Multistate Outbreak of MDR TB Identified by Genotype Cluster Investigation

Barry, Pennan M.; Gardner, Tracie J.; Funk, Elizabeth; Oren, Eyal; Field, Kim; Shaw, Tambi; Langer, Adam J.

doi:10.3201/eid1801.110671

Cited by 14 publications

(8 citation statements)

References 3 publications

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“…In several central Asian and eastern European countries, Ͼ30% of the newly diagnosed patients had MDR-TB, suggesting active transmission of primary drug-resistant strains (33). In several other countries, the primary transmission of MDR-/XDR-TB has been well documented (5,(34)(35)(36)(37). These reports showed that primary transmission played a major role in the epidemic of drug-resistant tuberculosis.…”

Section: Discussionmentioning

confidence: 78%

Evolution and Transmission Patterns of Extensively Drug-Resistant Tuberculosis in China

Wang

Shao

Fan

et al. 2015

Antimicrob Agents Chemother

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The emergence and transmission of extensively drug-resistant tuberculosis (XDR-TB) pose an increasing threat to global TB control. This study aimed to identify the patterns of evolution and transmission dynamics of XDR-TB in populations in a region of China where TB is highly endemic. We analyzed a total of 95 XDR-TB isolates collected from 2003 to 2009 in Chongqing, China. Eight drug resistance genes covering 7 drugs that define XDR-TB were amplified by PCR followed by DNA sequencing. Variable-number tandem repeat 16-locus (VNTR-16) genotyping and genotypic drug resistance profiles were used to determine the evolution or transmission patterns of XDR-TB strains. Our results indicated that the Beijing genotype was predominant (85/95 [89.5%]) in XDR-TB strains, and as many as 40.0% (38/95) of the isolates were distributed into 6 clusters based on VNTR-16 genotyping and drug resistance mutation profiles. All isolates of each cluster harbored as many as six identical resistance mutations in the drug resistance genes rpoB, katG, inhA promoter, embB, rpsL, and gidB. Among the nine cases with continuous isolates from multidrug-resistant (MDR) to XDR-TB, 4 cases represented acquired drug resistance, 4 cases were caused by transmission, and 1 case was due to exogenous superinfection. The XDR-TB epidemic in China is mainly caused by a high degree of clonal transmission, but evolution from MDR to XDR and even superinfection with a new XDR strain can also occur.

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Section: Discussionmentioning

confidence: 78%

Evolution and Transmission Patterns of Extensively Drug-Resistant Tuberculosis in China

Wang

Shao

Fan

et al. 2015

Antimicrob Agents Chemother

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“…Eight clusters (57%) had an identifiable source case, seven (50%) were characterised by abuse of illicit drugs or alcohol, two (14%) included confirmed transmission to a child, 27 and one included transmission across state lines (table 3). 8 Overall, people with MDR tuberculosis attributed to transmission in the USA were more likely to be male (p<0·0001), have been born in the USA (p<0·0001), be of Hispanic ethnic origin (p<0·0001), abuse illicit drugs or alcohol (p<0·0001), and to have an M tuberculosis isolate of Euro-American lineage (p<0·0001) than were those who had disease not attributed to transmission in the USA (table 4). 75 (82%) of the 92 individuals who had an in-depth interview and health-record abstraction were born outside the USA.…”

Section: Resultsmentioning

confidence: 99%

“…7 Person-to-person transmission of MDR tuberculosis could be further fuelled by slow bacteriological conversion, delayed diagnosis and initiation of MDRspecific treatment, and treatment failure, as suggested by widespread outbreaks and secondary transmission of MDR tuberculosis within individual households and communities. [8][9][10] Migration of foreign-born individuals from areas with a high burden of MDR tuberculosis to those with a low burden could be an important factor. [11][12][13] A multiyear study of all cases of MDR tuberculosis reported in California, USA, showed that 92% were foreign-born individuals.…”

Section: Introductionmentioning

confidence: 99%

Transmission of multidrug-resistant tuberculosis in the USA: a cross-sectional study

Moonan¹,

Teeter²,

Salcedo³

et al. 2013

The Lancet Infectious Diseases

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“…The methods were all, to some degree, based on geospatial concentration, and predictably did not identify outbreak “I” where the TB diagnoses occurred in three different states, even though M. tuberculosis transmission had occurred in a single workplace [15]. County-based LLR and SaTScan did not identify outbreak “D,” which was associated with the most common genotype in the United States, accounting for 1,077 (4.1%) of the 25,973 TB cases with a genotype result during 2008–2009.…”

Section: Discussionmentioning

confidence: 99%

Using statistical methods and genotyping to detect tuberculosis outbreaks

et al. 2013

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BackgroundEarly identification of outbreaks remains a key component in continuing to reduce the burden of infectious disease in the United States. Previous studies have applied statistical methods to detect unexpected cases of disease in space or time. The objectives of our study were to assess the ability and timeliness of three spatio-temporal methods to detect known outbreaks of tuberculosis.MethodsWe used routinely available molecular and surveillance data to retrospectively assess the effectiveness of three statistical methods in detecting tuberculosis outbreaks: county-based log-likelihood ratio, cumulative sums, and a spatial scan statistic.ResultsOur methods identified 8 of the 9 outbreaks, and 6 outbreaks would have been identified 1–52 months (median = 10 months) before local public health authorities identified them. Assuming no delays in data availability, 46 (59.7%) of the 77 patients in the 9 outbreaks were identified after our statistical methods would have detected the outbreak but before local public health authorities became aware of the problem.ConclusionsStatistical methods, when applied retrospectively to routinely collected tuberculosis data, can successfully detect known outbreaks, potentially months before local public health authorities become aware of the problem. The three methods showed similar results; no single method was clearly superior to the other two. Further study to elucidate the performance of these methods in detecting tuberculosis outbreaks will be done in a prospective analysis.

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Multistate Outbreak of MDR TB Identified by Genotype Cluster Investigation

Cited by 14 publications

References 3 publications

Evolution and Transmission Patterns of Extensively Drug-Resistant Tuberculosis in China

Evolution and Transmission Patterns of Extensively Drug-Resistant Tuberculosis in China

Transmission of multidrug-resistant tuberculosis in the USA: a cross-sectional study

Using statistical methods and genotyping to detect tuberculosis outbreaks

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