Transmission of tuberculosis in a high incidence urban community in South Africa.
BACKGROUND
The objective of this study was to identify risk factors for ongoing community transmission of tuberculosis (TB) in two densely populated urban communities with a high incidence rate of TB in Cape Town, South Africa.


METHODS
Between 1993 and 1998 DNA fingerprints of mycobacterial isolates from TB patients were determined by restriction fragment length polymorphism (RFLP). Cases whose isolates shared identical fingerprint patterns were considered to belong to the same cluster and to be attributable to ongoing community transmission.


RESULTS
The average annual notification rate of new smear positive TB was 238/100000. In all, 1023/1526 reported patients were culture positive, and RFLP was available for 768 (75%) of the isolates from these patients. Since some patients experienced more than one infection during the study period, 797 cases were included in the analysis. Of the cases, 575/797 (72%) were clustered. Smear-positive cases and those who were retreated after default were more likely to be clustered than smear-negative and new cases, respectively. Patients from Uitsig were more often part of large clusters than were patients from Ravensmead. Age, sex, year of diagnosis, and outcome of disease were not risk factors for clustering, nor for being the first case in a cluster, although various analytical approaches were used.


CONCLUSIONS
The incidence and proportion of cases that are clustered in this area are higher than reported elsewhere. An overwhelming majority of TB cases in this area is attributed to ongoing community transmission, and only very few to reactivation. This may explain the lack of demographic risk factors for clustering.
Verver
Suzanne
S
Department of Paediatrics and Child Health, Stellenbosch University, South Africa. ververs@kncvtbc.nl
Warren
Robin M
RM
Munch
Zahn
Z
Vynnycky
Emilia
E
van Helden
Paul D
PD
Richardson
Madalene
M
van der Spuy
Gian D
GD
Enarson
Donald A
DA
Borgdorff
Martien W
MW
Behr
Marcel A
MA
Beyers
Nulda
N
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000635:transmission; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013029:Space-Time Clustering; D014376:Tuberculosis / Q000453:epidemiology / Q000635:transmission*; D014504:Urban Health / Q000706:statistics & numerical data*