Background
Tuberculosis (TB) transmission in nontraditional settings and relationships (non-TSR)
often eludes detection by conventional contact investigation and is increasingly common.
The U.S.-based National Tuberculosis Genotyping and Surveillance Network collected
epidemiologic data and genotyping results of Mycobacterium tuberculosis isolates from 1996 to 2000.
Methods
In 2003–2004, we determined the number and characteristics of TB patients in non-TSR
that were involved in recent transmission, generated a decision tree to profile those
patients, and performed a case-control study to identify predictors of being in non-TSR.
Results
Of 10,844 culture-positive reported TB cases that were genotyped, 4724 (43.6%) M. tuberculosis isolates were clustered with at least one other isolate. Among these, 520 (11%) had
epidemiologic linkages discovered during conventional contact investigation or cluster
investigation and confirmed by genotyping results. The decision tree identified race/ethnicity
(non-Hispanic white or black) as having the greatest predictive ability to determine
patients in non-TSR, followed by being aged 15 to 24 years and having positive or
unknown HIV infection status. From the 520, 85 (16.4%) had non-TSR, and 435 (83.6%)
had traditional settings and relationships (TSR). In multivariate analyses, patients
in non-TSR were significantly more likely than those in TSR to be non-Hispanic white
(adjusted odds ratio [aOR]=6.1; 95% confidence interval [CI]=1.7–21.1]) or to have
an M. tuberculosis isolate resistant to rifampin (aOR=5.2; 95% CI=1.5–17.7).
Conclusions
Decision-tree analyses can be used to enhance both the efficiency and effectiveness
of TB prevention and control activities in identifying patients in non-TSR.
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References
- Transmission of Mycobacterium tuberculosis through casual contact with an infectious case.Arch Intern Med. 2001; 161: 2254-2258
- Transmission dynamics of tuberculosis in Tarrant County, Texas.Am J Respir Crit Care Med. 2002; 166: 36-42
- Molecular epidemiology of tuberculosis in a low- to moderate-incidence state.Emerg Infect Dis. 2002; 8: 1271-1279
- Restriction fragment length polymorphism analysis detecting a community-based tuberculosis outbreak among persons infected with human immunodeficiency virus.J Infec Dis. 1994; 169: 189-192
- Outcomes of contact investigations of infectious tuberculosis patients.Am J Respir Crit Care Med. 2000; 162: 2033-2038
- Outbreak of tuberculosis associated with a floating card game in the rural south.Clin Infect Dis. 1998; 27: 1221-1226
- The added epidemiologic value to tuberculosis prevention and control of the investigation of clustered genotypes of Mycobacterium tuberculosis isolates.Am J Epidemiol. 2004; 160: 589-597
- Rationale and methods for the National Tuberculosis Genotyping and Surveillance Network.Emerg Infect Dis. 2002; 8: 1188-1191
- Molecular epidemiology of tuberculosis in a sentinel surveillance population.Emerg Infect Dis. 2002; 8: 1197-1209
- A decision tree for tuberculosis contact investigation.Am J Respir Crit Care Med. 2002; 166: 1122-1127
- Classification and regression trees. Wadsworth International Group, Belmont, CA1984
- National Tuberculosis Genotyping and Surveillance Network.Emerg Infect Dis. 2002; 8: 1192-1196
- The epidemiology of tuberculosis in San Francisco.N Engl J Med. 1994; 330: 1703-1709
- Contact investigations.Am J Respir Crit Care Med. 2002; 166 (Editorial): 1016-1017
- DNA fingerprinting and contact investigation.Int J Tuberc Lung Dis. 2000; 4: S45-48
- DNA fingerprinting of Mycobacterium tuberculosis isolates from epidemiologically linked case pairs.Emerg Infect Dis. 2002; 8: 1224-1229
- Proportion of tuberculosis transmission that takes place in households in a high-incidence area.Lancet. 2004; 363: 212-214
- Validity of a decision tree for predicting active pulmonary tuberculosis.Am J Respir Crit Care Med. 1997; 155: 1711-1716
- A decision tree for the early diagnosis of acute myocardial infarction in nontraumatic chest pain patients at hospital admission.Chest. 1995; 108: 1502-1509
- Tuberculosis contact investigation and DNA fingerprint surveillance in the Netherlands.Int J Tuberc Lung Dis. 2003; 7: S463-470
- Molecular epidemiology of tuberculosis.N Engl J Med. 2003; 349 (Letter): 2364
- A network-informed approach to investigating a tuberculosis outbreak.Int J Tuberc Lung Dis. 2003; 7: S486-493
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© 2005 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
