title: [Influence of immigration on tuberculosis transmission patterns in Castellón, Spain (2004-2007)].
abstract: BACKGROUND
  This study aimed to identify tuberculosis transmission patterns in Castellón in a period of major demographic changes.
  
  
  METHODS
  A prospective study of patients with positive culture in the province of Castellon over a 4-year period (2004-2007) was carried out. Cases were described by year and nationality and were compared with those reported to the Department of Public Health. We studied the population with available molecular patterns, identified through restriction fragment length polymorphism (RFLP) and analyzed the variables from patient clusters, based on data collected in surveys of the Department of Health and the Laboratory Management Program.
  
  
  RESULTS
  According to data from the Department of Public Health, the overall rate of tuberculosis per 100,000 inhabitants in the province of Castellón was 15.7 in 2004, 19.9 in 2005, 18.2 in 2006 and 17.5 in 2007. In our laboratory, strains were identified from 301 patients, representing 77% (301/390) of reported cases and 94% (301/321) of reported cases with a positive culture. The percentage of tuberculosis among foreigners increased with age, exceeding 50% in 2007. Molecular studies were available in 95% of patients (286); 58% were Spanish and 42% were foreigners, of whom 54% were Romanians. The cluster percentage was 40%, with 30% of mixed clusters. According to conventional contact studies, 85% of patients in clusters had been considered isolated cases.
  
  
  CONCLUSIONS
  The increased rate of tuberculosis in Castellón was mainly due to the increasing number of cases among foreigners, mostly Romanians. The availability of molecular studies in all patients with a positive culture allowed us to analyze how and where tuberculosis is transmitted in our province. Forty percent of the patients were grouped into clusters; of these, mixed clusters accounted for one third, indicating the high integration of immigrants in our area.
authors.affiliation: Servicio de Microbiología, Hospital General de Castelló, Castellón, España. gil marfor@gva.es
authors.forename: María
authors.initials: M
authors.lastname: Gil
authors.forename: Rosario
authors.initials: R
authors.lastname: Moreno
authors.forename: Margarita
authors.initials: M
authors.lastname: Marín
authors.forename: Maria Ángeles
authors.initials: MÁ
authors.lastname: Romeu
authors.forename: Bárbara
authors.initials: B
authors.lastname: Gomila
authors.forename: Francisco
authors.initials: F
authors.lastname: González
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics; D012150:Polymorphism, Restriction Fragment Length; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000635:transmission*; D055815:Young Adult