This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Weis, S. E. Articles by Barnes, P. F. Search for Related Content PubMed PubMed Citation Articles by Weis, S. E. Articles by Barnes, P. F.

Transmission Dynamics of Tuberculosis in Tarrant County, Texas

Division of Public Health, Department of Medicine, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas; Statology, Rocklin, California; Departments of Medicine and Anatomy, University of Arkansas for Medical Sciences and Medical Research Service, McClellan Memorial Veterans Hospital, Little Rock, Arkansas; Tuberculosis Control Program, Texas Department of Health, and Center for Pulmonary and Infectious Disease Control, Departments of Medicine, Microbiology, and Immunology, University of Texas Health Center, Tyler, Texas

Correspondence and requests for reprints should be addressed to Stephen E. Weis, D.O., University of North Texas Health Science Center, Patient Care Center, 855 Montgomery Street, Fort Worth, TX 76107. E-mail: sweis{at}hsc.unt.edu

To understand the transmission dynamics of tuberculosis in Tarrant County, Texas, we performed a population-based study of 159 patients with culture-proven tuberculosis, combining restriction fragment length polymorphism (RFLP) analysis of Mycobacterium tuberculosis isolates with prospective interviewing to identify epidemiologic links between patients. Patients whose isolates had identical or closely related RFLP patterns were considered a cluster. Seventy-six (48%) of 159 patients were in 19 clusters, suggesting that recent transmission accounted for 36% of tuberculosis morbidity. Unconditional logistic regression showed that birth in the United States, continuous residence in Tarrant County, a history of homelessness, and a history of visiting or working in bars were independent predictors of clustering. Four homeless shelters and five bars were associated with specific clusters, suggesting that they were sites of tuberculosis transmission. Patients in some clusters recognized more photographs of patients in their cluster than did patients outside their cluster. We conclude that (1) homeless shelters and bars are important sites of tuberculosis transmission in Tarrant County, and (2) the use of photograph recognition of patients with tuberculosis, in combination with RFLP analysis, has the potential to enhance tuberculosis control by facilitating identification of epidemiologic links between patients.

Key Words: epidemiology • homeless • restriction fragment length polymorphism • tuberculosis • transmission • urban

This article has been cited by other articles:

				M. Brimacombe, M. Hazbon, A. S. Motiwala, and D. Alland Antibiotic Resistance and Single-Nucleotide Polymorphism Cluster Grouping Type in a Multinational Sample of Resistant Mycobacterium tuberculosis Isolates Antimicrob. Agents Chemother., November 1, 2007; 51(11): 4157 - 4159. [Abstract] [Full Text] [PDF]

				R. Reves Universal Genotyping as a Tool for Establishing Successful Partnerships for Tuberculosis Elimination Am. J. Respir. Crit. Care Med., September 1, 2006; 174(5): 491 - 492. [Full Text] [PDF]

				M. H. Hazbon, M. Brimacombe, M. Bobadilla del Valle, M. Cavatore, M. I. Guerrero, M. Varma-Basil, H. Billman-Jacobe, C. Lavender, J. Fyfe, L. Garcia-Garcia, et al. Population Genetics Study of Isoniazid Resistance Mutations and Evolution of Multidrug-Resistant Mycobacterium tuberculosis. Antimicrob. Agents Chemother., August 1, 2006; 50(8): 2640 - 2649. [Abstract] [Full Text] [PDF]

				C. R. Driver, M. Macaraig, P. D. McElroy, C. Clark, S. S. Munsiff, B. Kreiswirth, J. Driscoll, and B. Zhao Which Patients' Factors Predict the Rate of Growth of Mycobacterium tuberculosis Clusters in an Urban Community? Am. J. Epidemiol., July 1, 2006; 164(1): 21 - 31. [Abstract] [Full Text] [PDF]

				American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Controlling Tuberculosis in the United States Am. J. Respir. Crit. Care Med., November 1, 2005; 172(9): 1169 - 1227. [Full Text] [PDF]

				S. H. Wootton, B. E. Gonzalez, R. Pawlak, L. D. Teeter, K. C. Smith, J. M. Musser, J. R. Starke, and E. A. Graviss Epidemiology of Pediatric Tuberculosis Using Traditional and Molecular Techniques: Houston, Texas Pediatrics, November 1, 2005; 116(5): 1141 - 1147. [Abstract] [Full Text] [PDF]

				M. H. Hazbon, M. Bobadilla del Valle, M. I. Guerrero, M. Varma-Basil, I. Filliol, M. Cavatore, R. Colangeli, H. Safi, H. Billman-Jacobe, C. Lavender, et al. Role of embB Codon 306 Mutations in Mycobacterium tuberculosis Revisited: a Novel Association with Broad Drug Resistance and IS6110 Clustering Rather than Ethambutol Resistance Antimicrob. Agents Chemother., September 1, 2005; 49(9): 3794 - 3802. [Abstract] [Full Text] [PDF]

				H. van Deutekom, P. Supply, P. E. W. de Haas, E. Willery, S. P. Hoijng, C. Locht, R. A. Coutinho, and D. van Soolingen Molecular Typing of Mycobacterium tuberculosis by Mycobacterial Interspersed Repetitive Unit-Variable-Number Tandem Repeat Analysis, a More Accurate Method for Identifying Epidemiological Links between Patients with Tuberculosis J. Clin. Microbiol., September 1, 2005; 43(9): 4473 - 4479. [Abstract] [Full Text] [PDF]

				M.-C. Kempf, N. E. Dunlap, K. H. Lok, W. H. Benjamin Jr., N. B. Keenan, and M. E. Kimerling Long-Term Molecular Analysis of Tuberculosis Strains in Alabama, a State Characterized by a Largely Indigenous, Low-Risk Population J. Clin. Microbiol., February 1, 2005; 43(2): 870 - 878. [Abstract] [Full Text] [PDF]

				L. Richeldi, K. Ewer, M. Losi, B. M. Bergamini, P. Roversi, J. Deeks, L. M. Fabbri, and A. Lalvani T Cell-Based Tracking of Multidrug Resistant Tuberculosis Infection after Brief Exposure Am. J. Respir. Crit. Care Med., August 1, 2004; 170(3): 288 - 295. [Abstract] [Full Text] [PDF]

				H. van Deutekom, S. P. Hoijng, P. E. W. de Haas, M. W. Langendam, A. Horsman, D. van Soolingen, and R. A. Coutinho Clustered Tuberculosis Cases: Do They Represent Recent Transmission and Can They Be Detected Earlier? Am. J. Respir. Crit. Care Med., April 1, 2004; 169(7): 806 - 810. [Abstract] [Full Text] [PDF]

				D. Nguyen, J.-F. Proulx, J. Westley, L. Thibert, S. Dery, and M. A. Behr Tuberculosis in the Inuit Community of Quebec, Canada Am. J. Respir. Crit. Care Med., December 1, 2003; 168(11): 1353 - 1357. [Abstract] [Full Text] [PDF]

				A. A Vernon and M S. McNabb Commentary: Can capture-recapture analysis of epidemiological and molecular data help us understand recent tuberculosis transmission? Int. J. Epidemiol., October 1, 2003; 32(5): 770 - 771. [Full Text] [PDF]

				P. F. Barnes and M. D. Cave Molecular Epidemiology of Tuberculosis N. Engl. J. Med., September 18, 2003; 349(12): 1149 - 1156. [Full Text] [PDF]

				M. J. Tobin Tuberculosis, Lung Infections, Interstitial Lung Disease, and Journalology in AJRCCM 2002 Am. J. Respir. Crit. Care Med., February 1, 2003; 167(3): 345 - 355. [Full Text] [PDF]

				S. Weis Contact Investigations: How Do They Need to Be Designed for the 21st Century? Am. J. Respir. Crit. Care Med., October 15, 2002; 166(8): 1016 - 1017. [Full Text] [PDF]