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Tuberculosis Outbreaks Predicted by Characteristics of First Patients in a DNA Fingerprint Cluster

¹ KNCV Tuberculosis Foundation, The Hague, The Netherlands; ² Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, The Netherlands; ³ National Mycobacteria Reference Unit, Centre for Infectious Disease Control (CIb/LIS), National Institute of Public Health and the Environment, Bilthoven, The Netherlands; and ⁴ Department of Tuberculosis Control, Municipal Health Service, Amsterdam, The Netherlands

Correspondence and requests for reprints should be addressed to Sandra V. Kik, M.Sc., KNCV Tuberculosis Foundation, P.O. Box 146, 2501 CC The Hague, The Netherlands. E-mail: kiks{at}kncvtbc.nl

Rationale: Some clusters of patients who have Mycobacterium tuberculosis isolates with identical DNA fingerprint patterns grow faster than others. It is unclear what predictors determine cluster growth.

Objectives: To assess whether the development of a tuberculosis (TB) outbreak can be predicted by the characteristics of its first two patients.

Methods: Demographic and clinical data of all culture-confirmed patients with TB in the Netherlands from 1993 through 2004 were combined with DNA fingerprint data. Clusters were restricted to cluster episodes of 2 years to only detect newly arising clusters. Characteristics of the first two patients were compared between small (2–4 cases) and large (5 or more cases) cluster episodes.

Measurements and Main Results: Of 5,454 clustered cases, 1,756 (32%) were part of a cluster episode of 2 years. Of 622 cluster episodes, 54 (9%) were large and 568 (91%) were small episodes. Independent predictors for large cluster episodes were as follows: less than 3 months' time between the diagnosis of the first two patients, one or both patients were young (<35 yr), both patients lived in an urban area, and both patients came from sub-Saharan Africa.

Conclusions: In the Netherlands, patients in new cluster episodes should be screened for these risk factors. When the risk pattern applies, targeted interventions (e.g., intensified contact investigation) should be considered to prevent further cluster expansion.

Key Words: tuberculosis • transmission • DNA fingerprinting • prediction • epidemiology

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Individual risk factors for clustering of DNA fingerprints of M. tuberculosis isolates are well known. It is currently unknown whether the development of an outbreak of tuberculosis can be predicted from patients that are assigned to the same cluster. What This Study Adds to the Field Large cluster episodes can be predicted by patient characteristics. Screening of such characteristics can thus be used as an early warning system for the detection and prevention of large tuberculosis outbreaks.

 

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