Transmission characteristics of student tuberculosis: a 12-year prospective population-based genomic epidemiological study
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目的 利用在四川省武胜县开展的一项前瞻性结核病分子流行病学研究的数据，从全人群的角度分析学生结核病的传播。 方法 2009年7月1日至2020年12月31日，收集武胜县培养阳性肺结核患者的菌株进行全基因组测序，以菌株之间相差≤12 单核苷酸多态性（SNP）判断簇菌株；使用logistic回归分析学生肺结核患者（简称学生患者）的成簇风险；对成簇患者进行流行病学调查以明确流行病学联系；基于全基因组测序数据和患者确诊时间，使用phybreak方法推断簇病例的传播方向。 结果 研究期间武胜县培养阳性患者共计1 289例，其中7.6%（98/1 289）为学生。学生患者中71.4%（70/98）是高中生，高三学生的比例为45.9%（45/98），初一和高一新生的比例为16.3%（16/98）。学生患者的成簇率为59.2%（58/98），其成簇风险是非学生患者的4.54倍（95%CI： 2.44~8.45）。在涉及学生患者的传播事件中，33.3%（11/33）是学生之间的传播，66.7%（22/33）是学生与非学生之间的传播；学生与非学生之间的传播事件中只有5次（22.7%，5/22）是发生在家庭，其余的17次（77.3%，17/22）均发生在家庭外；学生患者之间的确诊间隔时间为1.3（0.4，2.7）年，学生与非学生之间的确诊间隔时间为5.3（1.9，6.8）年，两者差异有统计学意义（Z=2.86，P=0.004）。 结论 学生结核病主要是近期传播导致的；大部分的传播发生在学生和非学生之间，且主要发生在家庭外；学校结核病筛查策略显著缩短了患者发现时间；学校结核病防控必须与社区防控策略相结合才能取得理想的效果。 Objective To analyze the transmission characteristics of student tuberculosis (TB) from a population-wide perspective using the data from a prospective molecular epidemiology study of tuberculosis conducted in Wusheng county, Sichuan Province. Methods From July 1, 2009 to December 31, 2020, isolates from culture-positive TB patients in Wusheng were collected for whole-genome sequencing. Genomic clusters were defined with a threshold distance of 12-single-nucleotide-polymorphisms. The risk for student patients clustering was analyzed by logistic regression. Epidemiological investigations were performed on clustered patients to clarify epidemiological links. Transmission direction was inferred using phybreak based on whole-genome sequencing and diagnosis time. Results In total, there were 1 289 culture-positive patients in Wusheng during the study period, of which 7.6% (98/1 289) were students. Among student patients, 71.4% (70/98) were high school students, 45.9% (45/98) were grade three senior school students, and 16.3% (16/98) were junior school and senior school freshmen. The clustering rate for student patients was 59.2% (58/98), and their risk of clustering was 4.54 times higher (95%CI 2.44-8.45) than that of non-student patients. Of the transmission events that included student patients, 33.3% (11/33) were transmitted between student patients and 66.7% (22/33) were between student and non-student patients and among the transmission events between student and non-student patients, only 22.7% (5/22) occurred at home, and the remaining 77.3% (17/22) occurred outside the home. The interval between diagnoses was 1.3 (0.4, 2.7) years for student patients and 5.3 (1.9, 6.8) years for student and non-student patients, with a statistically significant difference (Z=2.86, P=0.004). Conclusions Student tuberculosis was mainly caused by recent transmission. Most of the transmission occurred between students and non-students, and primarily outside the home. Student tuberculosis screening strategies identified the patients earlier. The TB control and prevention strategies of school and community must be combined to achieve the desired results..
Objective To analyze the transmission characteristics of student tuberculosis (TB) from a population-wide perspective using the data from a prospective molecular epidemiology study of tuberculosis conducted in Wusheng county, Sichuan Province. Methods From July 1, 2009 to December 31, 2020, isolates from culture-positive TB patients in Wusheng were collected for whole-genome sequencing. Genomic clusters were defined with a threshold distance of 12-single-nucleotide-polymorphisms. The risk for student patients clustering was analyzed by logistic regression. Epidemiological investigations were performed on clustered patients to clarify epidemiological links. Transmission direction was inferred using phybreak based on whole-genome sequencing and diagnosis time. Results In total, there were 1 289 culture-positive patients in Wusheng during the study period, of which 7.6% (98/1 289) were students. Among student patients, 71.4% (70/98) were high school students, 45.9% (45/98) were grade three senior school students, and 16.3% (16/98) were junior school and senior school freshmen. The clustering rate for student patients was 59.2% (58/98), and their risk of clustering was 4.54 times higher (95%CI 2.44-8.45) than that of non-student patients. Of the transmission events that included student patients, 33.3% (11/33) were transmitted between student patients and 66.7% (22/33) were between student and non-student patients and among the transmission events between student and non-student patients, only 22.7% (5/22) occurred at home, and the remaining 77.3% (17/22) occurred outside the home. The interval between diagnoses was 1.3 (0.4, 2.7) years for student patients and 5.3 (1.9, 6.8) years for student and non-student patients, with a statistically significant difference (Z=2.86, P=0.004). Conclusions Student tuberculosis was mainly caused by recent transmission. Most of the transmission occurred between students and non-students, and primarily outside the home. Student tuberculosis screening strategies identified the patients earlier. The TB control and prevention strategies of school and community must be combined to achieve the desired results..
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