Unsuspected Recent Transmission of Tuberculosis among High-Risk Groups: Implications of Universal Tuberculosis Genotyping in Its Detection

Malakmadze, Naile; González, Idalia M.; Oemig, Tanya V.; Isiadinso, Ijeoma; Rembert, Desiree; McCauley, Mary M.; Wand, Philip J.; Diem, Lois; Cowan, Lauren S.; Palumbo, Gabriel; Fraser, Michael R.; Ijaz, Kashef

doi:10.1086/427112

Cited by 50 publications

(50 citation statements)

References 30 publications

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“…Such action may include several overlapping contact investigations; coordination and proper communication to the exposed community, other healthcare providers and the media; analytical epidemiological studies; and additional public health resources. Early and DNA fingerprint technology enables the identification of molecular clusters [234,235,236] and exclusion of pseudooutbreaks due to laboratory cross-contamination [237] (C). Mycobacteriology laboratories have utilised DNA fingerprinting data, coupled to dates of specimen processing, to identify cases that are probably due to cross-contamination.…”

Section: Outbreak Managementmentioning

confidence: 99%

Tuberculosis contact investigation in low prevalence countries: a European consensus

Erkens

Kamphorst²,

Abubakar

et al. 2010

European Respiratory Journal

239

201

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Contact investigation to identify individuals with tuberculosis and latent infection with Mycobacterium tuberculosis is an important component of tuberculosis control in low tuberculosis incidence countries. This document provides evidence-based and best-practice policy recommendations for contact tracing among high-and medium-priority contacts in a variety of settings. It provides a basis for national guidelines on contact investigation and tuberculosis outbreak management, and should support countries and tuberculosis control managers in evaluating and revising national policies. A review of existing guidelines, a literature search, several meetings and consultation with experts were used to formulate and grade recommendations for action during contact investigation.Available tests to identify individuals with latent infection with M. tuberculosis are designed to identify immune response against mycobacterial antigens and have variable predictive value for the likelihood to develop active tuberculosis in different populations. Contact investigation should therefore be limited to situations with a clear likelihood of transmission or to those with a higher probability of developing active tuberculosis, for instance, young children and immunocompromised persons. A risk assessment-based approach is recommended, where the need to screen contacts is prioritised on the basis of the infectiousness of the index case, intensity of exposure and susceptibility of contacts.

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Section: Outbreak Managementmentioning

confidence: 99%

Tuberculosis contact investigation in low prevalence countries: a European consensus

Erkens

Kamphorst²,

Abubakar

et al. 2010

European Respiratory Journal

239

201

View full text Add to dashboard Cite

show abstract

“…As highlighted in the New Jersey and Houston studies, population-based studies, when used in conjunction with traditional TB control activities, may facilitate the identification of previously unrecognized transmission events or even outbreaks in populations where there is a high background of reported cases (25,160,167,173,286). Until recently, it was thought that in low-incidence countries, such as the United States, the majority of TB cases were due to endogenous reactivation.…”

Section: Molecular Epidemiology and Public Healthmentioning

confidence: 99%

Molecular Epidemiology of Tuberculosis: Current Insights

et al. 2006

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SUMMARY Molecular epidemiologic studies of tuberculosis (TB) have focused largely on utilizing molecular techniques to address short- and long-term epidemiologic questions, such as in outbreak investigations and in assessing the global dissemination of strains, respectively. This is done primarily by examining the extent of genetic diversity of clinical strains of Mycobacterium tuberculosis. When molecular methods are used in conjunction with classical epidemiology, their utility for TB control has been realized. For instance, molecular epidemiologic studies have added much-needed accuracy and precision in describing transmission dynamics, and they have facilitated investigation of previously unresolved issues, such as estimates of recent-versus-reactive disease and the extent of exogenous reinfection. In addition, there is mounting evidence to suggest that specific strains of M. tuberculosis belonging to discrete phylogenetic clusters (lineages) may differ in virulence, pathogenesis, and epidemiologic characteristics, all of which may significantly impact TB control and vaccine development strategies. Here, we review the current methods, concepts, and applications of molecular approaches used to better understand the epidemiology of TB.

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“…3 One such limitation is the inability or reluctance of persons engaged in illicit activities to name their contacts. [4][5][6] In the spring of 2005, TB control staff in Miami-Dade County detected a cluster of cases with Mycobacterium tuberculosis isolates resistant to isoniazid and with matching spacer oligonucleotide (spoligotype) polymerase chain reaction results. Many of these patients were HIV-infected, and nearly all used rock cocaine (crack) and lived in low-income neighborhoods in Miami.…”

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confidence: 99%

Limited Utility of Name-Based Tuberculosis Contact Investigations among Persons Using Illicit Drugs: Results of an Outbreak Investigation

et al. 2009

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Persons named by a patient with tuberculosis (TB) are the focus of traditional TB contact investigations. However, patients who use illicit drugs are often reluctant to name contacts. Between January 2004 and May 2005, 18 isoniazidresistant TB cases with matching Mycobacterium tuberculosis genotypes (spoligotypes) were reported in Miami; most patients frequented crack houses and did not name potentially infected contacts. We reviewed medical records and reinterviewed patients about contacts and locations frequented to describe transmission patterns and make recommendations to control TB in this population. Observed contacts were not named but were encountered at the same crack houses as the patients. Contacts were evaluated for latent TB infection with a tuberculosis skin test (TST). All 18 patients had pulmonary TB. Twelve (67%) reported crack use and 14 (78%) any illicit drug use. Of the 187 contacts evaluated, 91 (49%) were named, 16 (8%) attended a church reported by a patient, 61 (33%) used a dialysis center reported by a patient, and 19 (10%) were observed contacts at local crack houses. Compared to named contacts, observed contacts were eight times as likely to have positive TST results (relative risk=7.8; 95% confidence interval=3.8-16.1). Dialysis center and church contacts had no elevated risk of a positive TST result. Testing observed contacts may provide a higher yield than traditional name-based contact investigations for tuberculosis patients who use illicit drugs or frequent venues characterized by illicit drug use.

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Unsuspected Recent Transmission of Tuberculosis among High-Risk Groups: Implications of Universal Tuberculosis Genotyping in Its Detection

Cited by 50 publications

References 30 publications

Tuberculosis contact investigation in low prevalence countries: a European consensus

Tuberculosis contact investigation in low prevalence countries: a European consensus

Molecular Epidemiology of Tuberculosis: Current Insights

Limited Utility of Name-Based Tuberculosis Contact Investigations among Persons Using Illicit Drugs: Results of an Outbreak Investigation

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