RATIONALE: HIV-associated tuberculosis remains a major health problem among the gold-mining workforce in South Africa. We postulate that high levels of recent transmission, indicated by strain clustering, are fueling the tuberculosis epidemic among gold miners. OBJECTIVES: To combine molecular and epidemiologic data to describe Mycobacterium tuberculosis genetic diversity, estimate levels of transmission, and examine risk factors for clustering. METHODS: We conducted a cross-sectional study of culture-positive M. tuberculosis isolates in 15 gold mine shafts across three provinces in South Africa. All isolates were subject IS6110-based restriction fragment length polymorphisms, and we performed spoligotyping analysis and combined it with basic demographic and clinical information. MEASUREMENTS AND MAIN RESULTS: Of the 1,602 M. tuberculosis patient isolates, 1,240 (78%) had genotyping data available for analysis. A highly diverse bacillary population was identified, comprising a total of 730 discrete genotypes. Four genotypic families (Latin American Mediterranean spoligotype family; W-Beijing; AH or X; and T1-T4) accounted for over 50% of all strains. Overall, 45% (560/1,240) of strains were genotypically clustered. The minimum estimate for recent transmission (n - 1 method) was 32% (range, 27-34%). There were no individual-level risk factors for clustering, apart from borderline evidence for being non-South African and having self-reported HIV infection. CONCLUSIONS: The high M. tuberculosis genetic diversity and lack of risk factors for clustering are indicative of a universal risk for disease among gold miners and likely mixing with nonmining populations. Our results underscore the urgent need to intensify interventions to interrupt transmission across the entire gold-mining workforce in South Africa.
RATIONALE: HIV-associated tuberculosis remains a major health problem among the gold-mining workforce in South Africa. We postulate that high levels of recent transmission, indicated by strain clustering, are fueling the tuberculosis epidemic among gold miners. OBJECTIVES: To combine molecular and epidemiologic data to describe Mycobacterium tuberculosis genetic diversity, estimate levels of transmission, and examine risk factors for clustering. METHODS: We conducted a cross-sectional study of culture-positive M. tuberculosis isolates in 15 gold mine shafts across three provinces in South Africa. All isolates were subject IS6110-based restriction fragment length polymorphisms, and we performed spoligotyping analysis and combined it with basic demographic and clinical information. MEASUREMENTS AND MAIN RESULTS: Of the 1,602 M. tuberculosis patient isolates, 1,240 (78%) had genotyping data available for analysis. A highly diverse bacillary population was identified, comprising a total of 730 discrete genotypes. Four genotypic families (Latin American Mediterranean spoligotype family; W-Beijing; AH or X; and T1-T4) accounted for over 50% of all strains. Overall, 45% (560/1,240) of strains were genotypically clustered. The minimum estimate for recent transmission (n - 1 method) was 32% (range, 27-34%). There were no individual-level risk factors for clustering, apart from borderline evidence for being non-South African and having self-reported HIV infection. CONCLUSIONS: The high M. tuberculosis genetic diversity and lack of risk factors for clustering are indicative of a universal risk for disease among gold miners and likely mixing with nonmining populations. Our results underscore the urgent need to intensify interventions to interrupt transmission across the entire gold-mining workforce in South Africa.
Entities:
Keywords:
South Africa; gold mines; molecular epidemiology; tuberculosis
Authors: M Richardson; S W P van Lill; G D van der Spuy; Z Munch; C N Booysen; N Beyers; P D van Helden; R M Warren Journal: Int J Tuberc Lung Dis Date: 2002-11 Impact factor: 2.373
Authors: P J Bifani; B Mathema; Z Liu; S L Moghazeh; B Shopsin; B Tempalski; J Driscol; R Frothingham; J M Musser; P Alcabes; B N Kreiswirth Journal: JAMA Date: 1999 Dec 22-29 Impact factor: 56.272
Authors: E Vynnycky; N Nagelkerke; M W Borgdorff; D van Soolingen; J D van Embden; P E Fine Journal: Epidemiol Infect Date: 2001-02 Impact factor: 2.451
Authors: Barun Mathema; Pablo J Bifani; Jeffrey Driscoll; Lauren Steinlein; Natalia Kurepina; Soraya L Moghazeh; Elena Shashkina; Salvatore A Marras; Shannon Campbell; Bonita Mangura; Kenneth Shilkret; Jack T Crawford; Richard Frothingham; Barry N Kreiswirth Journal: J Infect Dis Date: 2002-02-14 Impact factor: 5.226
Authors: Elizabeth L Corbett; Gavin J Churchyard; Salome Charalambos; Badara Samb; Vicky Moloi; Tim C Clayton; Alison D Grant; Jill Murray; Richard J Hayes; Kevin M De Cock Journal: Clin Infect Dis Date: 2002-04-05 Impact factor: 9.079
Authors: Elizabeth L Corbett; Catherine J Watt; Neff Walker; Dermot Maher; Brian G Williams; Mario C Raviglione; Christopher Dye Journal: Arch Intern Med Date: 2003-05-12
Authors: Bourahima Kone; Anou M Somboro; Jane L Holl; Bocar Baya; Antieme Acg Togo; Yeya Dit Sadio Sarro; Bassirou Diarra; Ousmane Kodio; Robert L Murphy; William Bishai; Mamoudou Maiga; Seydou Doumbia Journal: Int J Mol Epidemiol Genet Date: 2020-06-15
Authors: Jonathan P Smith; Chawangwa Modongo; Patrick K Moonan; Mbatshi Dima; Ogopotse Matsiri; Othusitse Fane; Eleanor S Click; Rosanna Boyd; Alyssa Finlay; Diya Surie; James L Tobias; Nicola M Zetola; John E Oeltmann Journal: Infect Control Hosp Epidemiol Date: 2022-04-06 Impact factor: 6.520
Authors: Jonathan P Smith; John E Oeltmann; Andrew N Hill; James L Tobias; Rosanna Boyd; Eleanor S Click; Alyssa Finlay; Chawangwa Mondongo; Nicola M Zetola; Patrick K Moonan Journal: Sci Rep Date: 2022-04-26 Impact factor: 4.996
Authors: Parastu Kasaie; Barun Mathema; W David Kelton; Andrew S Azman; Jeff Pennington; David W Dowdy Journal: PLoS One Date: 2015-12-17 Impact factor: 3.240
Authors: Stewart T Chang; Violet N Chihota; Katherine L Fielding; Alison D Grant; Rein M Houben; Richard G White; Gavin J Churchyard; Philip A Eckhoff; Bradley G Wagner Journal: BMC Med Date: 2018-04-12 Impact factor: 8.775