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
Footnotes
Disclaimer: The opinions, results and conclusions reported in this paper are those of the authors. No endorsement by the University of Alberta or Alberta Health Services is intended or should be inferred.
Conflict of Interest: None to declare.
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