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Canadian Journal of Public Health

, Volume 104, Issue 1, pp e22–e27 | Cite as

Increase in Multidrug-resistant Tuberculosis (MDR-TB) in Alberta Among Foreign-born Persons: Implications for Tuberculosis Management

  • Richard LongEmail author
  • Deanne Langlois-Klassen
Quantitative Research

Abstract

OBJECTIVES: Globally, the prevalence of anti-tuberculosis drug resistance has been increasing. This study sought to identify trends in multidrug-resistant tuberculosis (MDR-TB) among foreign-born persons in Alberta, a major immigrant-receiving province of Canada.

METHODS: A retrospective cohort study design was used to investigate the prevalence of MDR-TB in foreign-born culture-positive TB cases between 1982 and 2011. Relevant demographic, clinical and laboratory data were abstracted from the TB Registry, individual medical records and the Provincial Laboratory for Public Health.

RESULTS: Of the 2,234 foreign-born culture-positive TB cases in Alberta in 1982–2011, 27 (1.2%) had MDR-TB. Overall, MDR was associated with age <65 years (p=0.025), TB relapse/retreatment, and diagnosis and arrival in the last decade (2002–2011). The prevalence of MDR-TB in 2002–2011 was 2.1%, a significant increase from 0.65% in 1982–1991 (p=0.022) and 0.56% in 1992–2001 (p=0.009). Only immigrants from the Philippines and Vietnam showed a significant increase in the prevalence of MDR-TB between the first two decades and the last. Compared to MDR-TB cases reported in the first two decades, those reported in the last decade were more frequently younger than 35 years of age, new active versus relapse/retreatment cases and diagnosed with non-respiratory versus respiratory TB. In 1992–2011, MDR-TB strains had unique DNA fingerprints.

CONCLUSIONS: Recent trends in the prevalence and clinical characteristics of foreign-born MDR-TB cases have important implications for TB case management in Canada. Early diagnosis of MDR-TB, using genotypic drug susceptibility testing, is suggested in foreign-born TB cases at increased risk of being MDR.

Key words

Multidrug-resistant tuberculosis immigrants 

Résumé

OBJECTIFS: La prévalence de la résistance aux médicaments antituberculeux augmente à l’échelle mondiale. Nous avons voulu cerner les tendances de la tuberculose multirésistante (TMR) chez les personnes nées à l’étranger vivant en Alberta, une province du Canada qui accueille un grand nombre d’immigrants.

MÉTHODE: Au moyen d’une étude de cohorte rétrospective, nous avons analysé la prévalence de la TMR entre 1982 et 2011 parmi les cas nés à l’étranger avec culture positive pour la tuberculose. Les données pertinentes (démographiques, cliniques et de laboratoire) ont été analysées à partir du Registre de la tuberculose, des dossiers médicaux des sujets et du laboratoire de santé publique provincial.

RÉSULTATS: Sur les 2 234 cas nés à l’étranger avec culture positive pour la tuberculose relevés en Alberta entre 1982 et 2011, 27 (1,2 %) avaient une TMR. Dans l’ensemble, la multirésistance aux médicaments était associée à l’âge de <65 ans (p=0,025), à la rechute ou au retraitement de la tuberculose, et au diagnostic et à l’arrivée au pays au cours de la dernière décennie (2002–2011). La prévalence de la TMR en 2002–2011 était de 2,1 %, en hausse significative par rapport à 0,65 % en 1982–1991 (p=0,022) et à 0,56 % en 1992–2001 (p=0,009). Seuls les immigrants des Philippines et du Vietnam ont affiché une augmentation significative de la prévalence de la TMR entre les deux premières décennies et la dernière. Comparativement aux cas de TMR déclarés dans les deux premières décennies, ceux déclarés au cours de la dernière décennie avaient plus souvent moins de 35 ans, étaient des nouveaux cas actifs plutôt que des cas de rechute ou de retraitement et présentaient un diagnostic de tuberculose non respiratoire plutôt que de tuberculose respiratoire. Les empreintes génétiques des souches de TMR relevées entre 1992 et 2011 étaient uniques.

CONCLUSION: Les tendances récentes de la prévalence et des caractéristiques cliniques des cas de TMR nés à l’étranger ont d’importantes conséquences pour la prise en charge de la tuberculose au Canada. Il est suggéré de faire le diagnostic précoce de la TMR, à l’aide de tests génotypiques de sensibilité médicamenteuse, chez les cas nés à l’étranger qui courent un risque accru de présenter une tuberculose multirésistante.

Mots clés

tuberculose multirésistante immigrants 

References

  1. 1.
    Long R, Ellis E (Eds.). Canadian Tuberculosis Standards, 6th Edition. Ottawa, ON: Public Health Agency of Canada and the Canadian Lung Association/Canadian Thoracic Society, 2007. Available at: http://www.phacaspc.gc.ca/tbpc-latb/pubs/tbstand07-eng.php (Accessed March 7, 2012).Google Scholar
  2. 2.
    Langlois-Klassen D, Wooldrage K, Manfreda J, Sutherland K, Ellis E, Phypers M, et al. Piecing the puzzle together: Foreign-born tuberculosis in an immigrant-receiving country. Eur Respir J 2011;38:895–902.CrossRefGoogle Scholar
  3. 3.
    Tuberculosis in Canada 2010 Pre-release. Public Health Agency of Canada. Minister of Public Works and Government Services Canada, 2012. Available at: http://www.publichealth.gc.ca/tuberculosis (Accessed September 24, 2012).Google Scholar
  4. 4.
    PHAC. Tuberculosis among the foreign-born in Canada. Can Commun Dis Rep 2003;29:10–16.Google Scholar
  5. 5.
    Public Health Agency of Canada. Tuberculosis in Canada, 2007. Ottawa: Minister of Public Works and Government Services Canada, 2009.Google Scholar
  6. 6.
    Hersi A, Elwood K, Cowie R, Kunimoto D, Long R. Multidrug-resistant tuberculosis in Alberta and British Columbia, 1989 to 1998. Can Respir J 1999;6:155–60.CrossRefGoogle Scholar
  7. 7.
    Long R, Nobert E, Chomyc S, van Embden J, McNamee C, Duran RR, et al. Transcontinental spread of multidrug-resistant Mycobacterium bovis. Am J Respir Crit Care Med 1999;159:2014–17.CrossRefGoogle Scholar
  8. 8.
    Avendano M, Goldstein RS. Multidrug-resistant tuberculosis: Long term follow-up of 40 non-HIV infected patients. Can Respir J 2000;7:383–89.CrossRefGoogle Scholar
  9. 9.
    Langlois-Klassen D, Kunimoto D, Saunders D, Chui L, Boffa J, Menzies D, et al. A population-based cohort study of Mycobacterium tuberculosis Beijing strains: An emerging public health threat in an immigrant-receiving country? PLoS ONE 2012;7:e38431.doi: 10.1371/journal.pone.oo38431.CrossRefGoogle Scholar
  10. 10.
    Iseman M. Drug therapy: Treatment of multidrug-resistant tuberculosis. N Engl J Med 1993;329:784–91.CrossRefGoogle Scholar
  11. 11.
    Long R, Chui L, Kakulphimp J, Zielinski M, Talbot J, Kunimoto D. Postsanatorium pattern of anti-tuberculosis drug resistance in the Canadian-born population of western Canada: Effects of outpatient care and immigration. Am J Epidemol 2001;153:903–11.CrossRefGoogle Scholar
  12. 12.
    Gandhi NR, Nunn P, Dheda K, Scharf HS, Zignol M, van Soolingen D, et al. Multidrug-resistant and extensively drug-resistant tuberculosis: A threat to global control of tuberculosis. Lancet 2010;375:1830–43.CrossRefGoogle Scholar
  13. 13.
    Iseman MD, Sbarbaro JA. The increasing prevalence of resistance to anti-tuberculosis chemotherapeutic agents: Implications for global tuberculosis control. Curr Clin Top Infect Dis 1992;12:188–207.PubMedGoogle Scholar
  14. 14.
    Lew W, Pai M, Oxlade O, Martin D, Menzies D. Initial drug resistance and treatment outcomes: Systematic review and meta-analysis. Ann Intern Med 2008;149:123–34.CrossRefGoogle Scholar
  15. 15.
    Multidrug and Extensively Drug Resistant TB (M/XDR-TB): 2010 Global Report on Surveillance and Response. Geneva, Switzerland: World Health Organization, 2010. Available at: http://whqlibdoc.who.int/publications/2010/9789241599191_eng.pdf (Accessed March 25, 2012).
  16. 16.
    Vareldzis BP, Grosset J, de Kantor I, Crofton J, Laszlo A, Felton M, et al. Drug-resistant tuberculosis: Laboratory issues: World Health Organization recommendations. Tubercle Lung Dis 1994;75:1–7.CrossRefGoogle Scholar
  17. 17.
    van Emden JDA, Cave MD, Crawford JT, Dale JW, Eisenach KD, Gicquel B, et al. Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: Recommendations for a standardized methodology. J Clin Microbiol 1993;31:406–9.Google Scholar
  18. 18.
    van Soolingen D. Molecular epidemiology of tuberculosis and other mycobac-terial infections: Main methodologies and achievements. J Intern Med 2001;249:1–26.CrossRefGoogle Scholar
  19. 19.
    Kunimoto D, Sutherland K, Wooldrage K, Fanning A, Chui L, Manfreda J, et al. Transmission characteristics of tuberculosis in the foreign-born and the Canadian-born population of Alberta, Canada. Int J Tuberc Lung Dis 2004;8:1213–20.PubMedGoogle Scholar
  20. 20.
    CDC. Report of expert consultations on rapid molecular testing to detect drug-resistant tuberculosis in the United States. Available at: http://www.cdc.gov/tb/topic/laboratory/rapidmoleculartesting/MolDSTreport.pdf (Accessed October 3, 2012).
  21. 21.
    Sensi P. History of the development of rifampin. Rev Infect Dis 1983;5:S402–S406.CrossRefGoogle Scholar
  22. 22.
    Gagneux S, DeRiemer K, Van T, Kato-Maeda M, de Jong BC, Narayanan S, et al. Variable host-pathogen compatibility in Mycobacterium tuberculosis. Proc Natl Acad Sci U S A 2006;103:2869–73.CrossRefGoogle Scholar
  23. 23.
    Hirsh AE, Tsolaki AG, DeRiemer K, Feldman MW, Small PM. Stable association between strains of Mycobacterium tuberculosis and their human host populations. Proc Natl Acad Sci U S A 2004;101:4871–76.CrossRefGoogle Scholar
  24. 24.
    Mitchison DA. The action of antituberculosis drugs in short course chemotherapy. Tubercle 1985;66:219–25.CrossRefGoogle Scholar
  25. 25.
    Fattorini L, Mustazzolu A, Piccaro G, Pardini M, Filippini P, Giannoni F, et al. Drug-resistant tuberculosis among foreign-born persons in Italy. Eur Respir J 2012;40:4979–500.CrossRefGoogle Scholar
  26. 26.
    Centers for Disease Control and Prevention (CDC). Trends in tuberculosis -United States, 2011. JAMA 2012;307:1791–93.Google Scholar
  27. 27.
    Taylor AB, Kurbatova E V, Cegielski J P. Prevalence of anti-tuberculosis drug resistance in foreign-born tuberculosis cases in the U.S. and in their countries of origin. PloS ONE 2012;7:e49355.CrossRefGoogle Scholar
  28. 28.
    Manns BJ, Fanning EA, Cowie RL. Antituberculosis drug resistance in immigrants to Alberta, Canada, with tuberculosis, 1982–1994. Int J Tuberc Lung Dis 1997;1:225–30.PubMedGoogle Scholar
  29. 29.
    Chaisson RE, Nuermberger EL. Confronting multidrug-resistant tuberculosis. N Engl J Med 2012;366:2223–24.CrossRefGoogle Scholar
  30. 30.
    Falzon D, Jaramillo E, Schünemann HJ, Arentz M, Bauer M, Bayona J, et al. WHO guidelines for the programmatic management of drug-resistant tuberculosis: 2011 update. Eur Respir J 2011;38(3):516–28.CrossRefGoogle Scholar
  31. 31.
    Ling DI, Zwerling AA, Pai M. Genotype MTBDR assays for the diagnosis of multidrug-resistant tuberculosis: A meta-analysis. Eur Respir J 2008;32:1165–74.CrossRefGoogle Scholar
  32. 32.
    Kalokhe AS, Shafiq M, Lee JC, Metchock B, Posey JE, Ray SM, et al. Discordance in Mycobacterium tuberculosis rifampin susceptibility. Emerg Infect Dis 2012;18:537–39.CrossRefGoogle Scholar
  33. 33.
    O’Grady J, Maeurer M, Mwaba P, Kapata N, Bates M, Hoelscher M, et al. New and improved diagnostics for detection of drug-resistant pulmonary tuberculosis. Curr Opin Pulmonary Medicine 2011;17:134–41.CrossRefGoogle Scholar
  34. 34.
    Boehme CC, Nabeta P, Hillemann D, Nicol MP, Shenai S, Krapp F, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med 2010;363(11):1005–15.CrossRefGoogle Scholar
  35. 35.
    Health Canada. Medical Device Active License Listing (MDALL). Available at: http://www.hc-sc.gc.ca/dhp-mps/md-im/licen/mdlic-eng.php (Accessed October 12, 2012).

Copyright information

© The Canadian Public Health Association 2012

Authors and Affiliations

  1. 1.TB Program Evaluation and Research Unit, Department of Medicine, Division of Pulmonary MedicineUniversity of Alberta, 8333 Aberhart CentreEdmontonCanada

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