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1 August 2005

Volume 192, Number 3
The Journal of Infectious Diseases 2005;192:480–487
© 2005 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2005/19203-0016$15.00
DOI: 10.1086/431517
MAJOR ARTICLE

The Importance of Recent Infection with Mycobacterium tuberculosis in an Area with High HIV Prevalence: A Long‐Term Molecular Epidemiological Study in Northern Malawi

Judith R. Glynn,1

Amelia C. Crampin,1,3

Malcolm D. Yates,2

Hamidou Traore,1

Frank D. Mwaungulu,3

Bagrey M. Ngwira,3

Richard Ndlovu,3

Francis Drobniewski,2 and

Paul E. M. Fine1

1Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, and 2Health Protection Agency National Mycobacterium Reference Laboratory, Kings College Hospital (Dulwich), London, United Kingdom; 3Karonga Prevention Study, Chilumba, Malawi

Background.The proportion of cases of tuberculosis due to recent infection can be estimated in long‐term population‐based studies using molecular techniques. Here, we present what is, to our knowledge, the first such study in an area with high human immunodeficiency virus (HIV) prevalence.

Methods.All patients with tuberculosis in Karonga District, Malawi, were interviewed. Isolates were genotyped using restriction‐fragment–length polymorphism (RFLP) patterns. Strains were considered to be “clustered” if at least 1 other patient had an isolate with an identical pattern.

Results.RFLP results were available from 83% of culture‐positive patients from late 1995 to early 2003. When strains with <5 bands were excluded, 72% (682/948) were clustered. Maximum clustering was reached using a 4‐year window, with an estimated two‐thirds of cases due to recent transmission. The proportion clustered decreased with age and varied by area of residence. In older adults, clustering was less common in men and more common in patients who were HIV positive (adjusted odds ratio, 5.1 [95% confidence interval, 2.1–12.6]).

Conclusions.The proportion clustered found in the present study was among the highest in the world, suggesting high rates of recent transmission. The association with HIV infection in older adults may suggest that HIV has a greater impact on disease caused by recent transmission than on that caused by reactivation.

Received 16 November 2004; accepted 2 March 2005; electronically published 23 June 2005.

Reprints or correspondence: Dr. Judith Glynn, Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7HT, United Kingdom ().

Cited by

Rein M. G. J. Houben, Judith R. Glynn. (2009) A systematic review and meta-analysis of molecular epidemiological studies of tuberculosis: development of a new tool to aid interpretation. Tropical Medicine & International Health
Online publication date: 1-Aug-2009.
CrossRef

  • Financial support: Until 1996, the Karonga Prevention Study was funded primarily by LEPRA (The British Leprosy Relief Association) and ILEP (The International Federation of Anti‐Leprosy Organizations), with contributions from the World Health Organisation/United Nations Development Programme/World Bank Special Programme for Research and Training in Tropical Diseases. Since 1996, the Wellcome Trust has been the principal funder. J.R.G. was supported in part by the UK Department for International Development and is now funded by the UK Department of Health (Public Health Career Scientist award).

    Potential conflicts of interest: none reported.

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