Cross-District Transmission of Tuberculosis in a High-Mobility City in China: Implications for Regional Collaboration in Infectious Disease Control

Chuangyue Hong,1,&ast; Jinjin Ge,2,&ast; Jing Gui,1 Xiaoling Che,1 Yilin Li,1 Zhipeng Zhuo,1 Mingzhen Li,1 Feng Wang,1 Weiguo Tan,1 Zhiguang Zhao1 1Department of Tuberculosis Prevention and Control, Shenzhen Center for Chronic Disease Control; Shenzhen Institute of Pulmonology, Shenzhen, 518020, People’s Republic of China; 2National Clinical Research Center for Infectious Diseases, Shenzhen Clinical Research Center for Tuberculosis, Shenzhen Third People’s Hospital, Shenzhen, 518112, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhiguang Zhao, Department of tuberculosis prevention and control, Shenzhen Center for Chronic Disease Control; Shenzhen Institute of Pulmonology, Shenzhen, 518020, People’s Republic of China, Email [email protected]: This study aims to elucidate the transmission dynamics of tuberculosis in a Chinese city with high population mobility and to identify the associated risk factors.Methods: We included the data from ten city-level surveillance sites in Shenzhen between 2018 and 2023. Genomic clusters were defined as having a genomic distance of 12 single nucleotide polymorphisms based on whole-genome sequencing. Cross-district clusters were characterized as clusters containing patients from at least two districts, indicating cross-district transmission. Risk factors for clustering were identified using logistic regression.Results: Of the 2,519 enrolled patients, 263 (10.4%) were grouped into 119 genomic clusters. Notably, 52.1% (62/119) of these clusters were cross-district clusters. We analyzed the data from Shenzhen’s 10 districts separately and compared the results with a citywide combined analysis, finding that the combined analysis revealed significantly higher clustering rates across all districts (P< 0.001). Furthermore, the risk of cross-district transmission was 3.41 times higher (95% CI: 1.49– 7.80) among internal migrants than among residents. Multivariable logistic regression analysis identified significant risk factors for TB transmission, including age under 25 years (OR=3.07, 95% CI: 1.17– 8.03), age 25– 44 years (OR=2.86, 95% CI: 1.13– 7.23), and drug-resistant TB (OR=1.57, 95% CI: 1.15– 2.13).Conclusion: Cross-district transmission is a key factor in the spread of tuberculosis in cities with high population mobility. TB control institutions at all levels must transcend regional boundaries and enhance collaboration to achieve more effective tuberculosis control.Keywords: Mycobacterium tuberculosis, cross-district transmission, whole-genome sequencing, risk factors