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Am J Epidemiol 2004; 159:507-513.
Copyright © 2004 by the Johns Hopkins Bloomberg School of Public Health

ORIGINAL CONTRIBUTIONS

Diversity of Mycobacterium tuberculosis Isolates in an Immigrant Population: Evidence against a Founder Effect

Sophie Kulaga1, Marcel Behr1,2,3, Dao Nguyen1,2,3, Jacquelyn Brinkman3, Jennifer Westley3, Dick Menzies1,2,3, Paul Brassard1,2,3,4, Terry Tannenbaum1,4, Louise Thibert5, Jean-François Boivin1,2, Lawrence Joseph1,2,3 and Kevin Schwartzman1,2,3 

1 Joint Departments of Epidemiology and Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
2 Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
3 Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
4 Direction de la Santé Publique, Montréal-Centre, Montréal, Québec, Canada.
5 Laboratoire de Santé Publique du Québec, Montréal, Québec, Canada.

Population-based studies have used DNA typing of Mycobacterium tuberculosis organisms to estimate the extent of ongoing tuberculosis transmission in various communities and to characterize associated risk factors. The finding of matched DNA "fingerprints" among isolates from an immigrant subgroup may reflect transmission in the adopted country but could also reflect limited diversity among M. tuberculosis organisms within that immigrant community. The authors sought to determine which hypothesis is more likely to explain the high frequency of matched isolates among Haitian-born tuberculosis patients in Montreal, Quebec, Canada. The authors determined the number of different bacterial genotypes in this community as compared with other foreign-born tuberculosis patients and applied a recently described measure of genetic similarity between M. tuberculosis organisms ("genetic distance"). Among 76 Haitian-born tuberculosis patients diagnosed during 1996–1998, the authors identified 47 distinct genotypes on the basis of standard IS6110 DNA typing and categorical analysis. In genetic distance analysis, these 47 genotypes showed as great a genetic diversity as that observed among the 191 distinct genotypes identified in 216 other foreign-born tuberculosis patients. A mycobacterial "founder effect" is unlikely to account for the high proportion of shared isolates among Haitian-born Montrealers. Recent transmission remains the most likely explanation.

disease transmission; DNA fingerprinting; emigration and immigration; tuberculosis; variation (genetics)

Abbreviations: Abbreviations: CI, confidence interval; IS, insertion sequence; RFLP, restriction fragment length polymorphism.


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