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Genomic studies of the Mycobacterium tuberculosis complex (MTBC) might shed light on the dynamics of its transmission, especially in high-burden settings, where recent outbreaks are embedded in the complex natural history of the disease. To this end, we conducted a 1 year prospective surveillance-based study in Mozambique. We applied whole-genome sequencing (WGS) to 295 positive cultures. We fully characterized MTBC isolates by phylogenetics and dating evaluation, and carried out a molecular epidemiology analysis to investigate further associations with pre-defined transmission risk factors. The majority of strains (49.5%, 136/275) belonged to lineage (L) 4; 57.8 % of them (159/275) were in genomic transmission clusters (cut-off 5 SNPs), and a strikingly high proportion (45.5%) shared an identical genotype (0 SNP pairwise distance). We found two 'likely endemic' clades, comprising 67 strains, belonging to L1.2, which dated back to the late 19th century and were associated with recent spread among people living with human immunodeficiency virus (PLHIV). We describe for the first time the population structure of MTBC in our region, a high tuberculosis (TB)/HIV burden area. Clustering analysis revealed an unforeseen pattern of spread and high rates of progression to active TB, suggesting weaknesses in TB control activities. The long-term presence of local strains in Mozambique, which were responsible for large transmission among HIV/TB-coinfected patients, calls into question the role of HIV in TB transmission.

Background: In Argentina, with the aim of moving to a safe supportive and inclusive National Blood System, in September 2015 the Ministry of Health stipulated that eligibility criteria for blood donation should only take into account the so-called 'risk practices', focusing on a 'gender-neutral' policy. The aim of this study is to demonstrate the impact of such regulation on the prevalence of STI in the population of blood donors in Argentina, through the analysis of the scientific evidence obtained from 174 074 donors from a large central region of the country, focused on a regional Blood Bank for a 6-year period (pre- and post-entry into force of the regulations)., Materials and Methods: To analyse the evolution of prevalence rates of STI, two periods of 3 years each were evaluated: The first period (P1) lasted from 16 September 2012 to 15 September 2015 (prior to the entry into force of the law) and the second one (P2) from 16 September 2015 to 15 September 2018 (after the entry into force of the law)., Results: A total of 82 838 subjects were enrolled in P1 and 91 236 in P2. The results show a significantly lower prevalence of HCV (P = 0·029), HBV (P = 0·028) and syphilis (P = 0·001) in P2, while no difference was observed for HIV infection (P = 0·60)., Conclusion: This study evidenced that the implementation of a 'gender-neutral' policy based on individual risk-assessment deferral criteria maintained the safety of blood supply and decreased the prevalence of STI among blood donors., (© 2020 International Society of Blood Transfusion.)

Simple effective tools to monitor the long treatment of tuberculosis (TB) are lacking. Easily measured host derived biomarkers have been identified but need to be validated in larger studies and different population groups. Here we investigate the early response in IP-10 levels (between day 0 and day 7 of TB therapy) to identify bacteriological status at diagnosis among 127 HIV-infected patients starting TB treatment. All participants were then classified as responding or not responding to treatment blindly using a previously described IP-10 kinetic algorithm. There were 77 bacteriologically confirmed cases and 41 Xpert MTB/RIF® and culture negative cases. Most participants had a measurable decline in IP-10 during the first 7 days of therapy. Bacteriologically confirmed cases were more likely to have high IP-10 levels at D0 and had a steeper decline than clinically diagnosed cases (mean decline difference 2231 pg/dl, 95% CI: 897-3566, p = 0.0013). Bacteriologically confirmed cases were more likely to have a measurable decline in IP-10 at day 7 than clinically diagnosed cases (48/77 (62.3%) vs 13/41 (31.7%), p < 0.001). This study confirms the association between a decrease in IP-10 levels during the first week of treatment and a bacteriological confirmation at diagnosis in a large cohort of HIV positive patients.