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Assessing spatiotemporal patterns of multidrug-resistant and drug-sensitive tuberculosis in a South American setting

  • H. LIN (a1) (a2) (a3), S. SHIN (a1) (a4) (a5), J. A. BLAYA (a5) (a6), Z. ZHANG (a1), P. CEGIELSKI (a7), C. CONTRERAS (a8), L. ASENCIOS (a9), C. BONILLA (a10), J. BAYONA (a1) (a8) (a11), C. J. PACIOREK (a12) (a13) and T. COHEN (a1) (a14)...

We examined the spatiotemporal distribution of laboratory-confirmed multidrug-resistant tuberculosis (MDR TB) cases and that of other TB cases in Lima, Peru with the aim of identifying mechanisms responsible for the rise of MDR TB in an urban setting. All incident cases of TB in two districts of Lima, Peru during 2005–2007 were included. The spatiotemporal distributions of MDR cases and other TB cases were compared with Ripley's K statistic. Of 11 711 notified cases, 1187 received drug susceptibility testing and 376 were found to be MDR. Spatial aggregation of patients with confirmed MDR disease appeared similar to that of other patients in 2005 and 2006; however, in 2007, cases with confirmed MDR disease were found to be more tightly grouped. Subgroup analysis suggests the appearance of resistance may be driven by increased transmission. Interventions should aim to reduce the infectious duration for those with drug-resistant disease and improve infection control.

Corresponding author
*Author for correspondence: T. Cohen, MD, DrPH, 641 Huntington Avenue, Boston, MA 02115, USA. (Email:
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1.World Health Organization.Global tuberculosis control: epidemiology, strategy, financing: WHO Report 2009 (WHO/HTM/TB/2009.411). Geneva, Switzerland: WHO, 2009.
2.World Health Organization.Anti-tuberculosis drug resistance in the world: fourth global report (WHO/HTM/TB/2008.394). Geneva, Switzerland: WHO, 2008.
3.Zignol M, et al. Global incidence of multidrug-resistant tuberculosis. Journal of Infectious Diseases 2006; 194: 479485.
4.Elliott P, Wartenberg D. Spatial epidemiology: current approaches and future challenges. Environmental Health Perspectives 2004; 112: 9981006.
5.Haase I, et al. Use of geographic and genotyping tools to characterise tuberculosis transmission in Montreal. International Journal of Tuberculosis and Lung Disease 2007; 11: 632638.
6.Randremanana RV, et al. Spatial clustering of pulmonary tuberculosis and impact of the care factors in Antananarivo City. Tropical Medicine & International Health 2009; 14: 429437.
7.Onozuka D, Hagihara A. Geographic prediction of tuberculosis clusters in Fukuoka, Japan, using the space-time scan statistic. BMC Infectious Diseases 2007; 7: 26.
8.Tiwari N, et al. Investigation of geo-spatial hotspots for the occurrence of tuberculosis in Almora district, India, using GIS and spatial scan statistic. International Journal of Health Geographics 2006; 5: 33.
9.Jia ZW, et al. Spatial analysis of tuberculosis cases in migrants and permanent residents, Beijing, 2000–2006. Emerging Infectious Diseases 2008; 14: 14131419.
10.Munch Z, et al. Tuberculosis transmission patterns in a high-incidence area: a spatial analysis. International Journal of Tuberculosis and Lung Disease 2003; 7: 271277.
11.Oeltmann JE, et al. Multidrug-resistant tuberculosis outbreak among US-bound Hmong refugees, Thailand, 2005. Emerging Infectious Diseases 2008; 14: 17151721.
12.Blaya JA, et al. Assessing effects of the e-Chasqui laboratory information system on accuracy and timeliness of bacteriology results in the Peruvian tuberculosis program. AMIA Annual Symposium Proceedings 2007, p. 873.
13.National Health Strategy on Prevention and Control of Tuberculosis.Technical Health Standards For The Control of Tuberculosis. Lima, Peru, April 2006 [in Spanish].
14.Asencios L, et al. Programmatic implementation of rapid DST for Mycobacterium tuberculosis in Peru. International Journal of Tuberculosis and Lung Disease 2008; 12: 743749.
15.Solis LA, et al. Validation of a rapid method for detection of M. tuberculosis resistance to isoniazid and rifampin in Lima, Peru. International Journal of Tuberculosis and Lung Disease 2005; 9: 760764.
16.Kent P, Kubica G. Public health mycobacteriology: a guide for the level III laboratory. Atlanta: Centers for Disease Control and Prevention, 1985.
17.Heifets LB. Clinical mycobacteriology. Drug susceptibility testing. Clinics in Laboratory Medicine 1996; 16: 641656.
18.Berman M, Diggle PJ. Estimating weighted integrals of the second-order intensity of spatial point patterns. Journal of the Royal Statistical Society 1989; B51: 8192.
19.Rowlingson B, Diggle P. Splancs: spatial point pattern analysis code in S-Plus. Computers and Geosciences 1993; 19: 627655.
20.Diggle PJ. Spatial point processes. In: Statistical Analysis of Spatial Point Patterns, 2nd edn. London: Hodder Arnold, 2003, pp. 4262.
21.Dye C. Doomsday postponed? Preventing and reversing epidemics of drug-resistant tuberculosis. Nature Reviews Microbiology 2009; 7: 8187.
22.Ozonoff A, et al. Effect of spatial resolution on cluster detection: a simulation study. International Journal of Health Geographics 2007; 6: 52.
23.Higgs BW, et al. Early detection of tuberculosis outbreaks among the San Francisco homeless: trade-offs between spatial resolution and temporal scale. PLoS One 2007; 2: e1284.
24.Zhao M, et al. Transmission of MDR and XDR tuberculosis in Shanghai, China. PLoS One 2009; 4: e4370.
25.Calver AD, et al. Emergence of increased resistance and extensively drug-resistant tuberculosis despite treatment adherence, South Africa. Emerging Infectious Diseases 2010; 16: 264271.
26.Andrews JR, et al. Exogenous reinfection as a cause of multidrug-resistant and extensively drug-resistant tuberculosis in rural South Africa. Journal of Infectious Diseases 2008; 198: 15821589.
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Epidemiology & Infection
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