ABSTRACT
SETTING: The management of multidrug-resistant tuberculosis (MDR-TB) is strictly regulated in Norway. However, nationwide studies of the epidemic are lacking. OBJECTIVE: To describe the MDR-TB epidemic in Norway over two decades. DESIGN: Retrospective analysis of data on MDR-TB cases in Norway, 1995-2014, obtained from the national registry, patient records and the reference laboratory, with genotyping and cluster analysis data. Data for non-MDR-TB cases were collected from the national registry. RESULTS: Of 4427 TB cases, 89 (2.0%) had MDR-TB, 7% of whom had extensively drug-resistant TB (XDR-TB) and 24% pre-XDR-TB. Of the 89 MDR-TB cases, 96% were immigrants, mainly from the Horn of Africa or the former Soviet Union (FSU); 37% had smear-positive TB; and 4% were human immunodeficiency virus co-infected. Of the 19% infected in Norway, the majority belonged to a Delhi/Central Asian lineage cluster in a local Somali community. Among the MDR-TB cases, smear-positive TB and FSU origin were independent risk factors for XDR/pre-XDR-TB. Treatment was successful in 66%; 17% were lost to follow-up, with illicit drug use and adolescence being independent risk factors. Forty-four per cent of patients treated with linezolid discontinued treatment due to adverse effects. CONCLUSION: MDR-TB is rare in Norway and is predominantly seen in immigrants from the Horn of Africa and FSU. Domestic transmission outside immigrant populations is minimal.
Subject(s)
Epidemics , Extensively Drug-Resistant Tuberculosis/epidemiology , HIV Infections/epidemiology , Tuberculosis, Multidrug-Resistant/epidemiology , Adolescent , Adult , Africa/ethnology , Antitubercular Agents/therapeutic use , Child , Child, Preschool , Cluster Analysis , Emigrants and Immigrants , Extensively Drug-Resistant Tuberculosis/drug therapy , Female , Follow-Up Studies , Genotyping Techniques , HIV Infections/drug therapy , Humans , Linezolid/therapeutic use , Lost to Follow-Up , Male , Middle Aged , Norway/epidemiology , Retrospective Studies , Risk Factors , Tuberculosis, Multidrug-Resistant/drug therapy , USSR/ethnology , Young AdultABSTRACT
Six outbreaks of infectious syphilis in the United Kingdom, ongoing since 2012, have been investigated among men who have sex with men (MSM) and heterosexual men and women aged under 25 years. Interventions included case finding and raising awareness among healthcare professionals and the public. Targeting at-risk populations was complicated as many sexual encounters involved anonymous partners. Outbreaks among MSM were influenced by the use of geospatial real-time networking applications that allow users to locate other MSM within close proximity.
