title: Spatiotemporal evidence for cross-border spread of MDR-TB along the Trans-Siberian Railway line.
abstract: BACKGROUND
  Mongolia has the fifth highest incidence of tuberculosis (TB) in the Western Pacific Region, with high rates of multidrug-resistant TB (MDR-TB).
  
  
  OBJECTIVE
  To examine the recent spatiotemporal dynamics of MDR-TB in Mongolia.
  
  
  METHODS
  All MDR-TB cases diagnosed from 2004 to 2012, identified from the National Tuberculosis Control Programme database, were included in the study. Cases diagnosed from 2006 to 2012 were further examined using spatial scan statistics.
  
  
  RESULTS
  Few MDR-TB cases (n = 29) were diagnosed before the programmatic management of MDR-TB was introduced in 2006. During 2006-2012, 1106 MDR-TB cases were detected, at an annualised rate of 5.9 cases per 100 000 population. Most (>80%) cases were identified in the 15-44 year age group; 45% were among those aged 15-29 years. Case notification rates were highest in the capital city, Ulaanbaatar, with an increasing trend over time in all locations. Three MDR-TB hotspots were identified, all in close proximity to the Trans-Siberian Railway line. The majority of the MDR-TB isolates were resistant to all first-line drugs tested.
  
  
  CONCLUSIONS
  Spatiotemporal analysis indicates likely cross-border spread of MDR-TB along the Trans-Siberian Railway line, with subsequent spatial expansion across Mongolia. The frequency of MDR-TB among young patients with pan-resistance to all first-line drugs suggests ongoing MDR-TB transmission within the community.
authors.affiliation: Sydney Medical School and the Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia; Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: U
authors.initials: U
authors.lastname: Gurjav
authors.affiliation: National Tuberculosis Reference Laboratory, National Centre for Communicable Diseases, Ulaanbaatar, Mongolia.
authors.forename: B
authors.initials: B
authors.lastname: Burneebaatar
authors.affiliation: National Tuberculosis Reference Laboratory, National Centre for Communicable Diseases, Ulaanbaatar, Mongolia.
authors.forename: E
authors.initials: E
authors.lastname: Narmandakh
authors.affiliation: National Tuberculosis Reference Laboratory, National Centre for Communicable Diseases, Ulaanbaatar, Mongolia.
authors.forename: O
authors.initials: O
authors.lastname: Tumenbayar
authors.affiliation: National Tuberculosis Programme, National Centre for Communicable Diseases, Ulaanbaatar, Mongolia.
authors.forename: B
authors.initials: B
authors.lastname: Ochirbat
authors.affiliation: Sydney Medical School and the Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: G A
authors.initials: GA
authors.lastname: Hill-Cawthorne
authors.affiliation: Sydney Medical School and the Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: B J
authors.initials: BJ
authors.lastname: Marais
authors.affiliation: Sydney Medical School and the Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia; Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Sintchenko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008986:Mongolia; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D062211:Spatio-Temporal Analysis; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents