Identifying hotspots of multidrug-resistant tuberculosis transmission using spatial and molecular genetic data

Jonathan L. Zelner, Megan B. Murray, Mercedes C. Becerra, Jerome Galea, Leonid Lecca, Roger Calderon, Rosa Yataco, Carmen Contreras, Zibiao Zhang, Justin Manjourides, Bryan T. Grenfell, Ted Cohen

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


Background. We aimed to identify and determine the etiology of "hotspots" of concentrated multidrug-resistant tuberculosis (MDR-tuberculosis) risk in Lima, Peru. Methods. From 2009 to 2012, we conducted a prospective cohort study among households of tuberculosis cases from 106 health center (HC) areas in Lima, Peru. All notified tuberculosis cases and their household contacts were followed for 1 year. Symptomatic individuals were screened by microscopy and culture; positive cultures were tested for drug susceptibility (DST) and genotyped by 24-loci mycobacterial interspersed repetitive units-variable-number tandem repeats (MIRU-VNTR). Results. 3286 individuals with culture-confirmed disease, DST, and 24-loci MIRU-VNTR were included in our analysis. Our analysis reveals: (1) heterogeneity in annual per-capita incidence of tuberculosis and MDR-tuberculosis by HC, with a rate of MDR-tuberculosis 89 times greater (95% confidence interval [CI], 54,185) in the most-affected versus the least-affected HC; (2) high risk for MDR-tuberculosis in a region spanning several HCs (odds ratio = 3.19, 95% CI, 2.33, 4.36); and (3) spatial aggregation of MDR-tuberculosis genotypes, suggesting localized transmission. Conclusions. These findings reveal that localized transmission is an important driver of the epidemic of MDR-tuberculosis in Lima. Efforts to interrupt transmission may be most effective if targeted to this area of the city.

Original languageEnglish (US)
Pages (from-to)287-294
Number of pages8
JournalJournal of Infectious Diseases
Issue number2
StatePublished - Jan 15 2016

All Science Journal Classification (ASJC) codes

  • General Medicine


  • MDR-tuberculosis
  • drug resistance
  • spatial analysis
  • tuberculosis


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