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The molecular epidemiology of tuberculosis in inner London

Published online by Cambridge University Press:  25 April 2002

A. C. HAYWARD
Affiliation:
PHLS Communicable Disease Surveillance Centre – London/University College London, Centre for Infectious Disease Epidemiology, London
S. GOSS
Affiliation:
PHLS Mycobacterium Reference Unit, Dulwich, London
F. DROBNIEWSKI
Affiliation:
PHLS Mycobacterium Reference Unit, Dulwich, London
N. SAUNDERS
Affiliation:
PHLS Virus Reference Division, Central Public Health Laboratories, London
R. J. SHAW
Affiliation:
Director of Medicine and Professor of Respiratory Medicine, Hammersmith Hospitals NHS Trust, London
M. GOYAL
Affiliation:
Department of Respiratory Medicine, NHLI, ICSM London
A. SWAN
Affiliation:
PHLS Statistics Unit, London
A. UTTLEY
Affiliation:
PHLS Mycobacterium Reference Unit, Dulwich, London
A. POZNIAK
Affiliation:
Department of GUM/HIV Medicine, Chelsea and Westminster Hospital, London
J. GRACE-PARKER
Affiliation:
PHLS Communicable Disease Surveillance Centre, London
J. M. WATSON
Affiliation:
PHLS Communicable Disease Surveillance Centre, London
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Abstract

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The study used DNA fingerprint typing (spoligotyping and Heminested-Inverse-PCR) of Mycobacterium tuberculosis from all culture-confirmed inner London patients over a 12-month period to describe transmission. The methodology was evaluated by comparison with standard IS6110 typing and by examining its ability to identify known household clusters of cases. Isolates sharing indistinguishable typing patterns using both techniques were defined as clustered. Clusters were investigated to identify epidemiological links. The methodology showed good discriminatory power and identified known household clusters of cases. Of 694 culture-confirmed cases, 563 (81%) were typed. Eleven (2%) were due to laboratory cross-contamination and were excluded. Of the remaining 552 isolates 148 (27%) were clustered. Multivariate analysis indicated that clustering was more common in those with pulmonary smear positive disease (P<0·02); those born in the United Kingdom (P<0·0003) and in patients living in south London (P = 0·02). There was also a trend towards clustering being more common in those not known to have HIV infection (P = 0·051). The results suggest that in inner London, recent local transmission makes an important contribution to notification rates.

Type
Research Article
Copyright
© 2002 Cambridge University Press