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Predictors of clustering of tuberculosis in Greater Vancouver: a molecular epidemiologic study

Eduardo Hernández-Garduño^*, Dennis Kunimoto, Lei Wang^*, Mabel Rodrigues, R. Kevin Elwood^*, William Black^*, Sunny Mak^* and J. Mark FitzGerald^*

From *the Department of Medicine, University of British Columbia, and the BC Centre for Disease Control, Vancouver, BC, and the Department of Medicine, University of Alberta, Edmonton, Alta.

Correspondence to: Dr. J. Mark FitzGerald, Center for Clinical Epidemiology and Evaluation Vancouver General Hospital Research Pavilion, 703–828 W 10th Ave., Vancouver BC V5Z 1L8; markf{at}interchange.ubc.ca

Background: The understanding of how tuberculosis is transmitted can be improved by combining DNA fingerprinting of Mycobacterium tuberculosis with conventional epidemiologic methods. We used such techniques to determine the predictors of clustering of identical isolates from tuberculosis patients in Vancouver.

Methods: We used the restriction fragment length polymorphism (RFLP) technique and, if necessary, spoligotyping to determine DNA patterns of M. tuberculosis isolates from all patients with newly diagnosed tuberculosis in Greater Vancouver reported to the Division of Tuberculosis Control from January 1995 to March 1999. Isolates were considered to be part of a cluster if they had an identical DNA pattern. We also collected demographic and epidemiologic data. Predictors associated with being in a cluster were analyzed in a multivariate logistic regression model.

Results: Isolates from 793 patients (430 men) were identified; 137 (17.3%) were considered to be in clusters. After adjustment for multiple potential predictors, we found that the following patients were more likely to be part of a cluster: Canadian-born Aboriginals (v. foreign-born patients) (adjusted odds ratio [OR] 6.0, 95% confidence interval [CI] 3.0–11.7), Canadian-born non-Aboriginals (v. foreign-born patients) (adjusted OR 3.6, 95% CI 2.1–6.3), and injection drug users (v. patients who did not inject drugs) (adjusted OR 3.9, 95% CI 1.9–8.1). Patients with a prior history of tuberculosis were less likely to be part of a cluster than were patients with no history of tuberculosis (adjusted OR 0.3, 95% CI 0.1–0.8).

Interpretation: Our findings indicate the need to target groups at high risk of tuberculosis more aggressively to prevent transmission and to treat latent infection. DNA fingerprinting may be a useful adjunct to conventional epidemiologic methods to monitor the transmission of tuberculosis in an innter-city setting.

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