Molecular epidemiology of tuberculosis in the Netherlands: a nationwide study from 1993 through 1997.
To disclose risk factors for active tuberculosis transmission in the Netherlands, restriction fragment length polymorphism (RFLP) patterns of 78% of the Mycobacterium tuberculosis isolates, from the period 1993-1997, were analyzed. Of the respective 4266 cases, 46% were found in clusters of isolates with identical RFLPs, and 35% were attributed to active transmission. The clustering percentage increased strongly with the number of isolates; taking this into account, fewer cases were clustered than has been reported in other studies. Contact investigations in the five largest clusters of 23-47 patients suggested epidemiological linkage between cases. Of patients identified through contact tracing, 91% were clustered. Demographic risk factors for active transmission of tuberculosis included male sex, urban residence, Dutch and Surinamese nationality, and long-term residence in the Netherlands. Human immunodeficiency virus infection was not an independent risk factor for active transmission. Isoniazid-resistant strains were relatively less frequently clustered, suggesting that these generated fewer secondary cases.
van Soolingen
D
D
Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of Public Health and the Environment, Bilthoven, The Netherlands. D.van.Soolingen@rivm.nl
Borgdorff
M W
MW
de Haas
P E
PE
Sebek
M M
MM
Veen
J
J
Dessens
M
M
Kremer
K
K
van Embden
J D
JD
D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D015897:Comorbidity; D016358:Contact Tracing; D003710:Demography; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000235:genetics* / Q000302:isolation & purification; D009426:Netherlands / Q000453:epidemiology; D012150:Polymorphism, Restriction Fragment Length; D012307:Risk Factors; D013532:Suriname / Q000208:ethnology; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D014505:Urban Population