Hyper transmission of Beijing lineage Mycobacterium tuberculosis: Systematic review and meta-analysis

J Infect. 2019 Dec;79(6):572-581. doi: 10.1016/j.jinf.2019.09.016. Epub 2019 Oct 1.


Objectives: The globally distributed "Beijing" lineage of Mycobacterium tuberculosis has been associated with outbreaks worldwide. Laboratory based studies have suggested that Beijing lineage may have increased fitness; however, it has not been established whether these differences are of epidemiological significance with regards to transmission. Therefore, we undertook a systematic review of epidemiological studies of tuberculosis clustering to compare the transmission dynamics of Beijing lineages versus the non-Beijing lineages.

Methods: We systematically searched Embase and MEDLINE before 31st December 2018, for studies which provided information on the transmission dynamics of the different M. tuberculosis lineages. We included articles that conducted population-based cross-sectional or longitudinal molecular epidemiological studies reporting information about extent of transmission of different lineages. The protocol for this systematic review was prospectively registered with PROSPERO (CDR42018088579).

Results: Of 2855 records identified by the search, 46 were included in the review, containing 42,700 patients from 27 countries. Beijing lineage was the most prevalent and highly clustered strain in 72.4% of the studies and had a higher likelihood of transmission than non-Beijing lineages (OR 1·81 [95% 1·28-2·57], I2 = 94·0%, τ2 = 0·59, p < 0·01).

Conclusions: Despite considerable heterogeneity across epidemiological contexts, Beijing lineage appears to be more transmissible than other lineages.

Keywords: Beijing lineage; Molecular genotyping; Transmission; Tuberculosis.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cluster Analysis
  • Disease Transmission, Infectious*
  • Female
  • Global Health
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / classification*
  • Mycobacterium tuberculosis / isolation & purification*
  • Prevalence
  • Tuberculosis / epidemiology
  • Tuberculosis / microbiology*
  • Tuberculosis / transmission*
  • Young Adult