996. Patterns of Mycobacterium tuberculosis transmission in the Al Ain Medical Area of the United Arab Emirates
Session: Poster Abstract Session: Clinical Studies of Tuberculosis
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Tuberculosis is a global problem and the incidence is on the increase in many parts of the world. A unique situation exists in Countries of the Gulf Cooperation Council (GCC) in the Middle East, where 3 major demographic groups are present. The first is the national population of these countries (mostly stationary and a minority), second is the migrant workers from the neighboring Gulf /Arab countries and the third are immigrants from tuberculosis endemic Asia and Africa (highly mobile and with a high turnover). The latter accounts for ~ 50% of the population. Tuberculosis control programs of the GCC countries are primarily based on the assumption that tuberculosis in GCC countries is imported via these immigrant workers. Methods: In order to verify this assumption, we have reviewed the laboratory and case records of 713 culture positive cases detected during the period 1996-2008, at the tuberculosis diagnostic laboratory at the Al Ain Hospital, Al Ain, United Arab Emirates. Criteria used were patient age, source or origin, nature of sample submitted, sputum microscopy results, culture positivity and drug sensitivity. Results: Our data show (1) an overall increase in the detection of culture positive cases between 1996-2008 (2) the majority of the cases among immigrants are reactivation of latent infections (3) transmission occurs at two levels (4), first a low level transmission among the relatively immobile local population (Emiratis) (5) the culture positive cases were higher among Asian and African expatriates (6) M. tuberculosis strains prevalent among local and expatriate populations are different (7) there is no evidence of significant cross transmission among the two populations (8) a high proportion of culture positives are extra-pulmonary (9) during the period 2006-2008, of 357 isolates tested, only 12% (44/357) showed mono-resistance, 4% (15/357) were resistant to 2 drugs and only 1% (4/357) were multi-drug resistant. Conclusion: The increased incidence of culture positive tuberculosis among expatriates is most likely due to re-activation of old infections, as these individuals are subject to tuberculosis screening and certified as tuberculosis free at arrival and followed up every 2-3 years for visa renewal.

Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Senarath Dissanayake, UAE University, Al Ain, United Arab Emirates

Disclosures:

S. Dissanayake, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.