title: Clusters of new tuberculosis cases in North-west London: a survey from three hospitals based on IS6110 RFLP typing.
abstract: OBJECTIVE
  The relative contributions of reactivation of latent infection and clusters of new infections to the overall incidence of tuberculosis in the U.K. is unknown. A study was carried out in North-West London to determine the feasibility of IS6110 RFLP strain typing as a tool to investigate the relative contributions of these two sources.
  
  
  METHODS
  All available isolates of M. tuberculosis from specimens collected over a calendar year at three participating hospitals were typed by RFLP using an IS6110 probe. Isolates exhibiting a single band pattern were subject to further typing using an oligonucleotide direct repeat probe. Demographic and clinical information on cases was obtained from the National Survey of Tuberculosis Notifications in England and Wales and further information sought on clustered cases as identified by RFLP typing.
  
  
  RESULTS
  Twenty-seven (23%) of the 118 cases had shared IS6110 RFLP patterns. Strains from nine cases had single band patterns, but these were all distinguishable from each other when subjected to further typing by direct repeat probe. The remaining 18 cases belonged to eight clusters. Epidemiological links were established between all the patients in each cluster. The likelihood of being in a cluster was increased in cases with pulmonary smear-positive disease. It was lower in cases of Indian Sub-continent ethnic origin. For 10 of the 18 clustered cases epidemiological links had not been established by conventional contact tracing.
  
  
  CONCLUSIONS
  Investigation of the relative contributions of reactivation of latent infection and new infection is feasible in a UJK population, using IS6110 RFLP typing of M. tuberculosis isolates and epidemiological enquiries. This study in London identified clustered, presumably new cases, the majority of whom had not been linked epidemiologically. Comprehensive IS6110 RFLP typing of UK isolates would probably identify many clusters of incident tubercular infection.
authors.affiliation: PHLS Communicable Disease Surveillance Centre, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Kumar
authors.forename: N A
authors.initials: NA
authors.lastname: Saunders
authors.forename: J M
authors.initials: JM
authors.lastname: Watson
authors.forename: A M
authors.initials: AM
authors.lastname: Ridley
authors.forename: S
authors.initials: S
authors.lastname: Nicholas
authors.forename: K F
authors.initials: KF
authors.lastname: Barker
authors.forename: R
authors.initials: R
authors.lastname: Wall
authors.forename: Q N
authors.initials: QN
authors.lastname: Karim
authors.forename: S
authors.initials: S
authors.lastname: Barrett
authors.forename: R C
authors.initials: RC
authors.lastname: George
authors.forename: A C
authors.initials: AC
authors.lastname: McCartney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015373:Bacterial Typing Techniques; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D004251:DNA Transposable Elements; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D012150:Polymorphism, Restriction Fragment Length; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000208:ethnology
chemical_list: D004251:DNA Transposable Elements