Evidence map›Paper›PMID 30086755›Full record

ArticleBMC medicine2018

Epidemiological and genomic determinants of tuberculosis outbreaks in First Nations communities in Canada.

Alexander Doroshenko, Caitlin S Pepperell, Courtney Heffernan, Mary Lou Egedahl, Tatum D Mortimer, Tracy M Smith, Hailey E Bussan, Gregory J Tyrrell, Richard Long

Abstract read
In one paragraph

Article in BMC medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Effects of Host, Sample, andFrontiers in genetics · 2019
    Article
  4. Dispersal ofFrontiers in microbiology · 2019
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Alexander DoroshenkoDivision of Preventive Medicine, Department of Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, Edmonton, Canada. adoroshe@ualberta.ca.ORCID 0000-0001-6804-1245
Caitlin S PepperellDepartments of Medicine (Infectious Diseases) and Medical Microbiology & Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA.
Courtney HeffernanDepartment of Medicine, Faculty of Medicine and Dentistry and TB Program Evaluation and Research Unit, University of Alberta, Edmonton, Canada.
Mary Lou EgedahlDepartment of Medicine, Faculty of Medicine and Dentistry and TB Program Evaluation and Research Unit, University of Alberta, Edmonton, Canada.
Tatum D MortimerDepartments of Medicine (Infectious Diseases) and Medical Microbiology & Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA.
Tracy M SmithDepartments of Medicine (Infectious Diseases) and Medical Microbiology & Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA.
Hailey E BussanDepartments of Medicine (Infectious Diseases) and Medical Microbiology & Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA.
Gregory J TyrrellDepartment of Laboratory Medicine and Pathology, University of Alberta, Provincial Laboratory for Public Health, Alberta Health Services, Edmonton, Canada.
Richard LongDepartment of Medicine, Faculty of Medicine and Dentistry and TB Program Evaluation and Research Unit, University of Alberta, Edmonton, Canada.

Funding

GRADUATE TRAINING IN MOLECULAR BIOSCIENCEST32GM007215 · NIGMS · UNIVERSITY OF WISCONSIN-MADISON · PI HULL, CHRISTINA M · 1985 to 2018
$22.5M
Drifting to victory: resolving the paradox of M.tuberculosis evolutionR01AI113287 · NIAID · UNIVERSITY OF WISCONSIN-MADISON · PI Caitlin S Pepperell · 2015 to 2026
$6.5M
National Science Foundation DGE-1256259NIAID NIH HHS R01 AI113287NIGMS NIH HHS T32 GM007215NIH HHS R01AI113287NIH HHS T32 GM07215
6 · The paper itself

Abstract

backgroundIn Canada, tuberculosis disproportionately affects foreign-born and First Nations populations. Within First Nations' peoples, a high proportion of cases occur in association with outbreaks. Tuberculosis transmission in the context of outbreaks is thought to result from the convergence of several factors including characteristics of the cases, contacts, the environment, and the pathogen.

methodsWe examined the epidemiological and genomic determinants of two well-characterized tuberculosis outbreaks attributed to two super-spreaders among First Nations in the province of Alberta. These outbreaks were associated with two distinct DNA fingerprints (restriction fragment-length polymorphisms or RFLPs 0.0142 and 0.0728). We compared outbreak isolates with endemic isolates not spatio-temporarily linked to outbreak cases. We extracted epidemiological variables pertaining to tuberculosis cases and contacts from individual public health records and the provincial tuberculosis registry. We conducted group analyses using parametric and non-parametric statistical tests. We carried out whole-genome sequencing and bioinformatic analysis using validated protocols.

resultsWe observed differences between outbreak and endemic groups in the mean number of total and child-aged contacts and the number of contacts with new positive and converted tuberculin skin tests in all group comparisons (p < 0.05). Differences were also detected in the proportion of cases with cavitation on a chest radiograph and the mean number of close contacts in selected group comparisons (p < 0.02). A phylogenetic network analysis of whole-genome sequencing data indicated that most outbreak and endemic strains were closely related to the source case for the 0.0142 fingerprint. For the 0.0728 fingerprint, the source case haplotype was circulating among endemic cases prior to the outbreak. Genetic and temporal distances were not correlated for either RFLP 0.0142 (r

conclusionsWe found no evidence that endemic strains acquired mutations resulting in their emergence in outbreak form. We conclude that the propagation of these outbreaks was likely driven by the combination of characteristics of the source cases, contacts, and the environment. The role of whole-genome sequencing in understanding mycobacterial evolution and in assisting public health authorities in conducting contact investigations and managing outbreaks is important and expected to grow in the future.

Indexed as

CanadaDisease OutbreaksFemaleGenomicsHumansMaleTuberculosisFirst nationsOutbreakTuberculosisWhole-genome sequencing

Identifiers

PMID30086755
PMCPMC6081810

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.