P76
PHIMS-TB: Enhancing public health actions by an integrated molecular surveillance of tuberculosis in Germany
T A Kohl(1,2,3) S Kröger(4,6) F P Maurer(3) L Bös(4) L Paulowski(3) M Merker(1,2,3) V Dreyer(1,2,3) M Diercke(4) M Huska(5) S Niemann(1,2,3) W Haas(4,6)
1:Molecular and Experimental Mycobacteriology, Research Center Borstel, Germany; 2:German Center for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; 3:National Tuberculosis Reference Laboratory, Research Center Borstel, Borstel, Germany; 4:Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; 5:Methodology and research infrastructure, Bioinformatics, Robert Koch Institute, Berlin, Germany; 6:German Center for Infection Research (DZIF), partner site Hannover-Braunschweig-Berlin, Germany
Tuberculosis (TB) control efforts require in-depth epidemiological data such as the information obtained by integrated molecular surveillance (IMS) systems to be effective even in low incidence countries. IMS should effectively combine high resolution whole genome sequencing strain typing with epidemiological data. This allows for detailed analysis of transmission dynamics and the development of efficient intervention and control policies. To establish a nationwide generic approach in Germany, the Robert Koch Institute (RKI) and the Research Center Borstel (RCB) started the PHIMS-TB project to implement the necessary workflows allowing evaluation of the impact of country-wide whole genome tuberculosis surveillance in Germany. Mycobacterium tuberculosis complex (Mtbc) strains obtained from TB patients living in Germany are sent to the RCB for whole genome sequencing, analyzed for resistance inference, phylogenetic classification, and cluster analysis, and results linked with epidemiological information at the RKI. In 2020 and 2021 we captured a third of German culture positive TB cases notified in these years. The majority of strains belonged to lineage 4, followed by strains of lineages 3, 2, and 1. Most Mtbc strains were found to be likely fully sensitive against antibiotics employed in TB treatment. The proportion of resistant Mtbc strains was remarkably higher for lineage 2 strains. Overall, more than a third of strains investigated were grouped in clusters, with clustering rates being higher both for resistant and lineage 2 strains. Overall, country wide TB surveillance potentially allows for rapid and comprehensive detection of transmission networks and outbreaks, and high-resolution measurement of resistance levels.