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Molecular epidemiology of Mycobacterium tuberculosis among South African gold miners

Mathema, Barun, Lewis, James J., Connors, Jeremy, Chihota, Violet N., Shashkina, Elena, van der Meulen, Minty, Graviss, Edward A., Ha, Ngan P., Kreiswirth, Barry N., Grant, Alison D., Fielding, Katherine L., Dorman, Susan E. and Churchyard, Gavin J. 2015. Molecular epidemiology of Mycobacterium tuberculosis among South African gold miners. Annals of the American Thoracic Society 12 (1) , pp. 12-20. 10.1513/AnnalsATS.201404-150OC

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Abstract

Rationale: HIV-associated tuberculosis remains a major health problem among the gold-mining workforce in South Africa. We postulate that high levels of recent transmission, indicated by strain clustering, are fueling the tuberculosis epidemic among gold miners. Objectives: To combine molecular and epidemiologic data to describe Mycobacterium tuberculosis genetic diversity, estimate levels of transmission, and examine risk factors for clustering. Methods: We conducted a cross-sectional study of culture-positive M. tuberculosis isolates in 15 gold mine shafts across three provinces in South Africa. All isolates were subject IS6110-based restriction fragment length polymorphisms, and we performed spoligotyping analysis and combined it with basic demographic and clinical information. Measurements and Main Results: Of the 1,602 M. tuberculosis patient isolates, 1,240 (78%) had genotyping data available for analysis. A highly diverse bacillary population was identified, comprising a total of 730 discrete genotypes. Four genotypic families (Latin American Mediterranean spoligotype family; W-Beijing; AH or X; and T1–T4) accounted for over 50% of all strains. Overall, 45% (560/1,240) of strains were genotypically clustered. The minimum estimate for recent transmission (n − 1 method) was 32% (range, 27–34%). There were no individual-level risk factors for clustering, apart from borderline evidence for being non–South African and having self-reported HIV infection. Conclusions: The high M. tuberculosis genetic diversity and lack of risk factors for clustering are indicative of a universal risk for disease among gold miners and likely mixing with nonmining populations. Our results underscore the urgent need to intensify interventions to interrupt transmission across the entire gold-mining workforce in South Africa.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Social Sciences (Includes Criminology and Education)
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Publisher: American Thoracic Society
ISSN: 2329-6933
Date of Acceptance: 22 October 2014
Last Modified: 01 Aug 2019 15:45
URI: http://orca.cf.ac.uk/id/eprint/123895

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