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Journal of Clinical Microbiology, March 2001, p. 1042-1047, Vol. 39, No. 3
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.3.1042-1047.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Molecular and Conventional Epidemiology of Mycobacterium tuberculosis in Botswana: a Population-Based Prospective Study of 301 Pulmonary Tuberculosis Patients

Shahin Lockman,1,2,* Jeffery D. Sheppard,3 Christopher R. Braden,1 Michael J. Mwasekaga,4 Charles L. Woodley,3 Thomas A. Kenyon,5 Nancy J. Binkin,1 Michael Steinman,5 Faustina Montsho,5 Matlhatso Kesupile-Reed,5 Colette Hirschfeldt,5 Malebogo Notha,5 Themba Moeti,6 and Jordan W. Tappero1

Division of Tuberculosis Elimination, National Centers for HIV/AIDS, STD and TB Prevention,1 Epidemiology Program Office,2 and Division of AIDS, STD and Tuberculosis Laboratory Research, National Center for Infectious Diseases,3 Centers for Disease Control and Prevention, Atlanta, Georgia, and National Tuberculosis Reference Laboratory,4 The BOTUSA Project,5 and Epidemiology Unit, Ministry of Health,6 Gaborone, Botswana

Received 10 October 2000/Returned for modification 14 November 2000/Accepted 26 December 2000

Little is known about patterns of tuberculosis (TB) transmission among populations in developing countries with high rates of TB and human immunodeficiency virus (HIV) infection. To examine patterns of TB transmission in such a setting, we performed a population-based DNA fingerprinting study among TB patients in Botswana. Between January 1997 and July 1998, TB patients from four communities in Botswana were interviewed and offered HIV testing. Their Mycobacterium tuberculosis isolates underwent DNA fingerprinting using IS6110 restriction fragment length polymorphism, and those with matching fingerprints were reinterviewed. DNA fingerprints with >5 bands were considered clustered if they were either identical or differed by at most one band, while DNA fingerprints with <= 5 bands were considered clustered only if they were identical. TB isolates of 125 (42%) of the 301 patients with completed interviews and DNA fingerprints fell into 20 different clusters of 2 to 16 patients. HIV status was not associated with clustering. Prior imprisonment was the only statistically significant risk factor for clustering (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). In three communities where the majority of eligible patients were enrolled, 26 (11%) of 243 patients overall and 26 (25%) of 104 clustered patients shared both a DNA fingerprint and strong antecedent epidemiologic link. Most of the increasing TB burden in Botswana may be attributable to reactivation of latent infection, but steps should be taken to control ongoing transmission in congregate settings. DNA fingerprinting helps determine loci of TB transmission in the community.

* Corresponding author. Mailing address: Harvard School of Public Health, Department of Immunology and Infectious Diseases, 651 Huntington Ave., FXB 401, Boston MA 02115. Phone: (617) 432-2334. Fax: (617) 739-8348. E-mail: slockman{at}hsph.harvard.edu. Reprint requests: Communication and Education Branch, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road N.E., MS (E-10), Atlanta, GA 30333. Phone: (404) 639-8135. Fax: (404) 639-8960. E-mail: tbinfo{at}cdc.gov.

Journal of Clinical Microbiology, March 2001, p. 1042-1047, Vol. 39, No. 3
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.3.1042-1047.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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