M. tuberculosis with Developing Drug Resistance | CDC EID

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Volume 17, Number 3–March 2011
Research
Mycobacterium tuberculosis Cluster with Developing Drug Resistance, New York, New York, USA, 2003–2009
Bianca R. Perri, Douglas Proops, Patrick K. Moonan, Sonal S. Munsiff, Barry N. Kreiswirth, Natalia Kurepina, Christopher Goranson, and Shama D. Ahuja

Author affiliations: New York City Department of Health and Mental Hygiene, New York, New York, USA (B.R. Perri, D. Proops, S.S. Munsiff, C. Goranson, S.D. Ahuja); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (B.R. Perri, P.K. Moonan, S.S. Munsiff); and Public Health Research Institute Tuberculosis Center, Newark, New Jersey, USA (B.N. Kreiswirth, N. Kurepina)

Suggested citation for this article

Abstract
In 2004, identification of patients infected with the same Mycobacterium tuberculosis strain in New York, New York, USA, resulted in an outbreak investigation. The investigation involved data collection and analysis, establishing links between patients, and forming transmission hypotheses. Fifty-four geographically clustered cases were identified during 2003–2009. Initially, the M. tuberculosis strain was drug susceptible. However, in 2006, isoniazid resistance emerged, resulting in isoniazid-resistant M. tuberculosis among 17 (31%) patients. Compared with patients with drug-susceptible M. tuberculosis, a greater proportion of patients with isoniazid-resistant M. tuberculosis were US born and had a history of illegal drug use. No patients named one another as contacts. We used patient photographs to identify links between patients. Three links were associated with drug use among patients infected with isoniazid-resistant M. tuberculosis. The photographic method would have been more successful if used earlier in the investigation. Name-based contact investigation might not identify all contacts, particularly when illegal drug use is involved.

Name-based contact investigation is a core tuberculosis (TB) control method, yet its limitations are documented (1–9). Although name-based contact investigations can elucidate TB transmission chains, these investigations are typically limited to household and other close contacts (10,11). Molecular characterization of Mycobacterium tuberculosis (i.e., TB genotyping), when combined with contact investigation, can increase screening yield and identify transmission venues, particularly among populations at high risk (e.g., substance users, immigrants, and other hard-to-reach populations) (2–5,12,13).

Since 2001, the New York City (NYC) Bureau of Tuberculosis Control (BTBC), new York, New York, USA, has conducted universal genotyping and used results to detect and investigate clusters of TB with suspected recent transmission (14). One cluster, first identified and characterized in NYC in 2004, was the focus of an extensive epidemiologic investigation. We describe the investigation and discuss novel methods used during the investigation to understand TB transmission.

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M. tuberculosis with Developing Drug Resistance | CDC EID


Suggested Citation for this Article
Perri BR, Proops D, Moonan PK, Munsiff SS, Kreiswirth BN, Kurepina N, et al. Mycobacterium tuberculosis cluster with developing drug resistance, New York, New York, USA, 2003–2009. Emerg Infect Dis [serial on the Internet]. 2011 Mar [date cited].
http://www.cdc.gov/EID/content/17/3/372.htm

DOI: 10.3201/eid1703.101002


Comments to the Authors
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Bianca R. Perri, Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, 225 Broadway, 22nd Floor, CN-72B, New York, NY 10007, USA; email: bperri@health.nyc.gov