Assessment of tuberculosis spatial hotspot areas in Antananarivo, Madagascar, by combining spatial analysis and genotyping

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Harijaona Ratovonirina, Noël | Rakotosamimanana, Niaina | Razafimahatratra, Solohery, Lalaina | Raherison, Mamy, Serge | Refrégier, Guislaine | Sola, Christophe | Rakotomanana, Fanjasoa | Razanamparany, Voahangy, Rasolofo

Edité par CCSD ; BioMed Central -

International audience. Background: Tuberculosis (TB) remains a public health problem in Madagascar. A crucial element of TB control isthe development of an easy and rapid method for the orientation of TB control strategies in the country. Our mainobjective was to develop a TB spatial hotspot identification method by combining spatial analysis and TB genotypingmethod in Antananarivo.Methods: Sputa of new pulmonary TB cases from 20 TB diagnosis and treatment centers (DTCs) in Antananarivo werecollected from August 2013 to May 2014 for culture. Mycobacterium tuberculosis complex (MTBC) clinical isolates weretyped by spoligotyping on a Luminex® 200 platform. All TB patients were respectively localized accordingto their neighborhood residence and the spatial distribution of all pulmonary TB patients and patients withgenotypic clustered isolates were scanned respectively by the Kulldorff spatial scanning method for identification ofsignificant spatial clustering. Areas exhibiting spatial clustering of patients with genotypic clustered isolateswere considered as hotspot TB areas for transmission.Results: Overall, 467 new cases were included in the study, and 394 spoligotypes were obtained (84.4%).New TB cases were distributed in 133 of the 192 Fokontany (administrative neighborhoods) of Antananarivo(1 to 15 clinical patients per Fokontany) and patients with genotypic clustered isolates were distributed in127 of the 192 Fokontany (1 to 13 per Fokontany). A single spatial focal point of epidemics was detectedwhen ignoring genotypic data (p = 0.039). One Fokontany of this focal point and three additional oneswere detected to be spatially clustered when taking genotypes into account (p < 0.05). These four areaswere declared potential TB transmission hotspots in Antananarivo and will be considered as priority targetsfor surveillance in the future.Conclusion: This method, combining spatial analysis and TB genotyping will now be used for further focused clinicaland epidemiological studies in Madagascar and will allow better TB control strategies by public health authorities.

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