title: A multi-state outbreak of tuberculosis among members of a highly mobile social network: implications for tuberculosis elimination.
abstract: METHODS
  Baltimore, Maryland.
  
  
  OBJECTIVE
  To describe a tuberculosis (TB) outbreak among a highly mobile population and the efforts required to control it.
  
  
  METHODS
  Epidemiologic outbreak investigation.
  
  
  RESULTS
  Between June 1998 and January 2000, 20 TB outbreak cases were identified, of which 18 were culture-confirmed. Seventeen isolates of Mycobacterium tuberculosis had an identical 11-band DNA fingerprint; another isolate had one additional band and was considered a match. Two cases were diagnosed in New York City; another patient lived primarily in Atlanta, but was diagnosed in Baltimore. Persons in the outbreak were predominantly young (median age 24 years), black, male, infected with the human immunodeficiency virus (HIV), and gay, transvestite or transsexual. Activities common among many TB cases included attending two nightclubs, membership in one of three social 'Houses', attending balls or pageants in East Coast cities, marijuana use, and prostitution. Community outreach, extended contact tracing, DNA fingerprinting, directly-observed therapy, and expanded use of preventive therapy were utilized to assess and control the outbreak. During the outbreak period the Baltimore City TB rate declined by 10%. However, additional public health personnel were required to control the outbreak, resulting in a 17% increase in TB clinic staff.
  
  
  CONCLUSIONS
  As TB rates decline, remaining cases are likely to occur in difficult-to-reach populations. Increased resources per case of TB treated will be required to eliminate TB.
authors.affiliation: Baltimore City Health Department Eastern Chest Clinic, Baltimore, Maryland. tsterls@jhmi.edu
authors.forename: T R
authors.initials: TR
authors.lastname: Sterling
authors.forename: D
authors.initials: D
authors.lastname: Thompson
authors.forename: R L
authors.initials: RL
authors.lastname: Stanley
authors.forename: P D
authors.initials: PD
authors.lastname: McElroy
authors.forename: A
authors.initials: A
authors.lastname: Madison
authors.forename: K
authors.initials: K
authors.lastname: Moore
authors.forename: R
authors.initials: R
authors.lastname: Ridzon
authors.forename: S
authors.initials: S
authors.lastname: Harrington
authors.forename: W R
authors.initials: WR
authors.lastname: Bishai
authors.forename: R E
authors.initials: RE
authors.lastname: Chaisson
authors.forename: S
authors.initials: S
authors.lastname: Bur
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control; D000328:Adult; D002876:Chromosomes, Bacterial / Q000235:genetics; D016358:Contact Tracing; D016172:DNA Fingerprinting; D004196:Disease Outbreaks; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D009169:Mycobacterium tuberculosis / Q000235:genetics; D009518:New York / Q000453:epidemiology; D012150:Polymorphism, Restriction Fragment Length; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control