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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Nosocomial transmission of extensively drug-resistant tuberculosis in a rural hospital in South Africa
Journal of Infectious Diseases, Volume 207, No. 1, Year 2013
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Description
Background. Extensively drug-resistant tuberculosis (XDR-tuberculosis) is a global public health threat, but few data exist elucidating factors driving this epidemic. The initial XDR-tuberculosis report from South Africa suggested transmission is an important factor, but detailed epidemiologic and molecular analyses were not available for further characterization. Methods. We performed a retrospective, observational study among XDR-tuberculosis patients to identify hospitalassociated epidemiologic links. We used spoligotyping, IS6110-based restriction fragment-length polymorphism analysis, and sequencing of resistance-determining regions to identify clusters. Social network analysis was used to construct transmission networks among genotypically clustered patients. Results. Among 148 XDR-tuberculosis patients, 98% were infected with human immunodeficiency virus (HIV), and 59% had smear-positive tuberculosis. Nearly all (93%) were hospitalized while infectious with XDR-tuberculosis (median duration, 15 days; interquartile range:10-25 days). Genotyping identified a predominant cluster comprising 96% of isolates. Epidemiologic links were identified for 82% of patients; social network analysis demonstrated multiple generations of transmission across a highly interconnected network. Conclusions. The XDR-tuberculosis epidemic in Tugela Ferry, South Africa, has been highly clonal. However, the epidemic is not the result of a point-source outbreak; rather, a high degree of interconnectedness allowed multiple generations of nosocomial transmission. Similar to the outbreaks of multidrug-resistant tuberculosis in the 1990s, poor infection control, delayed diagnosis, and a high HIV prevalence facilitated transmission. Important lessons from those outbreaks must be applied to stem further expansion of this epidemic. © The Author 2012.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3523793/bin/supp_207_1_9__index.html
https://efashare.b-cdn.net/share/pmc/articles/PMC3523793/bin/supp_jis631_jis631supp.doc
Authors & Co-Authors
Gandhi, Neel R.
United States, New York
Albert Einstein College of Medicine of Yeshiva University
United States, Atlanta
Rollins School of Public Health
Weissman, Darren
United States, New York
Albert Einstein College of Medicine of Yeshiva University
Moodley, Prashini
South Africa, Durban
The Nelson R. Mandela Medical School
Ramathal, Melissa
South Africa, Durban
The Nelson R. Mandela Medical School
Elson, Inga
South Africa, Durban
The Nelson R. Mandela Medical School
Kreiswirth, Barry N.
United States, Newark
Public Health Research Institute
Mathema, Barun
United States, Newark
Public Health Research Institute
Shashkina, Elena
United States, Newark
Public Health Research Institute
Rothenberg, Richard B.
United States, Atlanta
Georgia State University
Moll, Anthony P.
South Africa
Philanjalo and Church of Scotland Hospital
Friedland, Gerald H.
United States, New Haven
Yale School of Medicine
Sturm, Adriaan Willem
South Africa, Durban
The Nelson R. Mandela Medical School
Shah, N. Sarita
United States, New York
Albert Einstein College of Medicine of Yeshiva University
Statistics
Citations: 135
Authors: 13
Affiliations: 7
Identifiers
Doi:
10.1093/infdis/jis631
ISSN:
00221899
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
South Africa