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Spatiotemporal Clustering of Mycobacterium tuberculosis Complex Genotypes in Florida: Genetic Diversity Segregated by Country of Birth.

Séraphin MN, Lauzardo M, Doggett RT, Zabala J, Morris JG, Blackburn JK - PLoS ONE (2016)

Bottom Line: Both groups had HIV prevalence above twenty percent.Almost five percent of TB cases reported in Florida during 2009-2013 were potentially due to recent transmission.Due to the monomorphic nature of available markers, whole genome sequencing is needed to conclusively delineate recent transmission events between U.S. and foreign-born persons.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, FL, United States of America.

ABSTRACT

Background: Tuberculosis (TB) is caused by members of the Mycobacterium tuberculosis complex (MTBC). Although the MTBC is highly clonal, between-strain genetic diversity has been observed. In low TB incidence settings, immigration may facilitate the importation of MTBC strains with a potential to complicate TB control efforts.

Methods: We investigated the genetic diversity and spatiotemporal clustering of 2,510 MTBC strains isolated in Florida, United States, between 2009 and 2013 and genotyped using spoligotyping and 24-locus MIRU-VNTR. We mapped the genetic diversity to the centroid of patient residential zip codes using a geographic information system (GIS). We assessed transmission dynamics and the influence of immigration on genotype clustering using space-time permutation models adjusted for foreign-born population density and county-level HIV risk and multinomial models stratified by country of birth and timing of immigration in SaTScan.

Principal findings: Among the 2,510 strains, 1,245 were reported among foreign-born persons; including 408 recent immigrants (<5 years). Strain allelic diversity (h) ranged from low to medium in most locations and was most diverse in urban centers where foreign-born population density was also high. Overall, 21.5% of cases among U.S.-born persons and 4.6% among foreign-born persons clustered genotypically and spatiotemporally and involved strains of the Haarlem family. One Haarlem space-time cluster identified in the mostly rural northern region of Florida included US/Canada-born individuals incarcerated at the time of diagnosis; two clusters in the mostly urban southern region of Florida were composed predominantly of foreign-born persons. Both groups had HIV prevalence above twenty percent.

Conclusions/significance: Almost five percent of TB cases reported in Florida during 2009-2013 were potentially due to recent transmission. Improvements to TB screening practices among the prison population and recent immigrants are likely to impact TB control. Due to the monomorphic nature of available markers, whole genome sequencing is needed to conclusively delineate recent transmission events between U.S. and foreign-born persons.

No MeSH data available.


Related in: MedlinePlus

Spatiotemporal Clustering of Mycobacterium tuberculosis complex lineages.Maps show the locations of significant space-time clusters of M. tuberculosis Beijing (Panel A), and Haarlem (Panel B) sublineages in Florida, 2009–2013. Clusters were adjusted for county-level foreign-born population density and HIV risk. Adjusted Beijing Clusters were non-significant and are not shown). Base map layer reprinted from [28] under a CC BY license, with permission from University of Florida GeoPlan Center, original copyright 2012.
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pone.0153575.g002: Spatiotemporal Clustering of Mycobacterium tuberculosis complex lineages.Maps show the locations of significant space-time clusters of M. tuberculosis Beijing (Panel A), and Haarlem (Panel B) sublineages in Florida, 2009–2013. Clusters were adjusted for county-level foreign-born population density and HIV risk. Adjusted Beijing Clusters were non-significant and are not shown). Base map layer reprinted from [28] under a CC BY license, with permission from University of Florida GeoPlan Center, original copyright 2012.

Mentions: We ran twelve space-time permutation models including only genotype clustered strains: 107 Beijing strains, 17 M. Bovis strains, 6 CAS strains, 32 EAI strains, 250 Haarlem strains, 179 LAM strains, 31 S strains, 178 T strains, 32 U strains, 282 X strains, 4 others and 43 undefined, respectively. We identified one significant space-time cluster of the Beijing family in the Southeast Region of the state which persisted from March 2009 to October 2012 (Fig 2A). However, the cluster was no longer significant once we adjusted for county-level HIV risk and foreign-born population density. We detected two significant clusters of the Haarlem sublineage in North Central and East Central Florida (Fig 2B). These clusters persisted even after adjusting for both county-level HIV risk and foreign-born population density. In addition, cluster sizes, location or test statistics did not vary with varying combination of spatial or temporal windows. Of the 250 cases involved in the Haarlem genotype cluster, 163 were U.S.-born, 29 were recent immigrants (<5 years) and 58 had lived in the U.S. at least five years. Based on the adjusted space-time permutation models, potential recent TB transmission in Florida involved Haarlem strain families and was estimated at 15.60% overall; 21.47% (35/250) among U.S.-born cases, 5.17% (3/58) among foreign-born persons in the U.S. ≥5 years and 3.45% (1/29) among recent arrivals (<5 years).


Spatiotemporal Clustering of Mycobacterium tuberculosis Complex Genotypes in Florida: Genetic Diversity Segregated by Country of Birth.

Séraphin MN, Lauzardo M, Doggett RT, Zabala J, Morris JG, Blackburn JK - PLoS ONE (2016)

Spatiotemporal Clustering of Mycobacterium tuberculosis complex lineages.Maps show the locations of significant space-time clusters of M. tuberculosis Beijing (Panel A), and Haarlem (Panel B) sublineages in Florida, 2009–2013. Clusters were adjusted for county-level foreign-born population density and HIV risk. Adjusted Beijing Clusters were non-significant and are not shown). Base map layer reprinted from [28] under a CC BY license, with permission from University of Florida GeoPlan Center, original copyright 2012.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836742&req=5

pone.0153575.g002: Spatiotemporal Clustering of Mycobacterium tuberculosis complex lineages.Maps show the locations of significant space-time clusters of M. tuberculosis Beijing (Panel A), and Haarlem (Panel B) sublineages in Florida, 2009–2013. Clusters were adjusted for county-level foreign-born population density and HIV risk. Adjusted Beijing Clusters were non-significant and are not shown). Base map layer reprinted from [28] under a CC BY license, with permission from University of Florida GeoPlan Center, original copyright 2012.
Mentions: We ran twelve space-time permutation models including only genotype clustered strains: 107 Beijing strains, 17 M. Bovis strains, 6 CAS strains, 32 EAI strains, 250 Haarlem strains, 179 LAM strains, 31 S strains, 178 T strains, 32 U strains, 282 X strains, 4 others and 43 undefined, respectively. We identified one significant space-time cluster of the Beijing family in the Southeast Region of the state which persisted from March 2009 to October 2012 (Fig 2A). However, the cluster was no longer significant once we adjusted for county-level HIV risk and foreign-born population density. We detected two significant clusters of the Haarlem sublineage in North Central and East Central Florida (Fig 2B). These clusters persisted even after adjusting for both county-level HIV risk and foreign-born population density. In addition, cluster sizes, location or test statistics did not vary with varying combination of spatial or temporal windows. Of the 250 cases involved in the Haarlem genotype cluster, 163 were U.S.-born, 29 were recent immigrants (<5 years) and 58 had lived in the U.S. at least five years. Based on the adjusted space-time permutation models, potential recent TB transmission in Florida involved Haarlem strain families and was estimated at 15.60% overall; 21.47% (35/250) among U.S.-born cases, 5.17% (3/58) among foreign-born persons in the U.S. ≥5 years and 3.45% (1/29) among recent arrivals (<5 years).

Bottom Line: Both groups had HIV prevalence above twenty percent.Almost five percent of TB cases reported in Florida during 2009-2013 were potentially due to recent transmission.Due to the monomorphic nature of available markers, whole genome sequencing is needed to conclusively delineate recent transmission events between U.S. and foreign-born persons.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, FL, United States of America.

ABSTRACT

Background: Tuberculosis (TB) is caused by members of the Mycobacterium tuberculosis complex (MTBC). Although the MTBC is highly clonal, between-strain genetic diversity has been observed. In low TB incidence settings, immigration may facilitate the importation of MTBC strains with a potential to complicate TB control efforts.

Methods: We investigated the genetic diversity and spatiotemporal clustering of 2,510 MTBC strains isolated in Florida, United States, between 2009 and 2013 and genotyped using spoligotyping and 24-locus MIRU-VNTR. We mapped the genetic diversity to the centroid of patient residential zip codes using a geographic information system (GIS). We assessed transmission dynamics and the influence of immigration on genotype clustering using space-time permutation models adjusted for foreign-born population density and county-level HIV risk and multinomial models stratified by country of birth and timing of immigration in SaTScan.

Principal findings: Among the 2,510 strains, 1,245 were reported among foreign-born persons; including 408 recent immigrants (<5 years). Strain allelic diversity (h) ranged from low to medium in most locations and was most diverse in urban centers where foreign-born population density was also high. Overall, 21.5% of cases among U.S.-born persons and 4.6% among foreign-born persons clustered genotypically and spatiotemporally and involved strains of the Haarlem family. One Haarlem space-time cluster identified in the mostly rural northern region of Florida included US/Canada-born individuals incarcerated at the time of diagnosis; two clusters in the mostly urban southern region of Florida were composed predominantly of foreign-born persons. Both groups had HIV prevalence above twenty percent.

Conclusions/significance: Almost five percent of TB cases reported in Florida during 2009-2013 were potentially due to recent transmission. Improvements to TB screening practices among the prison population and recent immigrants are likely to impact TB control. Due to the monomorphic nature of available markers, whole genome sequencing is needed to conclusively delineate recent transmission events between U.S. and foreign-born persons.

No MeSH data available.


Related in: MedlinePlus