Internal migrants as drivers of long-distance cross-regional transmission of tuberculosis in China

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection Pub Date : 2025-01-01 DOI:10.1016/j.cmi.2024.09.005

Meng Li , Zhuo Quan , Peng Xu , Howard Takiff , Qian Gao

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引用次数: 0

Abstract

Objectives

Internal migrants in China frequently travel between their hometowns and the cities where they work, creating ample opportunities for cross-regional transmission of tuberculosis (TB). The aim of this study was to explore the role of internal migrants in transmitting TB across different regions and the contribution of cross-region transmission to China's TB burden.

Methods

The study included a total of 8664 patients with TB and their Mycobacterium tuberculosis isolates, collected from two large cities and three rural regions. Genomic clusters were defined as having a genomic distance of ≤12-single nucleotide polymorphisms. Cross-regional clusters were defined as clusters containing patients from at least two regions, indicative of cross-regional transmission.

Results

A total of 2403 clustered cases (27.7%) were grouped into 845 clusters, of which 142 (16.8%) were cross-regional. An increased risk for cross-regional transmission was found for internal migrants (adjusted OR (aOR), 1.45; 95% CI, 1.13–1.87), individuals aged <55 years (aOR, 2.73; 95% CI, 1.81–4.13), and housekeepers/factory workers (aOR, 1.16; 95% CI, 0.90–1.50). Among 200 cross-regional transmission events identified by transmission inference, 96 occurred between urban patients, 98 between urban and rural patients, and only six between rural patients. Notably, 93.5% (187/200) of cross-regional transmission events involved internal migrants. Epidemiological data showed that just 5.5% of cross-regional transmission events involved patients from the same township or neighbouring counties, where the transmission likely occurred.

Discussion

The mobility of the internal migrant population appears to be responsible for most cross-regional transmission of TB in China. The magnitude and dynamics of cross-regional transmission should be addressed in future strategies to reduce the incidence of TB in China.

查看原文本刊更多论文

国内移民是中国结核病长距离跨区域传播的驱动因素。

目的：中国的流动人口经常往返于家乡和工作城市之间，这为结核病的跨区域传播创造了大量机会。本研究旨在探讨国内流动人口在结核病跨地区传播中的作用，以及跨地区传播对中国结核病负担的贡献：研究对象包括来自两个大城市和三个农村地区的 8664 名结核病患者及其结核分枝杆菌分离株。基因组距离小于 12-SNPs 即为基因组集群。跨地区聚类是指至少包含两个地区患者的聚类，表明存在跨地区传播：共有 2403 个聚类病例（27.7%）被归入 845 个聚类，其中 142 个（16.8%）为跨区域聚类。发现国内移民（aOR=1.45，95% CI 1.13-1.87）、55 岁以下（aOR=2.73，95% CI 1.81-4.13）和管家/工厂工人（aOR=1.16，95% CI 0.90-1.50）的跨区域传播风险增加。在通过传播推断确定的 200 例跨地区传播事件中，96 例发生在城市患者之间，98 例发生在城市和农村患者之间，只有 6 例发生在农村患者之间。值得注意的是，93.5%（187/200）的跨区域传播事件涉及国内移民。流行病学数据显示，仅有 5.5%的跨区域传播事件涉及来自同一乡镇或邻近县城的患者，而传播很可能就发生在这些地方：结论：国内流动人口的流动性似乎是中国结核病跨区域传播的主要原因。在未来降低中国结核病发病率的战略中，应关注跨区域传播的规模和动态。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Microbiology and Infection 医学-传染病学

CiteScore

25.30

自引率

2.10%

发文量

441

审稿时长

2-4 weeks

期刊介绍： Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.