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.
Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
C
C
Conover
R
R
Ridzon
S
S
Valway
L
L
Schoenstadt
J
J
McAuley
I
I
Onorato
W
W
Paul
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