title: First insights into the molecular epidemiology of tuberculosis in Croatia during a three-year period, 2009 to 2011.
abstract: BACKGROUND
  Mycobacterium tuberculosis still represents a serious cause of morbidity and mortality worldwide. The aim of this study was to determine the transmission rate and genetic lineages of M. tuberculosis circulating in Croatia during a 3-y period, between 2009 and 2011.
  
  
  METHODS
  A total of 1587 M. tuberculosis strains (1 strain per tuberculosis patient) isolated in Croatia from 2009 to 2011 were genotyped using 15-locus mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) analysis.
  
  
  RESULTS
  The majority of tested isolates (66.73%) belonged to the Euro-American global lineage. The most prevalent sub-lineages were Haarlem (48.64%), followed by S (6.05%), Cameroon (3.72%), and Latin American-Mediterranean (3.4%). Among the total 1587 tested isolates, 996 (63%) were included in 1 of 236 clusters. The cluster size ranged from 2 (114 clusters) to 45 (1 cluster) patients, the mean cluster size being 4.2. These results indicate that 47.83% of tuberculosis cases during the period analyzed were the result of recent transmission.
  
  
  CONCLUSIONS
  The most prevalent global lineage in Croatia is Euro-American (sub-lineages Haarlem, S, Cameroon, and Latin American-Mediterranean). The high clustering rate and high medium clustering size of 4.2 tuberculosis cases could indicate a possible failure in interrupting the transmission of infection and points to the need for improvements in national and local tuberculosis control activities. This is the first study describing the molecular epidemiology of tuberculosis in Croatia.
authors.affiliation: From the National Mycobacteria Reference Laboratory, Croatian National Institute of Public Health , Zagreb , Croatia.
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Zmak
authors.forename: Mihaela
authors.initials: M
authors.lastname: Obrovac
authors.forename: Vera
authors.initials: V
authors.lastname: Katalinic Jankovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D017523:Croatia / Q000453:epidemiology; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058889:Molecular Typing; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult