Clonal expansion of multidrug-resistant and extensively drug-resistant tuberculosis, Japan.
The emergence and spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) has raised public health concern about global control of TB. To estimate the transmission dynamics of MDR and XDR TB, we conducted a DNA fingerprinting analysis of 55 MDR/XDR Mycobacterium tuberculosis strains isolated from TB patients throughout Japan in 2002. Twenty-one (38%) of the strains were classified into 9 clusters with geographic links, which suggests that community transmission of MDR/XDR TB is ongoing. Furthermore, the XDR M. tuberculosis strains were more likely than the non-XDR MDR strains to be clustered (71% vs. 24%; p = 0.003), suggesting that transmission plays a critical role in the new incidence of XDR TB. These findings highlight the difficulty of preventing community transmission of XDR TB by conventional TB control programs and indicate an urgent need for a more appropriate strategy to contain highly developed drug-resistant TB.
Molecular Epidemiology Division, The Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association, Matsuyama, Tokyo, Japan. ymurase@jata.or.jp
Yoshiro
Y
Murase
Shinji
S
Maeda
Hiroyuki
H
Yamada
Akihiro
A
Ohkado
Kinuyo
K
Chikamatsu
Kazue
K
Mizuno
Seiya
S
Kato
Satoshi
S
Mitarai
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000032:analysis / Q000235:genetics; D054908:Extensively Drug-Resistant Tuberculosis / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D005260:Female; D005843:Geography; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics* / Q000302:isolation & purification; D011110:Polymorphism, Genetic; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*
D004269:DNA, Bacterial