Observational studyThe Lancet. Infectious diseases2017
Transmission of multidrug-resistant Mycobacterium tuberculosis in Shanghai, China: a retrospective observational study using whole-genome sequencing and epidemiological investigation.
Observational study in The Lancet. Infectious diseases, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 177 papers, 1 of them a synthesis that pooled it.
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Who cites it
177 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Reporting practices for genomic epidemiology of tuberculosis: a systematic review of the literature using STROME-ID guidelines as a benchmark.The Lancet. Microbe · 2021Pooled it
- Transmissibility and potential for disease progression of drug resistantBMJ (Clinical research ed.) · 2019Trial
- Estimating the contribution to transmission of asymptomatic tuberculosis from population-based genomic epidemiology studies.Emerging microbes & infections · 2026Article
- Role of casual contact in drug-resistant tuberculosis transmission: a molecular epidemiology study.American journal of respiratory and critical care medicine · 2026Article
- Analysis of Drug Resistance Characteristics and Risk Factors of Cavitary Tuberculosis Based on Whole Genome Sequencing and Machine Learning.Open forum infectious diseases · 2026Article
- Long-term spatiotemporal evolution of drug-resistant Mycobacterium tuberculosis in China.Nature communications · 2026Article
- Drug Resistance and Risk Factors of Bacteriologically Confirmed Tuberculosis Cases in 10 Sites - Hunan Province, China, 2018-2025.China CDC weekly · 2026Article
- Identification of tuberculosis transmission hotspots in urban China using surveillance data: a machine learning approach based on genomic and spatial analysis.BMC infectious diseases · 2026Article
- Molecular epidemiology of drug resistance and transmission ofMicrobiology spectrum · 2026Article
- Mutations in sugar metabolism-related genes driving global drug-resistant Mycobacterium tuberculosis transmission revealed by whole-genome sequencing.BMC infectious diseases · 2026Article
- Whole-genome sequencing reveals lineage-associated drug resistance and enables machine learning-based prediction inFrontiers in microbiology · 2026Article
- Respiratory chain gene mutations associated with global phylogenetic clustering of drug-resistantFrontiers in immunology · 2026Article
- Transmission dynamics and attributable burden of tuberculosis among young and middle-aged adults in urban Shanghai: a genomic epidemiology study.Frontiers in public health · 2026Article
- Drug-resistant tuberculosis in Lishui, China: first-line drug resistance patterns, trends, and risk factors from a 10-year retrospective study (2015-2024).Frontiers in public health · 2026Article
- Genomic epidemiology of theFrontiers in microbiology · 2026Article
- Punicalagin Enhances Autophagy Through Sirtuin 1/FoxO3a Axis to Inhibit Intracellular Mycobacterium Abscessus Infection.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Mixed infections and heteroresistance ofEmerging microbes & infections · 2025Article
- Whole genome sequencing to characterize the molecular epidemiology and drug-resistance of tuberculosis in Huzhou, China.BMC genomics · 2025Article
- Unraveling Epistatic Interactions Between Sites Under Drug-Dependent Selection in the Mycobacterium tuberculosis Genome.Molecular biology and evolution · 2025Article
- Characteristics of compensatory mutations in rifampicin-resistant tuberculosis and their association with compensated transmission in Ningbo, China.BMC microbiology · 2025Article
117 more citing papers are in PubMed but not listed here.
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Funding
Abstract
backgroundMultidrug-resistance is a substantial threat to global elimination of tuberculosis. Understanding transmission patterns is crucial for control of the disease. We used a genomic and epidemiological approach to assess recent transmission of multidrug-resistant (MDR) tuberculosis and identify potential risk factors for transmission.
methodsWe did a population-based, retrospective study of patients who tested positive for tuberculosis between Jan 1, 2009, and Dec 31, 2012, in Shanghai, China. We did variable-number-of-tandem-repeat genotyping and whole-genome sequencing of isolates. We measured strain diversity within and between genomically clustered isolates. Genomic and epidemiological data were combined to construct transmission networks.
findings367 (5%) of 7982 patients with tuberculosis had MDR tuberculosis and 324 (88%) of these had isolates available for genomic analysis. 103 (32%) of the 324 MDR strains were in 38 genomic clusters that differed by 12 or fewer single nucleotide polymorphisms (SNPs), indicating recent transmission of MDR strains. Patients who had delayed diagnosis or were older than 45 years had high risk of recent transmission. 235 (73%) patients with MDR tuberculosis probably had transmission of MDR strains. Transmission network analysis showed that 33 (87%) of the 38 clusters accumulated additional drug-resistance mutations through emergence or fixation of mutations during transmission. 68 (66%) of 103 clustered MDR strains had compensatory mutations of rifampicin resistance.
interpretationRecent transmission of MDR tuberculosis strains, with increasing drug-resistance, drives the MDR tuberculosis epidemic in Shanghai, China. Whole-genome sequencing can measure of the heterogeneity of drug-resistant mutations within and between hosts and help to determine the transmission patterns of MDR tuberculosis.
fundingNational Science and Technology Major Project, National Natural Science Foundation of China, and US National Insitutes of Health.
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