title: Impact of immigration on the molecular epidemiology of tuberculosis in Rhode Island.
abstract: While foreign-born persons constitute only 11% of the population in the state of Rhode Island, they account for more than 65% of incident tuberculosis (TB) annually. We investigated the molecular-epidemiological differences between foreign-born and U.S.-born TB patients to estimate the degree of recent transmission and identify predictors of clustering. A total of 288 isolates collected from culture-confirmed TB cases in Rhode Island between 1995 and 2004 were fingerprinted by spoligotyping and 12-locus mycobacterial interspersed repetitive units. Of the 288 fingerprinted isolates, 109 (37.8%) belonged to 36 genetic clusters. Our findings demonstrate that U.S.-born patients, Hispanics, Asian/Pacific islanders, and uninsured patients were significantly more likely to be clustered. Recent transmission among the foreign-born population was restricted and occurred mostly locally, within populations originating from the same region. Nevertheless, TB transmission between the foreign-born and U.S.-born population should not be neglected, since 80% of the mixed clusters of foreign- and U.S.-born persons arose from a foreign-born source case. We conclude that timely access to routine screening and treatment for latent TB infection for immigrants is vital for disease elimination in Rhode Island.
authors.affiliation: WHO Supranational TB Reference Laboratory, TB & Mycobacteria Unit, Institut Pasteur de Guadeloupe, Pointe-à-Pitre, France. jvhomweg@pasteur.fr
authors.forename: Jessica
authors.initials: J
authors.lastname: Vanhomwegen
authors.forename: Awewura
authors.initials: A
authors.lastname: Kwara
authors.forename: Melissa
authors.initials: M
authors.lastname: Martin
authors.forename: Fizza S
authors.initials: FS
authors.lastname: Gillani
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fontanet
authors.forename: Peninnah
authors.initials: P
authors.lastname: Mutungi
authors.forename: Joyce
authors.initials: J
authors.lastname: Crellin
authors.forename: Stephen
authors.initials: S
authors.lastname: Obaro
authors.forename: Michael
authors.initials: M
authors.lastname: Gosciminski
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Carter
authors.forename: Nalin
authors.initials: N
authors.lastname: Rastogi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015373:Bacterial Typing Techniques; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058889:Molecular Typing; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000235:genetics*; D012237:Rhode Island / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial