775. An Epidemiological Analysis of Patients with Multidrug-Resistant Tuberculosis among Tibetan Refugees in India
Session: Poster Abstract Session: Tuberculosis and Other Mycobacterial Infections
Thursday, October 4, 2018
Room: S Poster Hall
  • IDSA poster 2018 ver 4.9.pdf (1.4 MB)
  • Background: Globally, refugee populations face an increased risk for tuberculosis (TB) due to malnutrition, overcrowding, and poor living conditions. Compared with the general Indian population, Tibetan refugees in India display a higher incidence rate of both TB and multidrug-resistant TB (MDR-TB). The high incidence of MDR-TB in younger population is a serious public health concern.

    Methods: We retrospectively reviewed the medical records of patients with MDR-TB treated from January 2010 to December 2013 in Tibetan Delek Hospital, which is the center of TB control among Tibetan refugees. Patients were classified into either new cases (supposed infection by exposure to MDR-TB) or previously treated MDR-TB cases (suspected acquirement of MDR-TB through anti-TB treatment or by MDR-TB exposure after treatment). We compared patients’ age, sex, birthplace, residence type, occupation, contact history, and treatment outcome.

    Results: Of 749 patients with TB, we enrolled 134 patients with MDR-TB [median age, 26 (interquartile range: 22-35) years; males, 55%]. The Tibetan ethnicity comprised 96% of the study population, whereas Indians (trans-Himalayan) comprised 4%. The birthplace was Tibet for 22% patients, India for 75%, and Nepal for 2%. New MDR-TB cases were 28% and previously treated MDR-TB cases were 72%. Failure was observed in 42% patients and cured and completed in 54% patients, during their previous TB treatment. The median age was significantly lower in new cases than in previously treated MDR-TB cases (24 vs. 28.5 years; P < 0.01). Tibet was the birthplace of 34% new cases and 18% in previously treated cases (P = 0.04). The residence was of the congregated type in 58% of new cases and 30% in previously treated MDR-TB cases (P = 0.01). The occupation was “student” and “unemployed” in 58% and 8% in new cases and 33% and 24% in previously treated cases, respectively (P = 0.03). Contact history with TB type and treatment outcome were not considerably different, although the rates of cured and completed were high in both new (82%) and previously treated (84%) MDR-TB cases.

    Conclusion: This study shows that new MDR-TB correlates with younger age, birth in Tibet, congregated residence, and student occupation. Targeting the above-listed characteristics could be effective in further reducing the MDR-TB transmission among Tibetan refugees in India.

    Tenzin Desel, MBBS1, Naonori Tsuda, MD2, Tenzin Tsundue, MBBS1, Rangjung Lingtsang, MBBS1, Sonam Topgyal, MBBS/DCH1, Akahito Sako, MD/MPH2, Hidekatsu Yanai, MD/PhD2 and Tsetan Sadutshang, MBBS/MPH1, (1)Tibetan Delek Hospital, Dharamshala, India, (2)Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan


    T. Desel, None

    N. Tsuda, None

    T. Tsundue, None

    R. Lingtsang, None

    S. Topgyal, None

    A. Sako, None

    H. Yanai, None

    T. Sadutshang, None

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