title: Public health response to a multidrug-resistant tuberculosis outbreak among Guatemalans in Tennessee, 2007.
abstract: BACKGROUND
  In June 2007, the Tennessee Department of Health notified the Centers for Disease Control and Prevention of four multidrug-resistant tuberculosis (MDR TB) cases in individuals of Guatemalan descent, and requested onsite epidemiologic assistance to investigate this outbreak.
  
  
  METHODS
  A case was defined as either culture-confirmed MDR TB with a drug-susceptibility pattern closely resembling that of the index case, or a clinical diagnosis of active TB disease and corroborated contact with a person with culture-confirmed MDR TB. Medical records were reviewed, and patients and their contacts were interviewed.
  
  
  RESULTS
  Five secondary TB cases were associated with the index case. Of 369 contacts of the index case, 189 (51%) were evaluated. Of those, 97 (51%) had positive tuberculin skin test (TST) results, 79 (81%) began therapy for latent TB infection (LTBI), and 38 (48%) completed LTBI therapy.
  
  
  CONCLUSIONS
  Despite consistent follow up by public health officials, a low proportion of patients diagnosed with LTBI completed therapy. Clinicians and public health practitioners who serve immigrant communities should be vigilant for MDR TB.
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Roque
authors.initials: R
authors.lastname: Miramontes
authors.forename: Lauren
authors.initials: L
authors.lastname: Lambert
authors.forename: Maryam B
authors.initials: MB
authors.lastname: Haddad
authors.forename: Valerie
authors.initials: V
authors.lastname: Boaz
authors.forename: Stephen
authors.initials: S
authors.lastname: Hawkins
authors.forename: Margaret
authors.initials: M
authors.lastname: Zylstra
authors.forename: Rachel
authors.initials: R
authors.lastname: Allen
authors.forename: Sheliah
authors.initials: S
authors.lastname: Rivers
authors.forename: Brenda
authors.initials: B
authors.lastname: Ali
authors.forename: Sarah Stuart
authors.initials: SS
authors.lastname: Chewning
authors.forename: Erin
authors.initials: E
authors.lastname: Holt
authors.forename: Jon
authors.initials: J
authors.lastname: Warkentin
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002487:Centers for Disease Control and Prevention, U.S.; D057210:Delayed Diagnosis; D023801:Directly Observed Therapy; D004196:Disease Outbreaks; D054242:Emigrants and Immigrants; D005260:Female; D006166:Guatemala / Q000208:ethnology; D006801:Humans; D055985:Latent Tuberculosis / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011635:Public Health Administration; D013714:Tennessee / Q000453:epidemiology; D014374:Tuberculin Test; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D014481:United States
chemical_list: D000995:Antitubercular Agents