TY - JOUR
T1 - Transmission of multidrug-resistant tuberculosis in the USA
T2 - A cross-sectional study
AU - Moonan, Patrick K.
AU - Teeter, Larry D.
AU - Salcedo, Katya
AU - Ghosh, Smita
AU - Ahuja, Shama D.
AU - Flood, Jennifer
AU - Graviss, Edward A.
N1 - Funding Information:
This study was funded by the CDC. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the CDC. We thank Melissa Valdez for her early work in the organisation and management of logistical aspects of protocol development and initial enrolment; the TBESC sites that participated in data collection, health-record abstraction, and interviews with patients (California Department of Public Health: Ed Desmond, Dayani Nualles, Peter Oh, Alicia Rodriguez, Lisa Pascopella; Denver Public Health and Hospitals Authority: Kirsten Wall, Randall Reves; Maryland Department of Health and Mental Hygiene: Wendy Cronin, Heather Rutz; Massachusetts Department of Public Health: Sue Etkind, C Robert Horsburgh Jr, Sharon Sharnprapai; New York City Department of Health and Mental Hygiene: Holly Anger, Bianca Perri; New York State Department of Health, Health Research: Wilson P Miranda, Stephen Hughes, Margaret J Oxtoby; Tennessee State Health Department: Tamara Chavez-Lindell, Fernanda Maururi, Jon Warkentin; Texas Department of State Health Services: Denise Dunbar, Nicole Evert, Ken Jost Jr, Charles Wallace, Pandora Williams, Frank Valdez; Seattle-King County Department of Public Health: Masa Narita, Jenny Pang; University of North Texas Health Science Center at Fort Worth: Gerry Drewyer, Thad Miller, Guadalupe Munguia, Le Turk, Stephen Weis); staff from the National Tuberculosis Genotyping Service contract laboratories, local and state public health laboratories, and local and state health departments who collected data included in these analyses; Barbara Seaworth and John Oeltmann for critically reading and commenting on the draft report; and Kashef Ijaz and Thomas Navin for contributions to the analytical approach.
PY - 2013/9
Y1 - 2013/9
N2 - Background: Multidrug-resistant (MDR) tuberculosis is a potential threat to tuberculosis elimination, but the extent of MDR tuberculosis disease in the USA that is attributable to transmission within the country is unknown. We assessed transmission of MDR tuberculosis and potential contributing factors in the USA. Methods: In a cross-sectional study, clinical, demographic, epidemiological, and Mycobacterium tuberculosis genotype data were obtained during routine surveillance of all verified cases of MDR tuberculosis reported from eight states in the USA (California from Jan 1, 2007, to Dec 31, 2009; Texas from Jan 1, 2007, to March 31, 2009; and the states of Colorado, Maryland, Massachusetts, New York, Tennessee, and Washington from Jan 1, 2007 to Dec 31, 2008). In-depth interviews and health-record abstraction were done for all who consented to ascertain potential interpersonal connections. Findings: 168 cases of MDR tuberculosis were reported in the eight states during our study period. 92 individuals (55%) consented to in-depth interview. 20 (22%) of these individuals developed MDR tuberculosis as a result of transmission in the USA; a source case was identified for eight of them (9%). 20 individuals (22%) had imported active tuberculosis (ie, culture-confirmed disease within 3 months of entry into the USA). 38 (41%) were deemed to have reactivation of disease, of whom 14 (15%) had a known previous episode of tuberculosis outside the USA. Five individuals (5%) had documented treatment of a previous episode in the USA, and so were deemed to have relapsed. For nine cases (10%), insufficient evidence was available to definitively classify reason for presentation. Interpretation: About a fifth of cases of MDR tuberculosis in the USA can be linked to transmission within the country. Many individuals acquire MDR tuberculosis before entry into the USA. MDR tuberculosis needs to be diagnosed rapidly to reduce potential infectious periods, and clinicians should consider latent tuberculosis infection treatment-tailored to the results of drug susceptibility testing of the putative source case-for exposed individuals.
AB - Background: Multidrug-resistant (MDR) tuberculosis is a potential threat to tuberculosis elimination, but the extent of MDR tuberculosis disease in the USA that is attributable to transmission within the country is unknown. We assessed transmission of MDR tuberculosis and potential contributing factors in the USA. Methods: In a cross-sectional study, clinical, demographic, epidemiological, and Mycobacterium tuberculosis genotype data were obtained during routine surveillance of all verified cases of MDR tuberculosis reported from eight states in the USA (California from Jan 1, 2007, to Dec 31, 2009; Texas from Jan 1, 2007, to March 31, 2009; and the states of Colorado, Maryland, Massachusetts, New York, Tennessee, and Washington from Jan 1, 2007 to Dec 31, 2008). In-depth interviews and health-record abstraction were done for all who consented to ascertain potential interpersonal connections. Findings: 168 cases of MDR tuberculosis were reported in the eight states during our study period. 92 individuals (55%) consented to in-depth interview. 20 (22%) of these individuals developed MDR tuberculosis as a result of transmission in the USA; a source case was identified for eight of them (9%). 20 individuals (22%) had imported active tuberculosis (ie, culture-confirmed disease within 3 months of entry into the USA). 38 (41%) were deemed to have reactivation of disease, of whom 14 (15%) had a known previous episode of tuberculosis outside the USA. Five individuals (5%) had documented treatment of a previous episode in the USA, and so were deemed to have relapsed. For nine cases (10%), insufficient evidence was available to definitively classify reason for presentation. Interpretation: About a fifth of cases of MDR tuberculosis in the USA can be linked to transmission within the country. Many individuals acquire MDR tuberculosis before entry into the USA. MDR tuberculosis needs to be diagnosed rapidly to reduce potential infectious periods, and clinicians should consider latent tuberculosis infection treatment-tailored to the results of drug susceptibility testing of the putative source case-for exposed individuals.
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U2 - 10.1016/S1473-3099(13)70128-2
DO - 10.1016/S1473-3099(13)70128-2
M3 - Article
C2 - 23759447
AN - SCOPUS:84882581160
VL - 13
SP - 777
EP - 784
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
SN - 1473-3099
IS - 9
ER -