title: An outbreak of Mycobacterium tuberculosis infection associated with acupuncture in a private clinic of Zhejiang Province, China, 2012.
abstract: BACKGROUND
  Acupuncture carries the potential risk of transmission of pathogenic microorganisms from the environment to the patient, and from one patient to another. An outbreak of tuberculosis at a private clinic in eastern China was investigated to identify the source of infection, mode of transmission, and risk factors for infection.
  
  
  METHODS
  A probable case was one who had the onset of unexplained pain, swelling, or abscess in the area of invasive treatment between January 1, 2011 and February 23, 2012. A confirmed case was a probable case with positive laboratory test results for Mycobacterium tuberculosis. Patient history and the frequency of invasive treatment were compared between 56 probable and confirmed cases and 98 controls in a case-control study.
  
  
  RESULTS
  Fifty-six of 2561 patients (2.2%) who had visited the clinic developed tuberculosis. The odds ratio (OR) of M. tuberculosis infection increased with the frequency of clinic visits (Chi-square for trend=28.943, p=0.000). Multivariate analysis showed that the frequency of acupuncture (Chi-square=24.258, adjusted p-value=0.000) and sharing acupuncture needles (Chi-square=8.936, adjusted p-value=0.003) were risk factors for M. tuberculosis infection. Thirty-two pus sample and nine sputum sample cultures were M. tuberculosis-positive.
  
  
  CONCLUSIONS
  This outbreak was caused by acupuncture and was transmitted through sharing acupuncture needles contaminated with M. tuberculosis.
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, 310051, Zhejiang Province, People's Republic of China.
authors.forename: Fan
authors.initials: F
authors.lastname: He
authors.affiliation: Yongjia Center for Disease Control and Prevention, Yongjia, Zhejiang Province, People's Republic of China.
authors.forename: Deyi
authors.initials: D
authors.lastname: Hu
authors.affiliation: Wenzhou Center for Disease Control and Prevention, Wenzhou, Zhejiang Province, People's Republic of China.
authors.forename: Xianghua
authors.initials: X
authors.lastname: Yu
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, 310051, Zhejiang Province, People's Republic of China.
authors.forename: Fudong
authors.initials: F
authors.lastname: Li
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, 310051, Zhejiang Province, People's Republic of China.
authors.forename: Enfu
authors.initials: E
authors.lastname: Chen
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, 310051, Zhejiang Province, People's Republic of China.
authors.forename: Xinyi
authors.initials: X
authors.lastname: Wang
authors.affiliation: Yongjia Center for Disease Control and Prevention, Yongjia, Zhejiang Province, People's Republic of China.
authors.forename: Dakun
authors.initials: D
authors.lastname: Huang
authors.affiliation: Yongjia Center for Disease Control and Prevention, Yongjia, Zhejiang Province, People's Republic of China.
authors.forename: Zhongyi
authors.initials: Z
authors.lastname: Lin
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, 310051, Zhejiang Province, People's Republic of China. Electronic address: zjlinjunfen@163.com.
authors.forename: Junfen
authors.initials: J
authors.lastname: Lin
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000209:etiology
keywords: Acupuncture; Case–control study; Mycobacterium tuberculosis; Outbreak