Clusters of multidrug-resistant Mycobacterium tuberculosis cases, Europe

Abstract

Molecular surveillance of multidrug-resistant tuberculosis (MDR TB) was implemented in Europe as case reporting in 2005. For all new MDR TB cases detected from January 2003 through June 2007, countries reported case-based epidemiologic data and DNA fingerprint patterns of MDR TB strains when available. International clusters were detected and analyzed. From 2003 through mid-2007 in Europe, 2,494 cases of MDR TB were reported from 24 European countries. Epidemiologic and molecular data were linked for 593 (39%) cases, and 672 insertion sequence 6110 DNA fingerprint patterns were reported from 19 countries. Of these patterns, 288 (43%) belonged to 18 European clusters; 7 clusters (242/288 cases, 84%) were characterized by strains of the Beijing genotype family, including the largest cluster (175/288 cases, 61%). Both clustering and the Beijing genotype were associated with strains originating in eastern European countries. Molecular cluster detection contributes to identification of transmission profile, risk factors, and control measures.

Figure 1

Description of MDR TB cases in Europe selected for data analysis, January 2003–July 2007. RFA does not include data from Germany and Lithuania. MDR TB, multidrug-resistant tuberculosis; SLD, second-line drug; DST, drug-susceptibility test; RFA, risk factor analysis. *Countries: Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Ireland, Israel, Lithuania, the Netherlands, Norway, Spain, Sweden, Switzerland, and the United Kingdom.

Figure 2

Origin and country of report for the largest European cluster of multidrug-resistant tuberculosis cases (cluster E0051). The cases were reported in 12 European countries (see Table 3). Five countries did not have information about the origin of the cases reported there. For cases reported in the countries shaded in dark gray, the base of the arrow shows where case-patients originated (1 case per arrow, unless otherwise indicated). The 6 case-patients reported in Lithuania were also born there. Of the 148 case-patients reported in Estonia, 119 were also born there. The remaining case-patients reported in Estonia were originally from Russia (13), Belarus (6), Ukraine (5), Lithuania (1) and Turkmenistan (1); origin was unknown for 3 case-patients.