Tuberculosis in Liberia: high multidrug-resistance burden, transmission and diversity modelled by multiple importation events Open Access

Abstract

Tuberculosis (TB) surveillance is scarce in most African countries, even though it is the continent with the greatest disease incidence according to the World Health Organization. Liberia is within the 30 countries with the highest TB burden, probably as a consequence of the long civil war and the recent Ebola outbreak, both crippling the health system and depreciating the TB prevention and control programmes. Due to difficulties working in the country, there is a lack of resistance surveys and bacillus characterization. Here, we use genome sequencing of clinical isolates to fill this gap. Our results highlight that the bacillus population structure is dominated by lineage 4 strains that harbour an outstanding genetic diversity, higher than in the rest of Africa as a whole. Coalescent analyses demonstrate that strains currently circulating in Liberia were introduced several times beginning in the early year 600 CE until very recently coinciding with migratory movements associated with the civil war and Ebola epidemics. A higher multidrug-resistant (MDR)-TB frequency (23.5 %) than current estimates was obtained together with non-catalogued drug-resistance mutations. Additionally, 39 % of strains were in genomic clusters revealing that ongoing transmission is a major contribution to the TB burden in the country. Our report emphasizes the importance of TB surveillance and control in African countries where bacillus diversity, MDR-TB prevalence and transmission are coalescing to jeopardize TB control programmes.

Funding
This study was supported by the:
  • John D. and Catherine T. MacArthur Foundation (US) (Award Grant No. 97944-0-800/406/99)
    • Principle Award Recipient: Not Applicable
  • Ministerio de Economía y Competitividad (Award SAF2016-77346-R)
    • Principle Award Recipient: Iñaki Comas
  • Ministerio de Economía y Competitividad (Award SAF2013-43521-R)
    • Principle Award Recipient: Iñaki Comas
  • H2020 European Research Council (Award 638553-TB-ACCELERATE)
    • Principle Award Recipient: Iñaki Comas
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/content/journal/mgen/10.1099/mgen.0.000325
2020-01-14
2024-03-29
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