Phylogeography and transmission of Mycobacterium tuberculosis spanning prisons and surrounding communities in Paraguay

Gladys Estigarribia Sanabria (), Guillermo Sequera, Sarita Aguirre, Julieta Méndez, Paulo César Pereira Santos, Natalie Weiler Gustafson, Margarita Godoy, Analía Ortiz, Cynthia Cespedes, Gloria Martínez, Alberto L. García-Basteiro, Jason R. Andrews, Julio Croda and Katharine S. Walter ()
Additional contact information
Gladys Estigarribia Sanabria: Instituto Regional de Investigación en Salud
Guillermo Sequera: Instituto de Salud Global de Barcelona (ISGLOBAL)
Sarita Aguirre: Ministerio de Salud Pública y Bienestar Social (MSPyBS)
Julieta Méndez: Instituto Regional de Investigación en Salud
Paulo César Pereira Santos: Federal University of Mato Grosso do Sul
Natalie Weiler Gustafson: Ministerio de Salud Publica y Bienestar Social (MSPyBS)
Margarita Godoy: Ministerio de Salud Publica y Bienestar Social (MSPyBS)
Analía Ortiz: Instituto Regional de Investigación en Salud
Cynthia Cespedes: Ministerio de Salud Pública y Bienestar Social (MSPyBS)
Gloria Martínez: Instituto Regional de Investigación en Salud
Alberto L. García-Basteiro: Instituto de Salud Global de Barcelona (ISGLOBAL)
Jason R. Andrews: Stanford University School of Medicine
Julio Croda: Federal University of Mato Grosso do Sul - UFMS
Katharine S. Walter: University of Utah

Nature Communications, 2023, vol. 14, issue 1, 1-10

Abstract: Abstract Recent rises in incident tuberculosis (TB) cases in Paraguay and the increasing concentration of TB within prisons highlight the urgency of targeting strategies to interrupt transmission and prevent new infections. However, whether specific cities or carceral institutions play a disproportionate role in transmission remains unknown. We conducted prospective genomic surveillance, sequencing 471 Mycobacterium tuberculosis complex genomes, from inside and outside prisons in Paraguay’s two largest urban areas, Asunción and Ciudad del Este, from 2016 to 2021. We found genomic evidence of frequent recent transmission within prisons and transmission linkages spanning prisons and surrounding populations. We identified a signal of frequent M. tuberculosis spread between urban areas and marked recent population size expansion of the three largest genomic transmission clusters. Together, our findings highlight the urgency of strengthening TB control programs to reduce transmission risk within prisons in Paraguay, where incidence was 70 times that outside prisons in 2021.

Date: 2023
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DOI: 10.1038/s41467-023-35813-9

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