Mycobacterium Tuberculosis Infection Among Public University Students of Eastern Ethiopia: Disease Burden, Drug Resistance Patterns and Molecular Epidemiology

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Addis Ababa University


Identification of high-risk population groups and prompt initiation of treatment are critical components of tuberculosis (TB) control and prevention strategy in high-burden countries like Ethiopia. In Ethiopia, the number of public universities expanded from five to 45 in less than two decades with adequate housing infrastructure often lagging behind. Baseline data are not available on the prevalence of TB among this segment of the population. The study was aimed at examining the magnitude, risk factors, drug sensitivity patterns and molecular characterization of Mycobacterium tuberculosis complex (MTBC) isolates circulating among public university students in eastern Ethiopia. The study employed active and passive Pulmonary TB (PTB) case finding approaches. All full-time university students (n= 35,344) in eastern Ethiopia: Haramaya, Dire Dawa and Jigjiga universities were screened for symptoms of PTB using the WHO guideline. That is, sputum was collected from presumptive PTB cases for acid fast bacilli examination, TB culture and drug sensitivity testing. The MTBC isolates from the students (n=34), and from the local communities (n=126) surrounding these universities, were genotyped by using Spoligotyping and 24-loci MIRU-VNTR techniques to determine the population structure and transmission dynamics of the strains. In the three eastern Ethiopia universities, the estimated annual average prevalence of PTB was 433/100,000; 30.5% (11/36) isolates from students and 29.4% (37/126) isolates from local community were resistant to one or more first line anti-TB drugs. Among all PTB case study participants from eastern Ethiopia, 4 MTBC lineages and 11 sub-lineages were identified, with more strain diversity among the local community than students. Among the strains, 8.1% (13/160) phylogenetically related to the known Ethiopian sub-lineages, with a distinct Spoligotyping patterns, were identified and were designated in this study “Ethiopia_4”. Furthermore, 2.5% (4/160) Beijing strains were isolated. The clustering rate of MTBC strains was 52.9% for university students and 66.7% for community members. Overall, a high burden of tuberculosis was found among university students in eastern Ethiopia, and evidence was found for significant PTB case clustering and recent transmission among university students and the local community. “Ethiopia_3” was found to be the predominant sub-lineage circulating in the study population. Hence, the discovery of the newly identified sub-lineage, “Ethiopia_4” and circulation of more Beijing sub-lineage in the study population, relative to what was previously reported in the country, should alert the need for a detailed molecular investigation of MTB in Ethiopia. Therefore, to minimize TB transmission on university campuses, governmental and nongovernmental agencies involved in tuberculosis control must consider universities as focal points for prevention and elimination of tuberculosis. To begin with, PTB screening on university admission, followed by subsequent regular check-ups, must be done on the students. However, for a more effective prevention of PTB transmission in the student population, the on campus control effort must be conducted in conjunction v with PTB control and prevention programs in the communities where the universities are located.



University Students, Pulmonary Tuberculosis, Miru/Vntr-24 Loci, Molecular Epidemiology, Ethiopia