OR07
Tuberculosis along the pandemic: Molecular and genomic epidemiology to analyze changes in general dynamics and reinterprete relevant transmission clusters
L Pérez-Lago(1) S Vallejo-Godoy(2) M Martínez-Lirola(3) C Rodríguez-Grande(1) M Herranz(1,4) J A Garrido(5) M T Cabezas Fernández(3) S Buenestado-Serrano(1) F Escabias Machuca(6) P Barroso(7) A B Esteban-García(5) J M Viudez Martínez(8) E Domínguez-Iñarra(9) P Muñoz(1,4) D García de Viedma(1,4)
1:Instituto de Investigación sanitaria Gregorio Marañón. Madrid; 2:Unidad de TB de Poniente, Consejería de Salud. Junta de Andalucia, Almería, Spain; 3:Complejo Hospitalario Torrecárdenas. Almería; 4:CIBER Enfermedades Respiratorias CIBERES; 5:Universidad de Almería; 6:Unidad de Prevención, Promoción y Vigilancia de la Salud del Área Sanitaria Norte de Almería. Consejería de Salud. Junta de Andalucia, Almería, Spain,; 7:Unidad de Prevención, Promoción y Vigilancia de la Salud del Área Sanitaria Almería. Consejería de Salud. Junta de Andalucia, Almería, Spain; 8:Oficina Comarcal Agraria de Huercal-Overa. Junta de Andalucia; 9:Laboratorio de producción y Sanidad Animal, Córdoba. Junta de Andalucía
Almería (Southeast Spain), represents a complex population with a high proportion of TB involving migrants (77%). TB incidence increased before the pandemic (17-28/100.000), was reduced in 2020 (18) and stabilized in 2021 (20). The increase correlated with a higher number of migrant arrivals. The integration of epidemiological and molecular data indicated that cases involved mainly M. tuberculosis strains identified as orphan, most from recently arrived migrants, consistent with imported strains. It allowed us to rule out a role for transmission after arrival in the incidence increase, due to deficiencies in the control programs. In fact, the percentage of clustered cases did not increase during the pandemic. Compared to 2020, in 2021, the diagnosis delay in migrant cases with imported strains was more frequent. Regarding those migrant cases identified as clustered during the pandemic, we present examples of how the integration of WGS and a refined epidemiological investigation, supported on community health agents, helped to reorientate the investigations. The reorientation with a higher impact corresponded to a cluster initially considered as a self-limited family microepidemic. After WGS analysis and epidemiological investigation it was revealed as a previously non-suspected extense zoonotic event involving M. caprae, with 14 human cases along the last 10 years. The research was completed following a one-health approach, which identified close genomic relationships between the human strains and those infecting extensively a goat farm.
Funding : ISCIII (PI21/01823, PI19/00331, FI20/00129) together with FEDER fund “A way of making Europe”, and Junta de Andalucía (AP-0062-2021-C2-F2).