title: Tuberculosis transmission and use of methamphetamines in Snohomish County, WA, 1991-2006.
abstract: OBJECTIVE
  We investigated a cluster of tuberculosis (TB) cases among persons using methamphetamines in Snohomish County, Washington, to determine the extent of the outbreak, examine whether methamphetamine use contributed to TB transmission, and implement strategies to prevent further infections.
  
  
  METHODS
  We screened contacts to find and treat persons with TB disease or infection. We then formed a multidisciplinary team to engage substance abuse services partners and implement outreach strategies including novel methods for finding contacts and a system of incentives and enablers to promote finding, screening, and treating patients with TB and their infected contacts.
  
  
  RESULTS
  We diagnosed and completed treatment with 10 persons with TB disease. Eight of 9 adult patients and 67% of their adult contacts reported using methamphetamines. Of the 372 contacts, 319 (85.8%) were screened, 80 (25.1%) were infected, 71 (88.8%) started treatment for latent infection, and 57 (80.3%) completed treatment for latent infection.
  
  
  CONCLUSIONS
  Collaborative approaches integrating TB control, outreach, incentives, and enablers resulted in high rates of treatment adherence and completion among patients and infected contacts. TB control programs should collaborate with substance abuse programs to address addiction, overcome substance abuse-related barriers to treatment, treat TB, and prevent ongoing transmission.
authors.affiliation: Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. ecp9@cdc.gov
authors.forename: Eric S
authors.initials: ES
authors.lastname: Pevzner
authors.forename: Susan
authors.initials: S
authors.lastname: Robison
authors.forename: Jenny
authors.initials: J
authors.lastname: Donovan
authors.forename: Donna
authors.initials: D
authors.lastname: Allis
authors.forename: Chris
authors.initials: C
authors.lastname: Spitters
authors.forename: Rachel
authors.initials: R
authors.lastname: Friedman
authors.forename: Kashef
authors.initials: K
authors.lastname: Ijaz
authors.forename: John E
authors.initials: JE
authors.lastname: Oeltmann
mesh_terms: D000293:Adolescent; D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D003299:Cooperative Behavior; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008403:Mass Screening; D008605:Mental Health Services / Q000458:organization & administration; D008694:Methamphetamine; D008875:Middle Aged; D045808:Refusal to Participate; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014396:Tuberculosis, Pleural / Q000517:prevention & control / Q000635:transmission*; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control / Q000635:transmission*; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
chemical_list: D008694:Methamphetamine