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Risk factors for recent transmission of Mycobacterium tuberculosis

¹ Division of Communicable Disease Control, Norwegian Institute of Public Health, Oslo, ² Foundation for Health Services Research (HELTEF), Akershus University Hospital, Nordbyhagen, ³ Division of Epidemiology, Norwegian Institute of Public Health, Oslo, and ⁴ Dept of Thoracic Medicine, the National Hospital, University of Oslo, Oslo, Norway. ⁵ International Union Against Tuberculosis and Lung Disease, Paris, France

CORRESPONDENCE: E. Heldal, Division of Infectious Disease Control, Norwegian Institute of Public Health, PB 4404 Nydalen, 0403, Oslo, Norway. Fax: 47 22042513. E-mail: einar.heldal@fhi.no

Keywords: cluster, molecular epidemiology, Mycobacterium tuberculosis, Norway, restriction fragment length polymorphism, tuberculosis

Received: February 20, 2003
Accepted May 15, 2003

In recent decades, the decline of tuberculosis has stopped in Western Europe, mainly due to increased immigration from high-prevalence countries. The objective of the current study was to identify risk factors for developing tuberculosis following recent infection, in order to better target interventions.

Strains from 861 culture-positive cases, diagnosed in Norway in 1994–1999, were analysed by use of restriction fragment length polymorphism (RFLP). A cluster was defined as two or more isolates with identical RFLP patterns. Risk factors for being part of a cluster were identified by univariate and multivariate analysis.

A total of 134 patients were part of a cluster. These constituted 5% Asian-born, 18% Norwegian-born, 24% European-born and 29% African-born patients. Four independent risk factors for being part of a cluster were identified: being born in Norway, being of young age, being infected with an isoniazid-resistant strain and being infected with a multidrug-resistant strain.

Transmission of tuberculosis may be further reduced by improving case management, contact tracing, preventive treatment, screening of immigrants and access to health services for the foreign-born population.

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