Spatial Patterns of Extensively Drug-Resistant Tuberculosis Transmission in KwaZulu-Natal, South Africa

Kristin N. Nelson; N. Sarita Shah; Barun Mathema; Nazir Ismail; James C.M. Brust; Tyler S. Brown; Sara C. Auld; Shaheed Vally Omar; Natashia Morris; Angie Campbell; Salim Allana; Pravi Moodley; Koleka Mlisana; Neel R. Gandhi

doi:10.1093/infdis/jiy394

Spatial Patterns of Extensively Drug-Resistant Tuberculosis Transmission in KwaZulu-Natal, South Africa

Kristin N. Nelson, N. Sarita Shah, Barun Mathema, Nazir Ismail, James C.M. Brust, Tyler S. Brown, Sara C. Auld, Shaheed Vally Omar, Natashia Morris, Angie Campbell, Salim Allana, Pravi Moodley, Koleka Mlisana, Neel R. Gandhi

Medicine

Research output: Contribution to journal › Article › peer-review

22 Scopus citations

Abstract

Background: Transmission is driving the global drug-resistant tuberculosis (TB) epidemic; nearly three-quarters of drug-resistant TB cases are attributable to transmission. Geographic patterns of disease incidence, combined with information on probable transmission links, can define the spatial scale of transmission and generate hypotheses about factors driving transmission patterns. Methods: We combined whole-genome sequencing data with home Global Positioning System coordinates from 344 participants with extensively drug-resistant (XDR) TB in KwaZulu-Natal, South Africa, diagnosed from 2011 to 2014. We aimed to determine if genomically linked (difference of ≤5 single-nucleotide polymorphisms) cases lived close to one another, which would suggest a role for local community settings in transmission. Results: One hundred eighty-two study participants were genomically linked, comprising 1084 case-pairs. The median distance between case-pairs' homes was 108 km (interquartile range, 64-162 km). Between-district, as compared to within-district, links accounted for the majority (912/1084 [84%]) of genomic links. Half (526 [49%]) of genomic links involved a case from Durban, the urban center of KwaZulu-Natal. Conclusions: The high proportions of between-district links with Durban provide insight into possible drivers of province-wide XDR-TB transmission, including urban-rural migration. Further research should focus on characterizing the contribution of these drivers to overall XDR-TB transmission in KwaZulu-Natal to inform design of targeted strategies to curb the drug-resistant TB epidemic.

Original language	English (US)
Pages (from-to)	1964-1973
Number of pages	10
Journal	The Journal of infectious diseases
Volume	218
Issue number	12
DOIs	https://doi.org/10.1093/infdis/jiy394
State	Published - Nov 5 2018

ASJC Scopus subject areas

General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/infdis/jiy394

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Nelson, K. N., Shah, N. S., Mathema, B., Ismail, N., Brust, J. C. M., Brown, T. S., Auld, S. C., Omar, S. V., Morris, N., Campbell, A., Allana, S., Moodley, P., Mlisana, K., & Gandhi, N. R. (2018). Spatial Patterns of Extensively Drug-Resistant Tuberculosis Transmission in KwaZulu-Natal, South Africa. The Journal of infectious diseases, 218(12), 1964-1973. https://doi.org/10.1093/infdis/jiy394

Nelson, KN, Shah, NS, Mathema, B, Ismail, N, Brust, JCM, Brown, TS, Auld, SC, Omar, SV, Morris, N, Campbell, A, Allana, S, Moodley, P, Mlisana, K & Gandhi, NR 2018, 'Spatial Patterns of Extensively Drug-Resistant Tuberculosis Transmission in KwaZulu-Natal, South Africa', The Journal of infectious diseases, vol. 218, no. 12, pp. 1964-1973. https://doi.org/10.1093/infdis/jiy394

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title = "Spatial Patterns of Extensively Drug-Resistant Tuberculosis Transmission in KwaZulu-Natal, South Africa",

abstract = "Background: Transmission is driving the global drug-resistant tuberculosis (TB) epidemic; nearly three-quarters of drug-resistant TB cases are attributable to transmission. Geographic patterns of disease incidence, combined with information on probable transmission links, can define the spatial scale of transmission and generate hypotheses about factors driving transmission patterns. Methods: We combined whole-genome sequencing data with home Global Positioning System coordinates from 344 participants with extensively drug-resistant (XDR) TB in KwaZulu-Natal, South Africa, diagnosed from 2011 to 2014. We aimed to determine if genomically linked (difference of ≤5 single-nucleotide polymorphisms) cases lived close to one another, which would suggest a role for local community settings in transmission. Results: One hundred eighty-two study participants were genomically linked, comprising 1084 case-pairs. The median distance between case-pairs' homes was 108 km (interquartile range, 64-162 km). Between-district, as compared to within-district, links accounted for the majority (912/1084 [84%]) of genomic links. Half (526 [49%]) of genomic links involved a case from Durban, the urban center of KwaZulu-Natal. Conclusions: The high proportions of between-district links with Durban provide insight into possible drivers of province-wide XDR-TB transmission, including urban-rural migration. Further research should focus on characterizing the contribution of these drivers to overall XDR-TB transmission in KwaZulu-Natal to inform design of targeted strategies to curb the drug-resistant TB epidemic.",

author = "Nelson, {Kristin N.} and Shah, {N. Sarita} and Barun Mathema and Nazir Ismail and Brust, {James C.M.} and Brown, {Tyler S.} and Auld, {Sara C.} and Omar, {Shaheed Vally} and Natashia Morris and Angie Campbell and Salim Allana and Pravi Moodley and Koleka Mlisana and Gandhi, {Neel R.}",

note = "Funding Information: This work is supported by Innovation and Entrepreneurship Training Program for College Students of University of Science and Technology Liaoning with the project number of X202210146084.",

year = "2018",

month = nov,

day = "5",

doi = "10.1093/infdis/jiy394",

language = "English (US)",

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pages = "1964--1973",

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T1 - Spatial Patterns of Extensively Drug-Resistant Tuberculosis Transmission in KwaZulu-Natal, South Africa

AU - Nelson, Kristin N.

AU - Shah, N. Sarita

AU - Mathema, Barun

AU - Ismail, Nazir

AU - Brust, James C.M.

AU - Brown, Tyler S.

AU - Auld, Sara C.

AU - Omar, Shaheed Vally

AU - Morris, Natashia

AU - Campbell, Angie

AU - Allana, Salim

AU - Moodley, Pravi

AU - Mlisana, Koleka

AU - Gandhi, Neel R.

N1 - Funding Information: This work is supported by Innovation and Entrepreneurship Training Program for College Students of University of Science and Technology Liaoning with the project number of X202210146084.

PY - 2018/11/5

Y1 - 2018/11/5

N2 - Background: Transmission is driving the global drug-resistant tuberculosis (TB) epidemic; nearly three-quarters of drug-resistant TB cases are attributable to transmission. Geographic patterns of disease incidence, combined with information on probable transmission links, can define the spatial scale of transmission and generate hypotheses about factors driving transmission patterns. Methods: We combined whole-genome sequencing data with home Global Positioning System coordinates from 344 participants with extensively drug-resistant (XDR) TB in KwaZulu-Natal, South Africa, diagnosed from 2011 to 2014. We aimed to determine if genomically linked (difference of ≤5 single-nucleotide polymorphisms) cases lived close to one another, which would suggest a role for local community settings in transmission. Results: One hundred eighty-two study participants were genomically linked, comprising 1084 case-pairs. The median distance between case-pairs' homes was 108 km (interquartile range, 64-162 km). Between-district, as compared to within-district, links accounted for the majority (912/1084 [84%]) of genomic links. Half (526 [49%]) of genomic links involved a case from Durban, the urban center of KwaZulu-Natal. Conclusions: The high proportions of between-district links with Durban provide insight into possible drivers of province-wide XDR-TB transmission, including urban-rural migration. Further research should focus on characterizing the contribution of these drivers to overall XDR-TB transmission in KwaZulu-Natal to inform design of targeted strategies to curb the drug-resistant TB epidemic.

AB - Background: Transmission is driving the global drug-resistant tuberculosis (TB) epidemic; nearly three-quarters of drug-resistant TB cases are attributable to transmission. Geographic patterns of disease incidence, combined with information on probable transmission links, can define the spatial scale of transmission and generate hypotheses about factors driving transmission patterns. Methods: We combined whole-genome sequencing data with home Global Positioning System coordinates from 344 participants with extensively drug-resistant (XDR) TB in KwaZulu-Natal, South Africa, diagnosed from 2011 to 2014. We aimed to determine if genomically linked (difference of ≤5 single-nucleotide polymorphisms) cases lived close to one another, which would suggest a role for local community settings in transmission. Results: One hundred eighty-two study participants were genomically linked, comprising 1084 case-pairs. The median distance between case-pairs' homes was 108 km (interquartile range, 64-162 km). Between-district, as compared to within-district, links accounted for the majority (912/1084 [84%]) of genomic links. Half (526 [49%]) of genomic links involved a case from Durban, the urban center of KwaZulu-Natal. Conclusions: The high proportions of between-district links with Durban provide insight into possible drivers of province-wide XDR-TB transmission, including urban-rural migration. Further research should focus on characterizing the contribution of these drivers to overall XDR-TB transmission in KwaZulu-Natal to inform design of targeted strategies to curb the drug-resistant TB epidemic.

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VL - 218

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JO - The Journal of infectious diseases

JF - The Journal of infectious diseases

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Spatial Patterns of Extensively Drug-Resistant Tuberculosis Transmission in KwaZulu-Natal, South Africa

Abstract

ASJC Scopus subject areas

UN SDGs

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