Sheri M Saleeb, Silvia Vallejo-Godoy, Andrea Marcos Abellán, Pilar Barroso-García, Marta López-Llaría, Miguel Martínez-Lirola, Francisca Escabias, María Teresa Cabezas Fernández, Guadalupe Bernal, Linfeng Wang, Elisa Fernandez-Fuertes, Sergio Buenestado-Serrano, Francisco Jose Martínez Martínez, Mariana López, Iñaki Comas, Mercedes Guida Piqueras, Andrea López-Suarez, Patricia Muñoz, Begoña Santiago, Laura Pérez-Lago, Darío García de Viedma
This study may serve as an illustration of the integrative efforts and simultaneous strategic, methodological and analytical improvements that are required to address the numerous novel challenges arising for a proper surveillance of TB transmission in our current, increasingly complex, epidemiological scenario.
BACKGROUND: Genomic epidemiology has revolutionised how we can delineate tuberculosis (TB) transmission. However, surveillance in TB is restricted to the analysis of geographically limited populations, which impairs the identification of cross-regional transmission.
OBJECTIVE: To integrate genomic data from independent populations, targeted strain sequencing and refined epidemiological research to enhance tuberculosis transmission DESIGN: Integration of sequencing data from Madrid and Almería, evolutionary analysis of the SNPs identified in the cluster, standardized detailed interviews with patients to obtain more detailed epidemiological information to identify links among the individuals, and targeted sequencing of the strain-marker-SNPs to fast-track new involved cases.
RESULTS: We described the complex transmission patterns of a cluster involving 13 cases, characterised by the convergence of i) interterritorial transmission due to the mobility of migrant cases, involving six different nationalities and autochthonous cases, ii) enhanced transmission due to an undiagnosed advanced TB case, iii) extensive exposures attributable to substantial social gatherings, and iv) two independent populations where the majority of cases were exposed or diagnosed, respectively.
CONCLUSION: This study may serve as an illustration of the integrative efforts and simultaneous strategic, methodological and analytical improvements that are required to address the numerous novel challenges arising for a proper surveillance of TB transmission in our current, increasingly complex, epidemiological scenario.