International Journal of Epidemiology, Volume 33, Number 2, pp. 351-357
IJE vol.33 no.2 © International Epidemiological Association 2004; all rights reserved.
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Transmission of tuberculosis in a high incidence urban community in South Africa
1 Department of Paediatrics and Child Health, Stellenbosch University, South Africa
2 MRC Centre for Molecular and Cellular Biology, Department of Medical Biochemistry, Stellenbosch University, South Africa
3 KNCV Tuberculosis Foundation The Hague, The Netherlands
4 Infectious Disease Epidemiology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, UK
5 International Union against Tuberculosis and Lung Diseases (IUATLD), Paris, France
6 Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
Correspondence: Suzanne Verver, KNCV Tuberculosis Foundation, PO Box 146, 2501 CC The Hague, The Netherlands. E-mail: ververs{at}kncvtbc.nl
Background The objective of this study was to identify risk factors for ongoing community transmission of tuberculosis (TB) in two densely populated urban communities with a high incidence rate of TB in Cape Town, South Africa.
Methods Between 1993 and 1998 DNA fingerprints of mycobacterial isolates from TB patients were determined by restriction fragment length polymorphism (RFLP). Cases whose isolates shared identical fingerprint patterns were considered to belong to the same cluster and to be attributable to ongoing community transmission.
Results The average annual notification rate of new smear positive TB was 238/100 000. In all, 1023/1526 reported patients were culture positive, and RFLP was available for 768 (75%) of the isolates from these patients. Since some patients experienced more than one infection during the study period, 797 cases were included in the analysis. Of the cases, 575/797 (72%) were clustered. Smear-positive cases and those who were retreated after default were more likely to be clustered than smear-negative and new cases, respectively. Patients from Uitsig were more often part of large clusters than were patients from Ravensmead. Age, sex, year of diagnosis, and outcome of disease were not risk factors for clustering, nor for being the first case in a cluster, although various analytical approaches were used.
Conclusions The incidence and proportion of cases that are clustered in this area are higher than reported elsewhere. An overwhelming majority of TB cases in this area is attributed to ongoing community transmission, and only very few to reactivation. This may explain the lack of demographic risk factors for clustering.
Keywords Tuberculosis, transmission, urban
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