title: Occupational Tuberculosis in Denmark through 21 Years Analysed by Nationwide Genotyping.
abstract: Tuberculosis (TB) is a well-known occupational hazard. Based on more than two decades (1992-2012) of centralized nationwide genotyping of all Mycobacterium tuberculosis culture-positive TB patients in Denmark, we compared M. tuberculosis genotypes from all cases notified as presumed occupational (N = 130) with M. tuberculosis genotypes from all TB cases present in the country (N = 7,127). From 1992 through 2006, the IS6110 Restriction Fragment Length Polymorphism (RFLP) method was used for genotyping, whereas from 2005 to present, the 24-locus-based Mycobacterial Interspersed Repetitive Unit-Variable Number of Tandem Repeat (MIRU-VNTR) was used. An occupational TB case was classified as clustered if the genotype was 100% identical to at least one other genotype. Subsequently, based on genotype, time period, smear positivity, geography, susceptibility pattern, and any reported epidemiological links between the occupational cases and any potential source cases, the occupational case was categorized as confirmed, likely, possible or unlikely occupationally infected. Among the 130 notified presumed occupational cases, 12 (9.2%) could be classified as confirmed and 46 (35.4%) as unlikely, accounting for nearly half of all cases (44.6%). The remaining 72 cases (55.4%) were categorized as possible. Within this group, 15 cases (11.5%) were assessed to be likely occupational. Our study shows that genotyping can serve as an important tool for disentangle occupational TB in high-income low incidence settings, but still needs to be combined with good epidemiological linkage information.
authors.affiliation: International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Mathias Klok
authors.identifier: http://orcid.org/0000-0002-7469-5963
authors.initials: MK
authors.lastname: Pedersen
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Aase Bengaard
authors.initials: AB
authors.lastname: Andersen
authors.affiliation: Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Peter Henrik
authors.initials: PH
authors.lastname: Andersen
authors.affiliation: International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Svensson
authors.affiliation: Department of Pulmonary Medicine, Gentofte Hospital, Hellerup, Denmark.
authors.forename: Sidse Graff
authors.initials: SG
authors.lastname: Jensen
authors.affiliation: International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Troels
authors.initials: T
authors.lastname: Lillebaek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D009784:Occupational Diseases / Q000453:epidemiology* / Q000382:microbiology*; D012150:Polymorphism, Restriction Fragment Length; D012042:Registries; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D020080:Tandem Repeat Sequences; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology*; D055815:Young Adult