Multidrug-resistant tuberculosis in Norway: a nationwide study, 1995–2014
OBJECTIVE: To describe the MDR-TB epidemic in Norway over two decades.
DESIGN: Retrospective analysis of data on MDR-TB cases in Norway, 1995–2014, obtained from the national registry, patient records and the reference laboratory, with genotyping and cluster analysis data. Data for non-MDR-TB cases were collected from the national registry.
RESULTS: Of 4427 TB cases, 89 (2.0%) had MDR-TB, 7% of whom had extensively drug-resistant TB (XDR-TB) and 24% pre-XDR-TB. Of the 89 MDR-TB cases, 96% were immigrants, mainly from the Horn of Africa or the former Soviet Union (FSU); 37% had smear-positive TB; and 4% were human immunodeficiency virus co-infected. Of the 19% infected in Norway, the majority belonged to a Delhi/Central Asian lineage cluster in a local Somali community. Among the MDR-TB cases, smear-positive TB and FSU origin were independent risk factors for XDR/pre-XDR-TB. Treatment was successful in 66%; 17% were lost to follow-up, with illicit drug use and adolescence being independent risk factors. Forty-four per cent of patients treated with linezolid discontinued treatment due to adverse effects.
CONCLUSION: MDR-TB is rare in Norway and is predominantly seen in immigrants from the Horn of Africa and FSU. Domestic transmission outside immigrant populations is minimal.
Keywords: Norway; immigrants; linezolid; risk factor; treatment outcome
Document Type: Research Article
Affiliations: 1: Department of Infectious Diseases, Oslo University Hospital, Oslo 2: Norwegian Institute of Public Health, Oslo 3: Department of Medicine, Haukeland University Hospital, Bergen, Department of Clinical Science, University of Bergen, Bergen 4: Department of Infectious Diseases, Trondheim University Hospital, Trondheim 5: Department of Infectious Diseases, Tromsø University Hospital, Tromsø, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Institute of Clinical Medicine, Oslo University Hospital, Oslo 6: Department of Paediatrics, Oslo University Hospital, Oslo, Norway 7: Department of Infectious Diseases, Oslo University Hospital, Oslo, Department of Clinical Science, University of Bergen, Bergen, Institute of Clinical Medicine, Oslo University Hospital, Oslo
Publication date: 01 June 2016
This article was made available online on 13 April 2016 as a Fast Track article with title: "Multidrug-resistant tuberculosis in Norway: a nationwide study, 1995–2014".
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