Original Articles
The Importance of Genotyping of Strains for the Evaluation and Interpretation of 5 School-Based Epidemic Outbreaks of Tuberculosis
Pedro Jorge Marcos Rodrígueza,
, Daniel Díaz-Cabanelaa, María Isabel Ursua Díazb, María Fernández-Albalat Ruizb, Héctor Verea Hernandoa
Corresponding author
pedrojmarcos@canalejo.org
Correspondence: Dr. P.J. Marcos Rodríguez. Servicio de Neumología. Complejo Hospitalario Universitario Juan Canalejo. Xubias de Arriba, 84. 15006 A Coruña. España
Correspondence: Dr. P.J. Marcos Rodríguez. Servicio de Neumología. Complejo Hospitalario Universitario Juan Canalejo. Xubias de Arriba, 84. 15006 A Coruña. España
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"titulo" => "The Importance of Genotyping of Strains for the Evaluation and Interpretation of 5 School-Based Epidemic Outbreaks of Tuberculosis" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "611" "paginaFinal" => "616" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pedro Jorge Marcos Rodríguez, Daniel Díaz-Cabanela, María Isabel Ursua Díaz, María Fernández-Albalat Ruiz, Héctor Verea Hernando" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Pedro Jorge Marcos" "apellidos" => "Rodríguez" "email" => array:1 [ 0 => "pedrojmarcos@canalejo.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Daniel" "apellidos" => "Díaz-Cabanela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "María Isabel Ursua" "apellidos" => "Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 3 => array:3 [ "nombre" => "María Fernández-Albalat" "apellidos" => "Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 4 => array:3 [ "nombre" => "Héctor Verea" "apellidos" => "Hernando" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Complejo Hospitalario Universitario Juan Canalejo, A Coruña, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Preventiva y Salud Pública, Complejo Hospitalario Universitario Juan Canalejo, A Coruña, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. P.J. Marcos Rodríguez. Servicio de Neumología. Complejo Hospitalario Universitario Juan Canalejo. Xubias de Arriba, 84. 15006 A Coruña. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-08-30" "fechaAceptado" => "2007-03-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154664" "palabras" => array:5 [ 0 => "Tuberculosis" 1 => "Microepidemic" 2 => "Outbreak" 3 => "School" 4 => "Restriction fragment length polymorphism" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154663" "palabras" => array:5 [ 0 => "Tuberculosis" 1 => "Microepidemia" 2 => "Brote" 3 => "Escuela" 4 => "RFLP" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetive</span><p class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to describe 5 microepidemics of tuberculosis occurring in schools, establish the risk factors associated with the outbreaks, assess how well a concentric circles strategy for contact tracing predicts infection, and assess the usefulness of genotyping strains in the analysis of the outbreaks.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStyleSimplePara elsevierViewall">The study assessed 5 epidemic outbreaks of tuberculosis using a standard contact tracing procedure. The outbreaks occurred in 2 day nurseries and 2 high schools between 1998 and 2005. Contacts were stratified using a concentric circle system based on level of exposure. DNA fingerprints of the available strains were determined based on the restriction fragment length polymorphism (RFLP) IS6110 and compared with the contact study to interpret the transmission of the infection.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">We analyzed 5 outbreaks. Eighty-five contacts were analyzed in the first outbreak, 519 in the second, 116 in the third, 655 in the fourth, and 102 in the fifth. The rate of infection was 31%, 29%, 66%, 37.6%, and 32%, respectively. Secondary cases of active disease were detected: 9 in the first outbreak, 16 in the second, 5 in the third, 6 in the fourth, and 13 in the fifth. RFLP analysis revealed that a single strain was involved in 3 of the outbreaks, and in a fourth, at least 2 strains were involved. In outbreaks 2, 3, and 5, there was a significant association between the degree of contact and the probability of infection (<span class="elsevierStyleItalic">P</span><.05). In all of the outbreaks, the relative risk of developing the disease was associated with the level of exposure.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Analysis of contacts based on concentric circles of risk predicts the likelihood of infection. RFLP facilitates analysis of complex transmission routes that are not detected using traditional methods of contact screening.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">El propósito del presente estudio ha sido describir 5 microepidemias de tuberculosis en centros escolares, establecer los factores de riesgo relacionados con su aparición, valorar la predicción de infección mediante la estrategia de círculos concéntricos y analizar la utilidad de la tipificación genética de cepa en su interpretación.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se presenta el estudio de 5 brotes de tuberculosis, y su estudio convencional de contactos, ocurridos en 2 guarderías y 2 institutos de enseñanza media entre 1998 y 2005. Los contactos se estratificaron según el grado de convivencia siguiendo el sistema de círculos concéntricos. Se identificaron los perfiles genéticos (RFLP–polimorfismo de longitud de los fragmentos de restricción–IS6110) de las cepas disponibles y se cotejaron los resultados con el estudio de contactos para interpretar la transmisión de la infección.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Analizamos 5 brotes. En el primero estudiamos a 85 contactos; en el segundo, a 519; en el tercero, a 116; en el cuarto, a 655, y 102 en el quinto. La prevalencia de infección fue del 31, el 29, el 66, el 37,6 y el 32%, respectivamente. Se detectaron casos secundarios de enfermedad activa: 9 en el primero, 16 en el segundo, 5 en el tercero, 6 en el cuarto y 13 en el quinto. El análisis mediante RFLP identificó la coincidencia genética de todas las cepas en 3 brotes, y en el cuarto evidenció la existencia de al menos 2 cepas implicadas en su desarrollo. En los brotes 2, 3 y 5 encontramos una asociación importante entre el grado de convivencia y las probabilidades de infectarse (p < 0,05). En todos los brotes el riesgo relativo de infectarse y enfermar se asoció con la intensidad de la exposición.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">El estudio de contactos basado en círculos de riesgo predice la probabilidad de infección. La RFLP permite aclarar vías de transmisión complejas que no son detectables mediante el estudio convencional de contactos.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recomendaciones SEPAR. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 4 | 9 |
| 2024 October | 30 | 17 | 47 |
| 2024 September | 36 | 16 | 52 |
| 2024 August | 40 | 27 | 67 |
| 2024 July | 39 | 21 | 60 |
| 2024 June | 48 | 26 | 74 |
| 2024 May | 50 | 27 | 77 |
| 2024 April | 37 | 25 | 62 |
| 2024 March | 33 | 18 | 51 |
| 2024 February | 27 | 17 | 44 |
| 2023 April | 0 | 1 | 1 |
| 2023 March | 2 | 3 | 5 |
| 2023 February | 19 | 21 | 40 |
| 2023 January | 13 | 25 | 38 |
| 2022 December | 21 | 18 | 39 |
| 2022 November | 14 | 23 | 37 |
| 2022 October | 17 | 25 | 42 |
| 2022 September | 18 | 21 | 39 |
| 2022 August | 18 | 38 | 56 |
| 2022 July | 15 | 38 | 53 |
| 2022 June | 17 | 30 | 47 |
| 2022 May | 20 | 19 | 39 |
| 2022 April | 16 | 20 | 36 |
| 2022 March | 23 | 36 | 59 |
| 2022 February | 15 | 24 | 39 |
| 2022 January | 14 | 24 | 38 |
| 2021 December | 18 | 38 | 56 |
| 2021 November | 15 | 44 | 59 |
| 2021 October | 14 | 46 | 60 |
| 2021 September | 15 | 57 | 72 |
| 2021 August | 11 | 28 | 39 |
| 2021 July | 13 | 32 | 45 |
| 2021 June | 15 | 24 | 39 |
| 2021 May | 18 | 27 | 45 |
| 2021 April | 42 | 38 | 80 |
| 2021 March | 24 | 17 | 41 |
| 2021 February | 11 | 12 | 23 |
| 2021 January | 11 | 11 | 22 |
| 2020 December | 15 | 11 | 26 |
| 2020 November | 6 | 12 | 18 |
| 2020 October | 8 | 8 | 16 |
| 2020 September | 11 | 2 | 13 |
| 2020 August | 59 | 9 | 68 |
| 2020 July | 19 | 13 | 32 |
| 2020 June | 6 | 4 | 10 |
| 2020 May | 13 | 14 | 27 |
| 2020 April | 17 | 16 | 33 |
| 2020 March | 9 | 9 | 18 |
| 2020 February | 16 | 18 | 34 |
| 2020 January | 12 | 18 | 30 |
| 2019 December | 11 | 12 | 23 |
| 2019 November | 12 | 8 | 20 |
| 2019 October | 6 | 8 | 14 |
| 2019 September | 10 | 10 | 20 |
| 2019 August | 18 | 8 | 26 |
| 2019 July | 10 | 17 | 27 |
| 2019 June | 7 | 2 | 9 |
| 2019 May | 10 | 11 | 21 |
| 2019 April | 13 | 11 | 24 |
| 2019 March | 8 | 13 | 21 |
| 2019 February | 4 | 11 | 15 |
| 2019 January | 12 | 10 | 22 |
| 2018 December | 7 | 10 | 17 |
| 2018 November | 12 | 14 | 26 |
| 2018 October | 15 | 10 | 25 |
| 2018 September | 11 | 5 | 16 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 5 | 5 | 10 |
| 2018 March | 2 | 3 | 5 |
| 2018 February | 5 | 6 | 11 |
| 2018 January | 1 | 3 | 4 |
| 2017 December | 4 | 5 | 9 |
| 2017 November | 4 | 6 | 10 |
| 2017 October | 6 | 7 | 13 |
| 2017 September | 3 | 7 | 10 |
| 2017 August | 5 | 13 | 18 |
| 2017 July | 2 | 6 | 8 |
| 2017 June | 7 | 6 | 13 |
| 2017 May | 6 | 5 | 11 |
| 2017 April | 1 | 3 | 4 |
| 2017 March | 1 | 4 | 5 |
| 2017 February | 4 | 3 | 7 |
| 2017 January | 2 | 2 | 4 |
| 2016 December | 8 | 4 | 12 |
| 2016 November | 12 | 8 | 20 |
| 2016 October | 8 | 1 | 9 |
| 2016 September | 6 | 4 | 10 |
| 2016 August | 12 | 4 | 16 |
| 2016 July | 5 | 6 | 11 |
| 2016 May | 8 | 0 | 8 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 4 | 0 | 4 |
| 2015 October | 33 | 7 | 40 |
| 2015 September | 29 | 4 | 33 |
| 2015 August | 25 | 9 | 34 |
| 2015 July | 27 | 7 | 34 |
| 2015 June | 28 | 5 | 33 |
| 2015 May | 42 | 13 | 55 |
| 2015 April | 22 | 14 | 36 |
| 2015 March | 25 | 9 | 34 |
| 2015 February | 21 | 4 | 25 |
| 2015 January | 12 | 4 | 16 |
| 2014 December | 17 | 5 | 22 |
| 2014 November | 11 | 4 | 15 |
| 2014 October | 26 | 10 | 36 |
| 2014 September | 22 | 5 | 27 |
| 2014 August | 17 | 9 | 26 |
| 2014 July | 18 | 6 | 24 |
| 2014 June | 21 | 5 | 26 |
| 2014 May | 33 | 7 | 40 |
| 2014 April | 31 | 5 | 36 |
| 2014 March | 34 | 9 | 43 |
| 2014 February | 27 | 9 | 36 |
| 2014 January | 21 | 4 | 25 |
| 2013 December | 23 | 11 | 34 |
| 2013 November | 18 | 5 | 23 |
| 2013 October | 26 | 10 | 36 |
| 2013 September | 20 | 8 | 28 |
| 2013 August | 22 | 6 | 28 |
| 2013 July | 45 | 8 | 53 |
| 2013 June | 20 | 6 | 26 |
| 2013 May | 25 | 5 | 30 |
| 2013 April | 11 | 4 | 15 |
| 2013 March | 6 | 1 | 7 |
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