Transmission dynamics of drug-resistant tuberculosis in Ningbo, China: an epidemiological and genomic analysis

Yang Che; Xiangchen Li; Tong Chen; Yewei Lu; Guoxin Sang; Junli Gao; Junshun Gao; Zhengwei Liu; Tianfeng He; Yi Chen

doi:10.3389/fcimb.2024.1327477

Transmission dynamics of drug-resistant tuberculosis in Ningbo, China: an epidemiological and genomic analysis

Front Cell Infect Microbiol. 2024 Feb 7:14:1327477. doi: 10.3389/fcimb.2024.1327477. eCollection 2024.

Authors

Yang Che^#¹, Xiangchen Li^#², Tong Chen¹, Yewei Lu², Guoxin Sang¹, Junli Gao², Junshun Gao², Zhengwei Liu³, Tianfeng He¹, Yi Chen¹

Affiliations

¹ Institute of Tuberculosis Prevention and Control, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang, China.
² Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou, Zhejiang, China.
³ The Institute of Tuberculosis (TB) Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.

^# Contributed equally.

Abstract

Background: Tuberculosis (TB), particularly drug-resistant TB (DR-TB), remains a significant public health concern in Ningbo, China. Understanding its molecular epidemiology and spatial distribution is paramount for effective control.

Methods: From December 24, 2020, to March 12, 2023, we collected clinical Mycobacterium tuberculosis (MTB) strains in Ningbo, with whole-genome sequencing performed on 130 MTB strains. We analyzed DR-related gene mutations, conducted phylogenetic and phylodynamic analyses, identified recent transmission clusters, and assessed spatial distribution.

Results: Among 130 DR-TB cases, 41% were MDR-TB, 36% pre-XDR-TB, 19% RR-TB, and 3% HR-TB. The phylogenetic tree showed that 90% of strains were Lineage 2 (Beijing genotype), while remaining 10% were Lineage 4 (Euro-American genotype). The spatial analysis identified hotspots of DR-TB in Ningbo's northern region, particularly in traditional urban centers. 31 (24%) of the DR-TB cases were grouped into 7 recent transmission clusters with a large outbreak cluster containing 15 pre-XDR-TB patients. Epidemiological analyses suggested a higher risk of recent DR-TB transmission among young adult patients who frequently visited Internet cafes, game rooms, and factories.

Conclusion: Our study provides comprehensive insights into the epidemiology and genetics of DR-TB in Ningbo. The presence of genomic clusters highlights recent transmission events, indicating the need for targeted interventions. These findings are vital for informing TB control strategies in Ningbo and similar settings.

Keywords: drug resistance; molecular epidemiology; phylodynamics; recent transmission; spatial distribution; tuberculosis; whole-genome sequencing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antitubercular Agents / pharmacology
Antitubercular Agents / therapeutic use
China / epidemiology
Drug Resistance, Multiple, Bacterial / genetics
Extensively Drug-Resistant Tuberculosis* / drug therapy
Genomics
Genotype
Humans
Microbial Sensitivity Tests
Mycobacterium tuberculosis*
Phylogeny
Tuberculosis, Multidrug-Resistant* / epidemiology
Tuberculosis, Multidrug-Resistant* / microbiology
Young Adult

Substances

Antitubercular Agents

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by National Natural Science Foundation of China No. 82373649, Zhejiang Provincial Natural Science Foundation of China under Grant No. LTGY23H190001, LTGY23H190002, LGF22H260003, Zhejiang Provincial Medical Research Project (grant: 2022KY1189, 2021KY334), Ningbo Top Medical and Health Research Program (No.2023020713). The funder had no role in study design, data collection, analysis, interpretation of data and writing the manuscript.