Factors influencing the recent transmission of multidrug-resistant tuberculosis in Hainan Province
Objective To investigate the influencing factors related to the recent transmission of multidrug-resistant tuberculosis(MDR-TB)in Hainan Province,with the goal of providing an epidemiological basis for the region's prevention and control strategies,as well as clinical decision-making regarding MDR-TB.Methods Clinical respiratory specimens from MDR-TB patients treated at the Second Affiliated Hospital of Hainan Medical University from July 2019 to June 2021 were collected for mycobacterial isolation and cultivation.Isolates of multidrug-resistant Mycobacterium tuberculosis(MDR-MTB)identified through proportional drug-susceptibility screening were subjected to whole-genome sequencing(WGS).In conjunction with clinical and epidemiological data,factors influencing recent MDR-TB transmission were analyzed.Results A total of 202 MDR-TB patients were included in the study,primarily distributed across 18 cities and counties of Hainan Province(excluding Sansha City),and the patients were predominantly male.Phylogenetic analysis of the MDR-MTB strains showed that 56.4％(114/202)belonged to Lineage 2.2(Beijing),27.2％(55/202)to Lineage 2.1(non-Beijing),13.4％(27/202)to Lineage 4(Euro-American),and 3.0％(6/202)to Lineage 1(Indo-Oceanic).Through genetic distance analysis,42 strains of MDR-MTB were found to be grouped into 15 clusters,with a clustering rate of 20.8％,indicating a significant level of recent transmission.Analysis of transmission-related factors revealed that non-agricultural occupations,initial treatment,and unmarried status were positively correlated with recent MDR-TB transmission,while older age and a history of smoking were negatively correlated.Notably,Lineage 2.2(Beijing)showed a higher likelihood of MDR-TB transmission compared to Lineage 2.1(non-Beijing).Multivariate logistic regression analysis further identified that patients receiving initial treatment were an independent risk factor for recent MDR-TB transmission.Conclusions MDR-TB in Hainan Province exhibits distinctive genetic diversity,with Lineage 2.2(Beijing)being the predominant epidemic strain.Recent transmission of MDR-TB in Hainan Province is associated with non-agricultural occupations,initial treatment,unmarried status,and Lineage 2.2(Beijing),with the initial treatment being a likely independent risk factor for transmission.These findings offer vital clues for controlling MDR-TB and are expected to guide the formulation of targeted prevention and control strategies to reduce the transmission of the MDR-TB epidemic.
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