title: Analysis of Mycobacterium tuberculosis transmission patterns in a homeless shelter outbreak.
abstract: METHODS
  From July 1997 through May 1998, ten tuberculosis (TB) cases were reported among men in a Syracuse New York homeless shelter for men.
  
  
  OBJECTIVE
  Investigation to determine extent of, and prevent further, transmission of Mycobacterium tuberculosis.
  
  
  RESULTS
  Epidemiologic and laboratory evidence suggests that eight of the ten cases were related. Seven cases had isolates with matching six-band IS6110 DNA fingerprints; the isolate from another case had a closely related fingerprint pattern and this case was considered to be caused by a variant of the same strain. Isolates from eight cases had identical spoligotypes. The source case had extensive cavitary disease and stayed at the shelter nightly, while symptomatic, for almost 8 months before diagnosis. A contact investigation was conducted among 257 shelter users and staff, 70% of whom had a positive tuberculin skin test, including 21 with documented skin test conversions.
  
  
  CONCLUSIONS
  An outbreak of related TB cases in a high-risk setting was confirmed through the use of IS6110 DNA fingerprinting in conjunction with spoligotyping and epidemiologic evidence. Because of the high rate of infection in the homeless population, routine screening for TB and preventive therapy for eligible persons should be considered in shelters.
authors.affiliation: Division of Tuberculosis Elimination, National Center for STD, HIV, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. ajc8@cdc.gov
authors.forename: A B
authors.initials: AB
authors.lastname: Curtis
authors.forename: R
authors.initials: R
authors.lastname: Ridzon
authors.forename: L F
authors.initials: LF
authors.lastname: Novick
authors.forename: J
authors.initials: J
authors.lastname: Driscoll
authors.forename: D
authors.initials: D
authors.lastname: Blair
authors.forename: M
authors.initials: M
authors.lastname: Oxtoby
authors.forename: M
authors.initials: M
authors.lastname: McGarry
authors.forename: B
authors.initials: B
authors.lastname: Hiscox
authors.forename: C
authors.initials: C
authors.lastname: Faulkner
authors.forename: H
authors.initials: H
authors.lastname: Taber
authors.forename: S
authors.initials: S
authors.lastname: Valway
authors.forename: I M
authors.initials: IM
authors.lastname: Onorato
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics*; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000150:complications; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D009518:New York / Q000453:epidemiology; D012307:Risk Factors; D012621:Seasons; D013997:Time Factors; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*
chemical_list: D004269:DNA, Bacterial