Transmission of tuberculosis among people living in the border areas of Poland, the Czech Republic, and Slovakia.

INTRODUCTION: In 2007, Poland, the Czech Republic, and Slovakia joined the Schengen Agreement, abolishing restrictions on people crossing the borders. Currently, these areas are places of population movements for economic, family, and touristic reasons. This favors the transmission of infectious diseases, including tuberculosis, and requires enhanced control over the spread of the source of infection in the population of patients living in the border areas. OBJECTIVES: The aim of this study was to investigate the genetic relatedness among Mycobacterium tuberculosis complex strains isolated from patients living in 3 border areas: Poland, the Czech Republic, and Slovakia. PATIENTS AND METHODS The study group consisted of 209 patients with tuberculosis diagnosed and treated between 2007 and 2011 in health care facilities in the Silesia Province in Poland (121 patients [58%]), Zilina in Slovakia (57 [27%]), and the Moravian-Silesian Region in the Czech Republic (31 [15%]). Genotyping of strains was performed using spoligotyping and IS6110-Mtb1-Mtb2 polymerase chain reaction. RESULTS: Among 209 strains, 23 molecular families (clusters) were identified. Seventeen clusters were identified as national. Six international clusters consisted of 30 strains isolated from patients of various nationalities. CONCLUSIONS: We identified 6 potential outbreaks of tuberculosis transmission between patients of different nationalities. The circumstances favorable to potential contacts of patients included mainly travelling to the neighboring countries, hospital stays, and addictions. However, there was no evidence of an epidemiological link between these patients, so it may be assumed that if they had come in contact with one another, it was accidental. We observed that the greater incidence of tuberculosis on the Polish territory did not affect the incidence in the Czech Republic or Slovakia over the analysis period.

Tuberculosis among the homeless and inmates kept in custody and in penitentiary institutions in the Silesia region.

INTRODUCTION: There are more than 10 million prisoners in the world. Tuberculosis incidence is 10-100 times higher in prisoners than in the general population. Inmates have close contact with other prisoners and with prison workers and visitors, so tubercle bacilli may be easily spread. Most of the inmates come back to normal life and contact with the general population. The aim of the study was to assess active tuberculosis incidence among prisoners and homeless persons in the Silesia region. MATERIAL AND METHODS: In total 897 people entered the study, of whom 720 were Silesian penitentiary system inmates, and 177 were homeless. BACTEC MGIT fast TB detection system and GenoType Mycobacteria Direct test were used. Drug susceptibility testing was done using SIRE KIT and PZA KIT. RESULTS: Tuberculosis was diagnosed in 13 out of 897 persons (1.45%): in 11 out of 720 inmates (1.53%) and in 2 out of 177 homeless persons (1.13%). Data concerning drug susceptibility were obtained for 11 persons. M. tuberculosis strains isolated from eight persons were susceptible to four first-line antituberculosis drugs (streptomycin, isoniazid, rifampin, ethambutol), while M. tuberculosis strains isolated from three persons were drug-resistant. One out of three isolated strains was resistant to ethambutol, but susceptible to streptomycin, isoniazid, rifampin, and pirazynamide. The second strain was resistant to streptomycin and pyrazinamide but susceptible to isoniazid, rifampin, and ethambutol. The third strain was susceptible to rifampin but resistant to the other four tested drugs. According to the obtained data, culture-positive pulmonary tuberculosis was 100 times more frequent in the examined population than in the general population of the Silesia region in the same period of time. CONCLUSIONS: The health project enabled effective detection of tuberculosis in risk groups and should be continued in the following years. The set of the applied diagnostic methods allowed the detection of in the studied subpopulations people suffering from tuberculosis. Patients were treated with antituberculosis drugs that would stop them from spreading the disease to other people.