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Universal Genotyping for Tuberculosis Prevention Programs: a 5-Year Comparison with On-Request Genotyping.

Jennifer L Guthrie1, Clare Kong2, David Roth3

  • 1School of Population and Public Health, University of British Columbia, Vancouver, Canada jennifer.guthrie@alumni.ubc.ca jennifer.gardy@bccdc.ca.

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Universal genotyping of tuberculosis (TB) isolates identifies more transmission clusters than the previous on-request method. This comprehensive approach reveals complex patient networks and improves public health surveillance for TB.

Keywords:
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Area of Science:

  • Epidemiology
  • Microbiology
  • Public Health

Background:

  • Tuberculosis (TB) prevention programs previously relied on targeted genotyping requests.
  • This on-request method depended on public health professionals' judgment to identify potential transmission events.
  • Limited resources in public health necessitate demonstrating the value of universal genotyping programs.

Purpose of the Study:

  • To compare the effectiveness of universal versus on-request genotyping for detecting TB transmission clusters.
  • To evaluate the additional benefits of a universal genotyping program in a low-incidence setting.

Main Methods:

  • Retrospective analysis of 24-locus mycobacterial interspersed repetitive unit-variable-number tandem repeat genotyping for all culture-positive TB isolates over 5 years in British Columbia, Canada.
  • Comparison of clustering patterns identified by universal genotyping against those from the prior on-request genotyping program.
  • Statistical analysis of requested isolates and identified genotype clusters.

Main Results:

  • Universal genotyping identified 94 TB clusters involving 432 individuals, revealing complex and previously unrecognized patient linkages.
  • The on-request genotyping program missed 57.4% of these clusters and 30.1% of clustered individuals.
  • While requested isolates were more likely to be in clusters (aOR 2.3), only 54.6% clustered with the requested comparator.

Conclusions:

  • Prospective, province-wide universal genotyping is a more informative and bias-free tool for understanding TB transmission compared to on-request genotyping.
  • Universal genotyping is essential for uncovering the full extent of TB transmission networks.
  • This approach supports more effective public health interventions and resource allocation.