title: Molecular epidemiology of tuberculosis in Havana, Cuba, 2009.
abstract: OBJECTIVE
  To estimate the proportion of tuberculosis cases attributable to recent transmission and the risk factors possibly associated with tuberculosis clustering.
  
  
  METHODS
  Population-based study combining information from epidemiological investigation of tuberculosis cases notified to the National Tuberculosis Control Program in Havana, Cuba, in 2009 with the results of genotyping of Mycobacterium tuberculosis isolates with variable number tandem repeat of mycobacterial interspersed repetitive units (MIRU-VNTR) typing.
  
  
  RESULTS
  Of 186 cases, 61 were genotyped: 33 patterns and five clusters with 19, 7, 3, 2 and 2 cases were found. The proportion of cases due to recent transmission was 45% (95% confidence interval 33-58%). Routine contact investigation failed to identify a substantial number of epidemiological links. A history of living in a closed setting was strongly associated with clustering.
  
  
  CONCLUSIONS
  The proportion of cases due to recent transmission in Havana in 2009 is high. The existing control measures in closed settings should be strengthened. A study on a larger number of cases and for a longer time period should be carried out to obtain more precise estimates. Further studies on the utility and cost-effectiveness of the addition of molecular epidemiology techniques to support the progress towards tuberculosis elimination in Cuba, a low-incidence resource-limited setting, are also needed.
authors.affiliation: Research and Surveillance Group on TB, Leprosy and ARI, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba.
authors.forename: Alexander
authors.initials: A
authors.lastname: González Díaz
authors.affiliation: Epidemiology and Disease Control Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Tullia
authors.initials: T
authors.lastname: Battaglioli
authors.affiliation: National Reference Laboratory for TB and Mycobacteria, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba.
authors.forename: Raúl
authors.initials: R
authors.lastname: Díaz Rodríguez
authors.affiliation: National Reference Laboratory for TB and Mycobacteria, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba.
authors.forename: Roxana
authors.initials: R
authors.lastname: Goza Valdés
authors.affiliation: Research and Surveillance Group on TB, Leprosy and ARI, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba.
authors.forename: Edilberto
authors.initials: E
authors.lastname: González Ochoa
authors.affiliation: Epidemiology and Disease Control Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|Department of Public Health, Faculty of Medicine, Ghent University, Ghent, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Van der Stuyft
keywords: Cuba; Havana; La Habana; La Havane; MIRU-VNTR typing; epidemiología molecular; génotypage MIRU-VNTR; molecular epidemiology; tipado MIRU-VNTR; tuberculose; tuberculosis; épidémiologie moléculaire