14th ICID - Poster Abstracts - International Society for Infectious ...

When citing these abstracts please use the following reference:
Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.
Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1
is available electronically on http://www.sciencedirect.com
Final Abstract Number: 33.004
Session: Tuberculosis: Epidemiology, Prevention & Control
Date: Wednesday, March 10, 2010
Time: 12:30-13:30
Room: Poster & Exhibition Area/Ground Level
Type: Poster Presentation
Transmission of drug resistant tuberculosis and its implication for TB control in rural China
Y. Hu, W. Jiang, W. Wang, B. Xu
School of Public Health, Fudan University, Shanghai, China
Background: The transmission pattern of drug resistant TB might vary due to the difference in
the geographic feature, socio-economic development and TB epidemic from specific areas and
populations. This might also matter how effectively TB control program would work. The present
study attempted to describe the transmission of drug resistant TB in two comparable rural
Chinese areas albeit with different duration of direct observed treatment, short-course(DOTS)
implementation, as well as to discuss about its possible implication for TB control policies.
Methods: Setting in two rural counties: ten years’ DOTS covered Deqing and one year’s DOTS
covered Guanyun, this study included the pulmonary drug resistant TB patients registered in local
TB dispensaries as the subject. Proportion method and DNA sequencing determined drug
resistant pattern and genetic mutation of M.TB isolates. IS6110-RFLP identified clustered patients
and their epidemiological link was confirmed using concentric circle method.
Results: Totally 223 of 351 isolates(63.5%) were resistant to at least one anti-TB drug, including
53(15.1%) simultaneously resistant to isoniazid and rifampicin or multidrug resistant(MDR-TB,18
from Deqing and 35 from Guanyun). Of the 168 patterns identified by IS6110-RFLP, 20 were
shared only between drug resistant isolates; 12 were shared between the drug resistant isolates
and the pan-drug sensitive isolates. Deqing and Guanyun had significantly different cluster
proportion of drug resistant TB(32/101.vs.55/122,p=0.041) but similar cluster proportion of MDR-
TB isolates(11/19.vs.22/34,p=0.624). The significant high cluster proportion was observed in the
previous treated patients both in two counties but in the sputum smear positive patients with
cavitaries alone in Guanyun, so does happen to those infected with the strain from Beijing
genotype and resistant to isonazid and/or rifampicin. Of 87 clustered drug resistant strain, 67.8%
was clustered in same or neighboring villageThe remained 71.4% were scatted along the traffic
arteries.
Conclusion: Transmission pattern of drug resistant TB was consistent with attenuated properties
of pathogen as well as social activity of rural populations. Meanwhile, DOTS itself might not work
enough on the recent transmission of MDR-TB. These observations might suggest the need of
supplementing the additional strategies, including active case finding within village and effective
treatment on patients previously treated or with cavitaries.