, epidemiological and georeferencing information.
Results: The data reveal a unique complex scenario in Porto where the autochthonous population acts as a genetic reservoir of M. tuberculosis diversity with discreet episodes of transmission, mostly undetected using classical epidemiology alone.
Conclusions: Although control policies have been successful in decreasing incidence in Porto, the discerned complexity suggests that, for elimination to be a realistic goal, strategies need to be adjusted and coupled with a continuous genetic characterization of strains and detailed epidemiological evaluation, in order to successfully identify and interrupt transmission chains.This work was developed under the scope of the project NORTE-01-0145-FEDER-000013, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER), and supported by contributions from Iceland, Liechtenstein and Norway through the European Economic Area Grants under the Public Health Initiative programme, (PT06, Project 000138DT1). TR is supported by the Portuguese Foundation for Science and Technology (FCT) through a post-doctoral grant (SFRH/BPD/108126/2015)

Rito, T

Matos, C

Carvalho, C

Machado, H

Rodrigues, G

Oliveira, O

Ferreira, E

Gonçalves, J

Maio, L

Morais, C

Ramos, H

Guimarães, JT

Santos, CL

Duarte, R

Correia-Neves, M

Open Repository of the University of Porto

A complex scenario of tuberculosis transmission is revealed through genetic and epidemiological surveys in Porto

Rito, Teresa S

Matos, Carlos

Carvalho, Carlos

Machado, Henrique Pedro Pereira Silva Amaral

Rodrigues, Gabriela

Oliveira, Olena

Ferreira, Eduarda

Gonçalves, Jorge

Maio, Lurdes

Morais, Clara

Ramos, Helena

Guimarães, João Tiago

Santos, Catarina L.

Duarte, Raquel

Universidade do Minho: RepositoriUM

Abstract Background Tuberculosis (TB) incidence is decreasing worldwide and eradication is becoming plausible. In low-incidence countries, intervention on migrant populations is considered one of the most important strategies for elimination. However, such measures are inappropriate in European areas where TB is largely endemic, such as Porto in Portugal. We aim to understand transmission chains in Porto through a genetic characterization of Mycobacterium tuberculosis strains and through a detailed epidemiological evaluation of cases. Methods We genotyped the M. tuberculosis strains using the MIRU-VNTR system. We performed an evolutionary reconstruction of the genotypes with median networks, used in this context for the first time. TB cases from a period of two years were evaluated combining genetic, epidemiological and georeferencing information. Results The data reveal a unique complex scenario in Porto where the autochthonous population acts as a genetic reservoir of M. tuberculosis diversity with discreet episodes of transmission, mostly undetected using classical epidemiology alone. Conclusions Although control policies have been successful in decreasing incidence in Porto, the discerned complexity suggests that, for elimination to be a realistic goal, strategies need to be adjusted and coupled with a continuous genetic characterization of strains and detailed epidemiological evaluation, in order to successfully identify and interrupt transmission chains

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Background: Tuberculosis (TB) incidence is decreasing worldwide and eradication is becoming plausible. In low-incidence countries, intervention on migrant populations is considered one of the most important strategies for elimination. However, such measures are inappropriate in European areas where TB is largely endemic, such as Porto in Portugal. We aim to understand transmission chains in Porto through a genetic characterization of Mycobacterium tuberculosis strains and through a detailed epidemiological evaluation of cases.
Methods: We genotyped the M. tuberculosis strains using the MIRU-VNTR system. We performed an evolutionary reconstruction of the genotypes with median networks, used in this context for the first time. TB cases from a period of two years were evaluated combining genetic, epidemiological and georeferencing information.
Results: The data reveal a unique complex scenario in Porto where the autochthonous population acts as a genetic reservoir of M. tuberculosis diversity with discreet episodes of transmission, mostly undetected using classical epidemiology alone.
Conclusions: Although control policies have been successful in decreasing incidence in Porto, the discerned complexity suggests that, for elimination to be a realistic goal, strategies need to be adjusted and coupled with a continuous genetic characterization of strains and detailed epidemiological evaluation, in order to successfully identify and interrupt transmission chains.This work was developed under the scope of the project NORTE-01-0145-FEDER-000013, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER), and supported by contributions from Iceland, Liechtenstein and Norway through the European Economic Area Grants under the Public Health Initiative programme, (PT06, Project 000138DT1). TR is supported by the Portuguese Foundation for Science and Technology (FCT) through a post-doctoral grant (SFRH/BPD/108126/2015)

Repositório Aberto da Universidade do Porto

https://repositorio-aberto.up.pt/bitstream/10216/113042/1/RitoT20181853.pdf

A complex scenario of tuberculosis transmission is revealed through genetic and epidemiological surveys in Porto

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Open Repository of the University of Porto

Universidade do Minho: RepositoriUM

Universidade do Minho: RepositoriUM

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Repositório Aberto da Universidade do Porto