Detecting emerging strains of tuberculosis by using spoligotypes.

The W-Beijing strain of tuberculosis has been identified in many molecular epidemiological studies as being particularly prevalent. This identification has been made possible through the development of a number of genotyping technologies including spoligotyping. Highly prevalent genotypes associated with outbreaks, such as the W-Beijing strain, are implicitly regarded as fast spreading. Here we present a quantitative method to identify "emerging" strains, those that are spreading faster than the background rate inferred from spoligotype data. The approach uses information about the mutation process specific to spoligotypes, combined with a model of both transmission and mutation. The core principle is that if two comparable strains have the same number of isolates, then the strain with fewer inferred mutation events must have spread faster if the mutation process is common. Applying this method to four different data sets, we find not only the W-Beijing strain, but also a number of other strains, to be emerging in this sense. Importantly, the strains that are identified as emerging are not simply those with the largest number of cases. The use of this method should facilitate the targeting of individual genotypes in intervention programs.