title: Using routinely reported tuberculosis genotyping and surveillance data to predict tuberculosis outbreaks.
abstract: We combined routinely reported tuberculosis (TB) patient characteristics with genotyping data and measures of geospatial concentration to predict which small clusters (i.e., consisting of only 3 TB patients) in the United States were most likely to become outbreaks of at least 6 TB cases. Of 146 clusters analyzed, 16 (11.0%) grew into outbreaks. Clusters most likely to become outbreaks were those in which at least 1 of the first 3 patients reported homelessness or excess alcohol or illicit drug use or was incarcerated at the time of TB diagnosis and in which the cluster grew rapidly (i.e., the third case was diagnosed within 5.3 months of the first case). Of 17 clusters with these characteristics and therefore considered high risk, 9 (53%) became outbreaks. This retrospective cohort analysis of clusters in the United States suggests that routinely reported data may identify small clusters that are likely to become outbreaks and which are therefore candidates for intensified contact investigations.
authors.affiliation: Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, Georgia, United States of America. Salthomsons@cdc.gov
authors.forename: Sandy P
authors.initials: SP
authors.lastname: Althomsons
authors.forename: J Steven
authors.initials: JS
authors.lastname: Kammerer
authors.forename: Nong
authors.initials: N
authors.lastname: Shang
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Navin
mesh_terms: D000428:Alcohol Drinking; D003663:Decision Trees; D004196:Disease Outbreaks; D055030:Drug Users; D005544:Forecasting; D005838:Genotype; D006703:Ill-Housed Persons; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D011330:Prisons; D012189:Retrospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000635:transmission; D014481:United States