title: Investigating transmission of Mycobacterium bovis in the United Kingdom in 2005 to 2008.
abstract: Due to an increase in bovine tuberculosis in cattle in the United Kingdom, we investigated the characteristics of Mycobacterium bovis infection in humans and assessed whether extensive transmission of M. bovis between humans has occurred. A cross-sectional study linking demographic, clinical, and DNA fingerprinting (using 15-locus mycobacterial interspersed repetitive-unit-variable-number tandem-repeat [MIRU-VNTR] typing) data on cases reported between 2005 and 2008 was undertaken. A total of 129 cases of M. bovis infection in humans were reported over the period, with a decrease in annual incidence from 0.065 to 0.047 cases per 100,000 persons. Most patients were born pre-1960, before widespread pasteurization was introduced (73%), were of white ethnicity (83%), and were born in the United Kingdom (76%). A total of 102 patients (79%) had MIRU-VNTR typing data. A total of 31 of 69 complete MIRU-VNTR profiles formed eight distinct clusters. The overall clustering proportion determined using the n - 1 method was 33%. The largest cluster, comprising 12 cases, was indistinguishable from a previously reported West Midlands outbreak strain cluster and included those cases. This cluster was heterogeneous, having characteristics supporting recent zoonotic and human-to-human transmission as well as reactivation of latent disease. Seven other, smaller clusters identified had demographics supporting recrudescence rather than recent infection. A total of 33 patients had incomplete MIRU-VNTR profiles, of which 11 may have yielded 2 to 6 further small clusters if typed to completion. The incidence of M. bovis in humans in the United Kingdom remains low, and the epidemiology is predominantly that of reactivated disease.
authors.affiliation: Tuberculosis Section, Health Protection Agency Centre for Infections, London, United Kingdom.
authors.forename: Sema
authors.initials: S
authors.lastname: Mandal
authors.forename: Louise
authors.initials: L
authors.lastname: Bradshaw
authors.forename: Laura F
authors.initials: LF
authors.lastname: Anderson
authors.forename: Tim
authors.initials: T
authors.lastname: Brown
authors.forename: Jason T
authors.initials: JT
authors.lastname: Evans
authors.forename: Francis
authors.initials: F
authors.lastname: Drobniewski
authors.forename: Grace
authors.initials: G
authors.lastname: Smith
authors.forename: John G
authors.initials: JG
authors.lastname: Magee
authors.forename: Anne
authors.initials: A
authors.lastname: Barrett
authors.forename: Oliver
authors.initials: O
authors.lastname: Blatchford
authors.forename: Ian F
authors.initials: IF
authors.lastname: Laurenson
authors.forename: Amie-Louise
authors.initials: AL
authors.lastname: Seagar
authors.forename: Michael
authors.initials: M
authors.lastname: Ruddy
authors.forename: P Lewis
authors.initials: PL
authors.lastname: White
authors.forename: Richard
authors.initials: R
authors.lastname: Myers
authors.forename: Peter
authors.initials: P
authors.lastname: Hawkey
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abubakar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D016172:DNA Fingerprinting; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058889:Molecular Typing; D009163:Mycobacterium bovis / Q000302:isolation & purification*; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult