Evidence of primary transmission of multidrug‐resistant tuberculosis in the Western Province of Papua New Guinea

Abstract

Objective: To review patient outcomes and the molecular epidemiology of multidrug‐resistant tuberculosis (MDR‐TB) strains isolated from patients living in the Western Province of Papua New Guinea (PNG) seeking treatment in Australia. Design, setting and participants: Review of all cases of MDR‐TB among people living in the open border region between the Western Province of PNG and the Torres Strait Islands of Australia who presented to health clinics in the region between 2000 and 2006. All cases of suspected TB were bacteriologically confirmed at the time of presentation by the Mycobacterium Reference Laboratory in Brisbane. Main outcome measures: Drug resistance patterns; drug use and duration; molecular typing of TB strains; patient outcomes. Results: Between 2000 and 2006, 60 patients from the Western Province of PNG were diagnosed with TB, of which 15 had MDR‐TB. Mortality was high, although no patient who was able to maintain access to supervised therapy died. All 15 MDR‐TB isolates were Beijing‐family strains showing the same unique mycobacterial interspersed repetitive unit (MIRU) profile, with the exception of a single strain that differed by a single repeat at one locus. Restriction fragment length polymorphism (RFLP) typing on 10 of these strains further differentiated them into two distinct clusters. Conclusion: Transmission of MDR‐TB is occurring in the Western Province of PNG. Additional resources are urgently needed to interrupt the ongoing transmission of MDR‐TB from the Western Province of PNG to the Torres Strait Islands. Good supervision and management of patient treatment, which includes ensuring a regular supply of second‐line anti‐TB drugs, are essential elements of TB control.

Comparing Risk Factors for Primary Multidrug-Resistant Tuberculosis and Primary Drug-Susceptible Tuberculosis in Jiangsu Province, China: A Matched-Pairs Case-Control Study

“…This maybe indicate that, compared with risk factors of primary DS-TB, primary MDR-TB more likely happens in the low social group. Previous studies displayed that the extensive transmission of MDR-TB had been indicated by molecular epidemiology and happened in urban and rural areas 30–32. However, our findings suggested that transmission range of MDR-TB is more limited than that of DS-TB and perhaps, still confined to the low social group.…”

The epidemiology of tuberculosis in the rural Balimo region of Papua New Guinea

“…Our estimate for the Balimo region is higher than the previous Western Province region incidence estimate of 549 cases per 100 000 people per year . The South Fly District and the provincial capital of Daru have previously been noted for having a high burden of TB, and particularly DR‐TB . A heavy burden of TB cases in the North Fly District has previously been observed, while more recent research described 18 cases of TB from Tabubil, with one of these identified as rifampicin resistant .…”

Human ecology in pathogenic landscapes: two hypotheses on how land use change drives viral emergence

“…Some EIDs threaten public health through pandemics with large-scale mortality (e.g., HIV/AIDS). Others cause smaller outbreaks with high fatality rates or lack effective therapies and vaccines (e.g., Ebola virus, rabies, multi-drug resistant TB) [3,4]. As a group, EIDs and re-emerging diseases cause millions of deaths each year, and some single outbreak events (e.g., SARS) have cost the global economy tens of billions of dollars [5].…”