Outbreak of multidrug-resistant tuberculosis at a methadone treatment program.
METHODS
An out-patient methadone treatment program MTP).


OBJECTIVE
To investigate transmission of multidrug-resistant tuberculosis (MDR-TB) in the MTP.


METHODS
Cases were defined as MTP clients or staff who developed TB between 1 January 1994 and 1 January 1996, with at least one positive culture for Mycobacterium tuberculosis resistant to isoniazid and rifampin. Contacts were identified, located and evaluated.


RESULTS
Thirteen cases of MDR-TB occurred among 462 clients and staff. One fifth (6/30) of the members of a counseling group for human immunodeficiency virus (HIV) infected clients developed MDR-TB. Individuals known to be HIV positive were at greater risk for TB than those who were HIV negative (RR 5.2, 95%CI 1.2-22.7). Of 449 clients and staff identified as contacts, 393 (87.5%) were located and screened. Among those with a negative baseline tuberculin skin test, 18.5% (56/303) were skin test converters. Attendance at the MTP during a period when the index case was infectious was associated with an increased risk of conversion (RR 2.5, 95%CI 1.1-6.0).


CONCLUSIONS
Extensive transmission of MDR-TB occurred at an out-patient MTP serving numerous clients with HIV infection. This outbreak underscores the importance of developing effective strategies to prevent TB transmission in this setting.
Conover
C
C
Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Ridzon
R
R
Valway
S
S
Schoenstadt
L
L
McAuley
J
J
Onorato
I
I
Paul
W
W
D000328:Adult; D000554:Ambulatory Care Facilities; D016009:Chi-Square Distribution; D016358:Contact Tracing; D003428:Cross Infection / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage; D009293:Opioid-Related Disorders / Q000534:rehabilitation; D012150:Polymorphism, Restriction Fragment Length; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000453:epidemiology* / Q000635:transmission
D009294:Narcotics; D008691:Methadone