Challenges and opportunities in a tuberculosis outbreak investigation in southern Mississippi, 2005-2007.
OBJECTIVE
Between December 2005 and November 2007, a cluster of 11 tuberculosis (TB) cases emerged in Jackson County, Mississippi. We investigated the potential sources of disease transmission and epidemiologic links in this cluster to prevent future transmission in the community.


METHODS
Cases of TB reported in Jackson County from December 2005 to November 2007 having matching genotypes or social links to patients with matching genotypes were included in the investigation. We interviewed patients, reviewed medical records, and performed contact investigations.


RESULTS
The combined genotyping and epidemiologic data pointed to ongoing TB transmission in this rural community. A combination of patient-specific and programmatic factors, including substance use, delays in TB diagnosis, nonadherence, and TB program staffing cuts, contributed to this outbreak in the context of the 2004 and 2005 Atlantic hurricane seasons.


CONCLUSIONS
To eliminate Mycobacterium tuberculosis transmission in this setting, recommendations for the TB program include enhanced coordination with substance abuse programs, community and provider education, and increased outreach capacity.
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Emily
E
Bloss
Kimberly
K
Newbill
Heather
H
Peto
Michael J
MJ
Rice
Gail
G
Ainsworth
Robert
R
Travnicek
Mike
M
Holcombe
Maryam B
MB
Haddad
John E
JE
Oeltmann
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D013029:Space-Time Clustering; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000635:transmission; D055815:Young Adult