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A joint cross-border investigation of a cluster of multidrug-resistant tuberculosis in Austria, Romania and Germany in 2014 using classic, genotyping and whole genome sequencing methods: lessons learnt
- Lena Fiebig1,2 , Thomas A Kohl2,3 , Odette Popovici4 , Margarita Mühlenfeld5 , Alexander Indra6 , Daniela Homorodean7 , Domnica Chiotan8 , Elvira Richter9 , Sabine Rüsch-Gerdes10 , Beatrix Schmidgruber11 , Patrick Beckert3,12 , Barbara Hauer1 , Stefan Niemann3,10,12 , Franz Allerberger6 , Walter Haas1
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View Affiliations Hide AffiliationsAffiliations: 1 Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany 2 These authors contributed equally to this work 3 Molecular and Experimental Mycobacteriology, Research Center Borstel, Leibniz-Center for Medicine and Biosciences, Borstel, Germany 4 National Institute of Public Health – National Center for Communicable Diseases Surveillance and Control, Bucharest, Romania 5 Local Public Health Office Ingolstadt, Ingolstadt, Germany 6 Austrian Reference Laboratory for Mycobacteria, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria 7 Clinical Hospital of Pneumology, Tuberculosis National Reference Laboratory, Cluj-Napoca, Romania 8 Pneumology Institute “Marius Nasta”, Bucharest, Romania 9 Labor Dr. Limbach, TB Laboratory, Heidelberg, Germany 10 National Reference Center (NRC) for Mycobacteria, Research Center Borstel, Borstel, Germany 11 Tuberculosis Patient Service, Health Service of the City of Vienna, Vienna, Austria 12 German Center for Infection Research, Partner Site Hamburg-Borstel-Lübeck, Borstel, GermanyLena FiebigFiebigL rki.de
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Citation style for this article: Fiebig Lena, Kohl Thomas A, Popovici Odette, Mühlenfeld Margarita, Indra Alexander, Homorodean Daniela, Chiotan Domnica, Richter Elvira, Rüsch-Gerdes Sabine, Schmidgruber Beatrix, Beckert Patrick, Hauer Barbara, Niemann Stefan, Allerberger Franz, Haas Walter. A joint cross-border investigation of a cluster of multidrug-resistant tuberculosis in Austria, Romania and Germany in 2014 using classic, genotyping and whole genome sequencing methods: lessons learnt. Euro Surveill. 2017;22(2):pii=30439. https://doi.org/10.2807/1560-7917.ES.2017.22.2.30439 Received: 30 May 2016; Accepted: 28 Sept 2016
Abstract
Molecular surveillance of multidrug-resistant tuberculosis (MDR-TB) using 24-loci MIRU-VNTR in the European Union suggests the occurrence of international transmission. In early 2014, Austria detected a molecular MDR-TB cluster of five isolates. Links to Romania and Germany prompted the three countries to investigate possible cross-border MDR-TB transmission jointly. We searched genotyping databases, genotyped additional isolates from Romania, used whole genome sequencing (WGS) to infer putative transmission links, and investigated pairwise epidemiological links and patient mobility. Ten isolates from 10 patients shared the same 24-loci MIRU-VNTR pattern. Within this cluster, WGS defined two subgroups of four patients each. The first comprised an MDR-TB patient from Romania who had sought medical care in Austria and two patients from Austria. The second comprised patients, two of them epidemiologically linked, who lived in three different countries but had the same city of provenance in Romania. Our findings strongly suggested that the two cases in Austrian citizens resulted from a newly introduced MDR-TB strain, followed by domestic transmission. For the other cases, transmission probably occurred in the same city of provenance. To prevent further MDR-TB transmission, we need to ensure universal access to early and adequate therapy and collaborate closely in tuberculosis care beyond administrative borders.

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