Just 10 yrs ago it was still generally accepted that bacteria of the Mycobacterium tuberculosis complex were so highly conserved, that phage typing, which could distinguish about 20 different phage types, was all one needed to study the epidemiology of tuberculosis [1][2][3][4]. From the late 1980s, repetitive deoxyribonucleic acid (DNA) sequences have been described, which are associated with different levels of genetic polymorphism [5][6][7][8][9][10][11][12][13][14][15][16][17]. In 1990, the highly similar insertion sequences IS986 and IS6110 were found in the genome of M. tuberculosis [10,13,14] and, when these elements were applied in restriction fragment length polymorphism (RFLP) typing, they provided an unprecedented degree of discrimination between M. tuberculosis complex isolates. When IS986-based RFLP typing was used in 1990 to confirm for the first time a suspected outbreak of tuberculosis in the Netherlands [8], interest in the molecular epidemiology of tuberculosis was awakened.RFLP typing seemed ideal for studying small-scale transmission of M. tuberculosis, such as outbreaks in institutions, hospitals or among families [16,[18][19][20][21][22]. Within a remarkably short period of time the utility of fingerprinting for managing outbreaks was established. The RFLP typing technique was optimized and standardized to enable computer-assisted analysis of DNA fingerprints [23,24]. This facilitated large-scale epidemiological studies. However, the utility and reliability of large-scale, or even routine, application of DNA fingerprinting in tuberculosis control is still debatable and hinges on whether clustering of DNA fingerprints among patients' isolates does truly reflect transmission of M. tuberculosis. VAN DEUTEKOM et al. [29] (in Amsterdam, the Netherlands) found that only 5-10% of the links indicated by DNA fingerprinting, were also found by conventional contact tracing. Furthermore, in the molecular epidemiological study in Bern, Switzerland, conducted by GENEWEIN et al. [30] cases in totally different social groups were in the same DNA fingerprint clusters.To examine the utility of DNA fingerprinting in more detail, BRADEN et al. [31] chose another approach in the rural area of Arkansas, USA. In this study, extensive interviews with patients identified epidemiological connections for only 33 out of 78 (42%) of the clustered patients. It is unclear whether the conclusions from this study can be generalized to other (e.g. urban) populations, as it was conducted in a rural area in which a large proportion of individuals were elderly.In contrast, in the study of BURMAN et al. [32] (in Denver, USA) 40 of the 51 patients (78%) with clustered isolates had definite or possible epidemiological links identified through contact tracing.In the molecular epidemiological study in the metropolitan area of ZĂźrich, Switzerland, presented by PFYFFER et al. [33] in this issue of the Journal, a very small percentage (20%) of cases were clustered. This reflects that in an area where tuberculosis control is orga...