Published ahead of print on April 3, 2008, doi:10.1164/rccm.200708-1256OC Am. J. Respir. Crit. Care Med., Volume 178, Number 1, July 2008, 96-104 A more recent version of this article appeared on July 1, 2008
Submitted on August 24, 2007 Tuberculosis Outbreaks Predicted by Characteristics of First Patients in a DNA Fingerprint ClusterSandra V Kik1*,1 KNCV Tuberculosis Foundation, The Hague, The Netherlands; Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, The Netherlands, 2 National Mycobacteria Reference Unit, Centre for Infectious Disease Control (CIb/LIS), National Institute of Public Health and the Environment, Bilthoven, The Netherlands, 3 Department of Tuberculosis Control, Municipal Health Service, Amsterdam, The Netherlands * To whom correspondence should be addressed. E-mail: kiks{at}kncvtbc.nl.
Rationale: Some clusters of patients that have M. tuberculosis isolates with identical DNA fingerprint patterns grow faster than others. It is unclear what predictors determine cluster growth. Objective: To assess whether the development of a tuberculosis outbreak can be predicted by the characteristics of its first 2 patients. Method: Demographic and clinical data of all culture-confirmed tuberculosis patients in the Netherlands from 1993 through 2004 were combined with DNA fingerprint data. Clusters were restricted to cluster episodes of 2 years in order to only detect newly arising clusters. Characteristics of the first 2 patients were compared between small (2-4 cases) and large (5 or more cases) cluster episodes. Measurements and Main Results: Of 5454 clustered cases, 1756 (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: less than 3 months' time between the diagnosis of the first 2 patients; one or both patients was young (<35 years); 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
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