Tuberculosis Genotype Clusters and Transmission in the U.S., 2009–2018

Details

• Alternative Title:
  Am J Prev Med
• Personal Author:
  Wortham, Jonathan M. ; Li, Rongxia ; Althomsons, Sandy ; Kammerer, Steve ; Haddad, Maryam B. ; Powell, Krista M.
• Description:
  Introduction:
  
  In the U.S., universal genotyping of culture-confirmed tuberculosis cases facilitates cluster detection. Early recognition of the small clusters more likely to become outbreaks can help prioritize public health resources for immediate interventions.
  
  Methods:
  
  This study used national surveillance data reported during 2009–2018 to describe incident clusters (≥3 tuberculosis cases with matching genotypes not previously reported in the same county); data were analyzed during 2020. Cox proportional hazards regression models were used to examine patient characteristics associated with clusters doubling in size to ≥6 cases.
  
  Results:
  
  During 2009–2018, a total of 1,516 incident clusters (comprising 6,577 cases) occurred in 47 U.S. states; 231 clusters had ≥6 cases. Clusters of ≥6 cases disproportionately included patients who used substances, had recently experienced homelessness, were incarcerated, were U.S.-born, or self-identified as of American Indian or Alaska Native race or of Black race. A median of 54 months elapsed between the first and third cases in clusters that remained at 3–5 cases, compared with 9.5 months in clusters that grew to ≥6 cases. Longer time between first and third cases and presence of ≥1 patient aged ≥65 years among the first 3 cases predicted lower hazard for accumulating ≥6 cases.
  
  Conclusions:
  
  Clusters accumulating ≥3 cases within a year should be prioritized for intervention. Effective responses strategies should include plans for targeted outreach to U.S.-born individuals, incarcerated people, those experiencing homelessness, people using substances, and individuals self-identifying as of American Indian or Alaska Native race or of Black race.
  
  
• Subjects:
  Article Disease Outbreaks Genotype Homeless Persons Humans Tuberculosis United States
• Source:
  Am J Prev Med. 61(2):201-208
• Pubmed ID:
  33992497
• Pubmed Central ID:
  PMC9254502
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  61
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:402598b7d2592a365318e27302cae47dbf1200aa0090a5efc88ad264300a1600
• Download URL:
  https://stacks.cdc.gov/view/cdc/119348/cdc_119348_DS1.pdf
• File Type:
  [PDF - 539.87 KB ]