Use of High-Resolution Geospatial and Genomic Data to Characterize Recent Tuberculosis Transmission, Botswana

Combining genomic and geospatial data can be useful for understanding Mycobacterium tuberculosis trans-mission in high-burden tuberculosis (TB) settings. We performed whole-genome sequencing on M. tuber-culosis DNA extracted from sputum cultures from a population-based TB study conducted in Gaborone, Botswana, during 2012-2016. We determined spatial distribution of cases on the basis of shared genotypes among isolates. We considered clusters of isolates with =5 single-nucleotide polymorphisms identified by whole-genome sequencing to indicate recent trans-mission and clusters of =10 persons to be outbreaks. We obtained both molecular and geospatial data for 946/1,449 (65%) participants with culture-confirmed TB; 62 persons belonged to 5 outbreaks of 10-19 per-sons each. We detected geospatial clustering in just 2 of those 5 outbreaks, suggesting heterogeneous spatial patterns. Our findings indicate that targeted interventions applied in smaller geographic areas of high-burden TB identified using integrated genomic and geospatial data might help interrupt TB transmis-sion during outbreaks.