Cross-Jurisdictional Transmission of Mycobacterium tuberculosis
Cross-Jurisdictional Transmission of Mycobacterium tuberculosis
From 1996 to 2000, 23 Maryland and Washington, D.C., tuberculosis cases were identified in one six-band DNA cluster. Cases were clustered on the basis of their Mycobacterium tuberculosis isolates. Medical record reviews and interviews were conducted to identify epidemiologic linkages. Eighteen (78%) of the 23 case-patients with identical restriction fragment length polymorphism patterns were linked to another member; half the patients were associated with a Washington, D.C., homeless shelter. Molecular epidemiology defined the extent of this large, cross-jurisdictional outbreak.
A rise in homelessness in particular and poverty in general partially accounted for the resurgence of tuberculosis (TB) in the United States from 1984 to 1992. In Maryland, as part of the National Tuberculosis Genotyping and Surveillance Network activities, population-based DNA fingerprinting of Mycobacterium tuberculosis isolates from culture-positive patients was conducted from January 1996 through December 2000. Selected Washington, D.C., isolates from TB patients with suspected or known homelessness were DNA fingerprinted as early as 1996.The Washington, D.C. TB Control staff determined suspected or known homelessness from information contained in case histories and medical records. An interjurisdictional investigation was conducted among homeless persons in Washington, D.C., and Maryland to establish epidemiologic linkages.
From 1996 to 2000, 23 Maryland and Washington, D.C., tuberculosis cases were identified in one six-band DNA cluster. Cases were clustered on the basis of their Mycobacterium tuberculosis isolates. Medical record reviews and interviews were conducted to identify epidemiologic linkages. Eighteen (78%) of the 23 case-patients with identical restriction fragment length polymorphism patterns were linked to another member; half the patients were associated with a Washington, D.C., homeless shelter. Molecular epidemiology defined the extent of this large, cross-jurisdictional outbreak.
A rise in homelessness in particular and poverty in general partially accounted for the resurgence of tuberculosis (TB) in the United States from 1984 to 1992. In Maryland, as part of the National Tuberculosis Genotyping and Surveillance Network activities, population-based DNA fingerprinting of Mycobacterium tuberculosis isolates from culture-positive patients was conducted from January 1996 through December 2000. Selected Washington, D.C., isolates from TB patients with suspected or known homelessness were DNA fingerprinted as early as 1996.The Washington, D.C. TB Control staff determined suspected or known homelessness from information contained in case histories and medical records. An interjurisdictional investigation was conducted among homeless persons in Washington, D.C., and Maryland to establish epidemiologic linkages.