Distinct modes of transmission of tuberculosis in aboriginal and non-aboriginal populations in Taiwan.
Tuberculosis incidence among aborigines is significantly higher than for Han Chinese in Taiwan, but the extent to which Mycobacterium tuberculosis (MTB) strain characteristics contribute to this difference is not well understood. MTB isolates from aborigines and Han Chinese living in eastern and southern Taiwan, the major regions of aborigines, were analyzed by spoligotyping and 24-loci MIRU-VNTR. In eastern Taiwan, 60% of aboriginal patients were ≤20 years old, significantly younger than the non-aboriginal patients there; aborigines were more likely to have clustered MTB isolates than Han Chinese (odds ratio (OR) = 5.98, p<0.0001). MTB lineages with high clustering were EAI (54.9%) among southern people, and Beijing (62.5%) and Haarlem (52.9%) among eastern aborigines. Resistance to first-line drugs and multidrug resistance (MDR) were significantly higher among eastern aborigines (≥15%) than in any other geographic and ethnic group (p<0.05); MDR was detected in 5 of 28 eastern aboriginal patients ≤20 years old. Among patients from the eastern region, clustered strains (p = 0.01) and aboriginal ethnicity (p = 0.04) were independent risk factors for MDR. The lifestyles of aborigines in eastern Taiwan may explain why the percentage of infected aborigines is much higher than for their Han Chinese counterparts. The significantly higher percentage of the MDR-MTB strains in the aboriginal population warrants close attention to control policy and vaccination strategy.
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli, Taiwan.
Yih-Yuan
YY
Chen
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli, Taiwan; Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan.
Fan-Chen
FC
Tseng
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli, Taiwan.
Jia-Ru
JR
Chang
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli, Taiwan.
Shu-Chen
SC
Kuo
Department of Microbiology, Hualien Tzu Chi Medical Center, Hualien, Taiwan.
Jen-Jyh
JJ
Lee
Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan; China Nan University of Pharmacy and Science, Tainan, Taiwan; Meiho university, Pingtung, Taiwan; Department of Medical Research, Pingtung Christian Hospital, Pingtung, Taiwan; Chung Shan Medical University, Taichung, Taiwan.
Jun-Jun
JJ
Yeh
Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
Tzong-Shi
TS
Chiueh
Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
Jun-Ren
JR
Sun
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli, Taiwan.
Ih-Jen
IJ
Su
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli, Taiwan.
Horng-Yunn
HY
Dou
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D044466:Asian People; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D005006:Ethnicity; D005260:Female; D016680:Genome, Bacterial; D005838:Genotype; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D018598:Minisatellite Repeats; D058885:Multilocus Sequence Typing; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000187:drug effects / Q000235:genetics*; D013624:Taiwan / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology / Q000208:ethnology* / Q000635:transmission*
D000995:Antitubercular Agents