Files
Abstract
Statement of Problem: As opposed to the United States, the epidemiology of TB in Georgia is fueled by recent transmission. If current trends in TB incidence continue, elimination of TB in Georgia and the United States in accordance with the 2050 global targets for tuberculosis will not be met. Goal: Conduct a secondary analysis of TB data to expand knowledge on the molecular epidemiology of TB in Georgia by examining the lineage diversity, transmission dynamic and persistence of Mycobacterium tuberculosis strains. Methods: Secondary analysis of TB surveillance and molecular data from 2009 to 2015. Cases surveillance data was linked to molecular data using a state case number. In Aim 1, we examined the diversity of lineages and their association with patient characteristics. In Aim 2 we examined the risk factors associated with recent transmission of tuberculosis and in Aim 3 we examined the persistence of TB strains. Results: The most predominant lineage in our study was lineage 4 or Euro-American lineage. A patients race and country of origin were significantly associated with Mycobacterium tuberculosis lineage. In aim 2 we found that 30% of the isolates in Georgia from 2009 to 2015 were clustered. The rate of transmission was estimated to be 25%. US-born cases that are Black, homeless or have resided in correctional facilities were more likely to be involved in a chain of recent transmission. Isoniazid resistance was associated with recent transmission and persistence of Mycobacterium tuberculosis strains. Conclusion: Our study shows a significant diversity of TB strains and a geographical relationship between these lineages and their hosts country of origin. TB in Georgia is mainly transmitted among racial minorities born in the United States who are either homeless or have been incarcerated. TB control efforts in Georgia should focus more resources on addressing drug resistance and transmission in homeless shelters and other congregate settings.