Spatial analysis of patients with multi-drug resistant pulmonary tuberculosis between 2009 and 2012 in Eastern China

Background: China has the second highest tuberculosis (TB) burden worldwide, with approximately 1 million new cases per year. Moreover, multidrug-resistant tuberculosis (MDR-TB) poses a major threat to TB control In China. In 2008, 5.7% of newly diagnosed and 25.6% of previously treated TB patients in China had MDR-TB. This study aims to analyze the spatial distribution of patients with multi-drug resistant pulmonary tuberculosis in Zhejiang Province, eastern China, to identify hotspot that may be subject to clustering of transmission, and provide a theoretical basis for the further study of the risk factors of tuberculosis and its prevention and control strategy. Methods & Materials: We collected the information related to notified cases of multi-drug resistant pulmonary tuberculosis patients from at county level in Zhejiang Province between 2009 and 2012, and analyzed the survey data by ArcGIS 10.0 software using geographic information system spatial analysis method. Results: During the study period, there were a total of 647 patients with multi-drug resistant pulmonary tuberculosis of all 90 counties in Zhejiang Province, overall space distribution showed a trend of central and southwestern more gathering. Spatial clustering analysis of the cases in 2009 identified 2 clusters, the first cluster included two urban areas, the other included rural sites; spatial clustering analysis of the cases in 2010 identified 1 cluster, included 5 counties/districts; spatial clustering analysis of the cases in 2011 identified 2 clusters, the first cluster included 5 counties/districts, the other included 2 counties from mountain areas; spatial clustering analysis of the cases in 2012 identified 2 clusters, the first cluster included two urban districts in the capital of Zhejiang Province, the other included 5 counties in relatively developed areas. Conclusion: There was a gathering phenomenon of patients with multi-drug resistant pulmonary tuberculosis in the central and southwestern of Zhejiang province between 2009 and 2012, the notifications were not randomly distributed in space, clusters did exist in Zhejiang province, and the clusters most likely existed in the region of Quzhou, Southwestern of Zhejiang, and the region of Hangzhou, central Zhejiang.