Tuberculosis Outbreak Investigations in the US, 2002-2008

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Tuberculosis Outbreak Investigations in the US, 2002-2008

Abstract and Introduction

Abstract


To understand circumstances of tuberculosis transmission that strain public health resources, we systematically reviewed Centers for Disease Control and Prevention (CDC) staff reports of US outbreaks in which CDC participated during 2002–2008 that involved ≥3 culture-confirmed tuberculosis cases linked by genotype and epidemiology. Twenty-seven outbreaks, representing 398 patients, were reviewed. Twenty-four of the 27 outbreaks involved primarily US-born patients; substance abuse was another predominant feature of outbreaks. Prolonged infectiousness because of provider- and patient-related factors was common. In 17 outbreaks, a drug house was a notable contributing factor. The most frequently documented intervention to control the outbreak was prioritizing contacts according to risk for infection and disease progression to ensure that the highest risk contacts were completely evaluated. US-born persons with reported substance abuse most strongly characterized the tuberculosis outbreaks in this review. Substance abuse remains one of the greatest challenges to controlling tuberculosis transmission in the United States.

Introduction


Among the major challenges in achieving tuberculosis (TB) elimination in the United States are preventing, detecting, and responding to TB outbreaks. Identifying high-risk settings and applying effective control measures to reduce TB transmission are basic principles of TB control. Since the 1985–1992 TB resurgence in the United States, enhanced infection control measures in health care facilities have successfully reduced nosocomial transmission and outbreaks. However, outbreaks in community settings have continued to occur, calling for increased vigilance in understanding and controlling TB transmission.

When health departments determine that they have exceeded their surge capacity to control a TB outbreak, the Centers for Disease Control and Prevention (CDC) Division of Tuberculosis Elimination may be invited to assist. During an onsite investigation lasting ≍2–3 weeks, CDC works closely with its public health partners to describe the epidemiology of the outbreak, find additional cases, identify transmission sites, prioritize contacts for screening, and implement control measures. To understand circumstances of TB transmission that tax local resources, we present an overview of US TB outbreaks during 2002–2008 for which CDC assisted in the investigation. We identified the outbreak population, outbreak contributing factors, the most common transmission sites, and interventions used to control these challenging outbreaks.

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