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Whole Genome Sequencing Analysis Reveals Interregional Transmission Dynamics of Tuberculosis in Spain: A Study of Catalonia and the Valencian Community

M G López(5,9) V Saludes(1,2,9) E Sicart-Torres(3) L Gavaldà(3) A E Bordoy(1) P Cano(5) V Furió(5) M Moreno-Molina(5) L Soler(1) A Antuori(1) D Panisello-Yagüe(1) M Torres-Puente(5) S Pequeño(3) J Mendioroz(3) P J Cardona(1,6) E Martró(1,2,10) I Comas(2,5,10) O n Behalf of TB-SEQ study group (Cataluña) and Tuberculosis study group from Valencia Region(7)

1: Institut de Recerca i Hospital Germans Trias i Pujol (IGTP); 2:CIBER en Epidemiología y Salud Pública (CIBERESP); 3:Agència de Salud Pública de Catalunya, Generalitat de Catalunya, Barcelona; 4:Instituto de Biomedicina de Valencia, Valencia; 5: Instituto de Biomedicina de Valencia, IBV-CSIC; 6:CIBER en Enfermedades Respiratorias (CIBERES); 7:Spain; 8:Spain; 9:Co-First; 10:Co-Last

Whole genome sequencing (WGS) of Mycobacterium tuberculosis plays a crucial role in tuberculosis control, particularly in outbreak detection. In Spain, both Catalonia and the Valencian Community utilize WGS to assess tuberculosis transmission. They have observed a substantial rate of intracommunity transmission, with a majority of transmission cases identified through genomic analysis that were missed by corresponding contact studies. The sequencing effort included 2,150 isolates from the Valencian Community and 791 from Catalonia, representing about 70% of positive cultures reported to Public Health. By analyzing the data, we identified 61 mixed genomic clusters between the two regions, encompassing 375 cases. Some of these clusters indicated transmission dating back to 2014, with one cluster showing ongoing transmission since 2015. The largest clusters mostly include cases born in Spain, while among recent transmission groups, one of Moroccan origin stands out. These findings underscore the significant impact of recent transmission between Autonomous Communities, emphasizing the necessity of understanding local transmission dynamics for the formulation of effective tuberculosis control strategies. This research also sheds light on the importance of conducting supraregional tuberculosis surveillance and integrating genomic analysis as a complementary tool.

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