title: Persistence of a highly resistant strain of tuberculosis in New York City during 1990-1999.
abstract: One multidrug-resistant Mycobacterium tuberculosis (MDRTB) strain, strain W, caused several nosocomial outbreaks in New York City (NYC) during 1 January 1990-31 July 1993. We reviewed all MDRTB cases verified during 1 August 1993-31 December 1999 that had isolates with either this DNA pattern or a variant of this strain, and we compared them to the outbreak cases. Of 427 DNA-confirmed cases from 1990-1999, 161 (37%) were from 1 August 1993-31 December 1999; these 161 cases, from 56 hospitals and 2 correctional sites, constituted 28% of all MDRTB cases in NYC during this period. Compared with those from 1 January 1990-31 July 1993, patients from 1 August 1993-31 December 1999 were less likely to be infected with human immunodeficiency virus, to have been born in the United States, to be homeless, to have been incarcerated, and to have epidemiological links; 16% of patients had nosocomial- and 9% had community-exposure links. This strain was disseminated widely in the community during the outbreaks; postoutbreak cases likely represent reactivated disease among individuals infected during the outbreak periods in the community.
authors.affiliation: Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York, New York 10013, USA. smunsiff@health.nyc.gov.
authors.forename: Sonal S
authors.initials: SS
authors.lastname: Munsiff
authors.forename: Beth
authors.initials: B
authors.lastname: Nivin
authors.forename: Galit
authors.initials: G
authors.lastname: Sacajiu
authors.forename: Barun
authors.initials: B
authors.lastname: Mathema
authors.forename: Pablo
authors.initials: P
authors.lastname: Bifani
authors.forename: Barry N
authors.initials: BN
authors.lastname: Kreiswirth
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004251:DNA Transposable Elements / Q000235:genetics; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial / Q000235:genetics; D005260:Female; D014644:Genetic Variation; D006679:HIV Seropositivity / Q000150:complications; D006703:Ill-Housed Persons; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000235:genetics; D009519:New York City / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D004251:DNA Transposable Elements; D004269:DNA, Bacterial