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Standardised PCR-based molecular epidemiology of tuberculosis

¹ Laboratoire Tuberculose et Mycobactéries, Institut Pasteur – Institut Scientifique de Santé Publique, ⁴ Belgian Lung and Tuberculosis Association, Brussels, Belgium, ² Genoscreen, and ³ Laboratoire des Mécanismes Moléculaires de la Pathogenèse Bactérienne, INSERM U629, Institut Pasteur, Lille, France.

CORRESPONDENCE: M. Fauville-Dufaux, Laboratoire Tuberculose et Mycobactéries, Institut Pasteur, Bruxelles (Institut Scientifique de Santé Publique), rue Engeland 642, 1180 Bruxelles, Belgium. Fax: 32 23733281. E-mail: mfauville{at}pasteur.be

Keywords: DNA fingerprinting, epidemiology, Mycobacterium tuberculosis, transmission

Received: May 3, 2007
Accepted December 5, 2007

A population-based molecular epidemiology investigation has been undertaken to evaluate tuberculosis transmission and control in the Brussels-Capital Region (Belgium).

All tuberculosis cases reported from January 2003 to December 2004 were investigated. In total, 536 Mycobacterium tuberculosis isolates (89% of culture-positive samples) were genotyped by the newly standardised 24 loci-based mycobacterial interspersed repetitive unit-variable number tandem-repeat typing, spoligotyping and IS6110 fingerprinting.

Of all the patients, 30% were grouped based on strain clusters, suggesting a transmission index of 20%. An unsuspected outbreak entailing 23 patients was evidenced by molecular typing analysis and confirmed by contact tracing. Foreign-born status accounted for 79% of the studied patients, including 37.9% illegal immigrants and asylum seekers. Among foreign-born patients, asylum seekers and illegal immigrants were significantly less abundant in strain clusters than settled residents.

Tuberculosis in the Brussels-Capital Region is a bi-faceted problem, comprising both persisting recent transmission and "imported diseases". Molecular epidemiology based on real-time genotyping techniques has proven invaluable in better understanding tuberculosis transmission. However, it will most efficiently contribute to tuberculosis control when implemented in an integrated public health system.