BACKGROUND: Tuberculosis remains a global health concern, with rising pediatric and adolescent cases. The advancement of diagnostic strategies is crucial for effective control, with whole-genome sequencing emerging as a promising tool. This study explores using whole-genome sequencing in pediatric Tuberculosis. METHODS: Mycobacterium tuberculosis isolates from pediatric patients and their contacts were collected between January 2023 and June 2024 in Slovakia and the Czech Republic. The isolates were subjected to WGS to characterize the resistance patterns and transmission. RESULTS: The study included 37 patients in total-30 pediatric cases and 7 adult index cases-with a single M. tuberculosis isolate collected per patient. The phylogenetic analysis results revealed that 32 out of 37 (86.5%) isolates belonged to the Euro-American lineage. Five isolates (13.5%) belonged to the East-Asian lineage. Genotypic resistance to at least one drug was confirmed in 6 patients (16%). 24 patients were divided into 9 clusters (65%), leaving 13 unclustered (35%). Moreover, the concordance between the identification of source case by WGS and epidemiological anamnesis was confirmed in 60% of patients. CONCLUSIONS: Epidemiological data may not always provide accurate insights into the transmission of TB. Consequently, integrating molecular methods, such as WGS, is essential to enhance the reliability and precision of epidemiological analyses.

• Keywords
• Drug resistance, Pediatric patients, tuberculosis, Transmission chains, Whole-genome sequencing,
• MeSH
• Child MeSH
• Adult MeSH
• Phylogeny MeSH
• Genotype MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Mycobacterium tuberculosis * genetics   classification   isolation & purification   drug effects   MeSH
• Child, Preschool MeSH
• Whole Genome Sequencing MeSH
• Tuberculosis * transmission   epidemiology   microbiology   MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Slovakia epidemiology   MeSH

BACKGROUND: The war in Ukraine has led to significant migration to neighboring countries, raising public health concerns. Notable tuberculosis (TB) incidence rates in Ukraine emphasize the immediate requirement to prioritize approaches that interrupt the spread and prevent new infections. METHODS: We conducted a prospective genomic surveillance study to assess migration's impact on TB epidemiology in the Czech Republic and Slovakia. Mycobacterium tuberculosis isolates from Ukrainian war refugees and migrants, collected from September 2021 to December 2022 were analyzed alongside 1574 isolates obtained from Ukraine, the Czech Republic, and Slovakia. RESULTS: Our study revealed alarming results, with historically the highest number of Ukrainian tuberculosis patients detected in the host countries. The increasing number of cases of multidrug-resistant TB, significantly linked with Beijing lineage 2.2.1 (p < 0.0001), also presents substantial obstacles to control endeavors. The genomic analysis identified the three highly related genomic clusters, indicating the recent TB transmission among migrant populations. The largest clusters comprised war refugees diagnosed in the Czech Republic, TB patients from various regions of Ukraine, and incarcerated individuals diagnosed with pulmonary TB specialized facility in the Kharkiv region, Ukraine, pointing to a national transmission sequence that has persisted for over 14 years. CONCLUSIONS: The data showed that most infections were likely the result of reactivation of latent disease or exposure to TB before migration rather than recent transmission occurring within the host country. However, close monitoring, appropriate treatment, careful surveillance, and social support are crucial in mitigating future risks, though there is currently no evidence of local transmission in EU countries.

• Keywords
• Control of tuberculosis, Migration, Refugees, Tuberculosis epidemiology,
• MeSH
• Adult MeSH
• Incidence MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Molecular Epidemiology * MeSH
• Tuberculosis, Multidrug-Resistant epidemiology   MeSH
• Mycobacterium tuberculosis * genetics   isolation & purification   MeSH
• Transients and Migrants * statistics & numerical data   MeSH
• Armed Conflicts MeSH
• Prospective Studies MeSH
• Tuberculosis * epidemiology   transmission   MeSH
• Refugees * statistics & numerical data   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Slovakia epidemiology   MeSH
• Ukraine epidemiology   MeSH