title: A clonal outbreak of tuberculosis in a homeless population in the interior of British Columbia, Canada, 2008-2015.
abstract: A tuberculosis (TB) case was reported May 2008 in Kelowna, British Columbia, leading to a multi-year outbreak in homeless persons. The epidemiological characteristics and social networks of cases are described. Outbreak-related cases were identified from epidemiological information in medical records and from genotyping of TB isolates. Social network information from case interviews were used to identify potential locations of TB transmission, where symptom screening and tuberculin skin testing was conducted. Fifty-two cases that were predominantly male (47/52), Canadian-born (44/50), and were homeless or associated with homeless individuals (42/52) were reported from May 2008 to May 2014. Many isolates (40/49) had partial resistance to isoniazid. Transmission primarily occurred at two homeless shelters, with potential further transmission at sites visited by the general population. TB outbreaks in homeless populations can occur in small, low-incidence cities. Social network information helped prioritize sites for TB screening, thereby improving detection of persons with TB disease or latent infection for treatment.
authors.affiliation: Public Health Agency of Canada,Guelph,ON,Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: Cheng
authors.affiliation: Interior Health Authority,Kelowna,BC,Canada.
authors.forename: L
authors.initials: L
authors.lastname: Hiscoe
authors.affiliation: Interior Health Authority,Kelowna,BC,Canada.
authors.forename: S L
authors.initials: SL
authors.lastname: Pollock
authors.affiliation: Vancouver Island Health Authority,Nanaimo,BC,Canada.
authors.forename: P
authors.initials: P
authors.lastname: Hasselback
authors.affiliation: School of Population and Public Health,University of British Columbia,Vancouver,BC,Canada.
authors.forename: J L
authors.initials: JL
authors.lastname: Gardy
authors.affiliation: Interior Health Authority,Kelowna,BC,Canada.
authors.forename: R
authors.initials: R
authors.lastname: Parker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D001955:British Columbia / Q000453:epidemiology; D016358:Contact Tracing; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006798:Housing; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification / Q000502:physiology; D012944:Social Support; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid
keywords: Infectious disease epidemiology; investigation; outbreaks; resistance to drugs; tuberculosis (TB)