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Guide to the Application of Genotyping to Tuberculosis Prevention
and Control
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Tuberculosis Genotyping Case Studies: How TB Programs
Have Used Genotyping
Homeless Shelter Outbreak Investigation: Universal Genotyping
Can Help in the Early Identification of Outbreaks
In April 2000, staff members of Wake County Human Services in North
Carolina became concerned about a recent increase in reports of
TB in men at a Raleigh homeless shelter. An extensive investigation
lasted several months and included the screening of 620 shelter
residents and 26 employees. Initially, the investigation established
that a) an outbreak probably was occurring, b) many of the affected
persons were HIV-infected, and c) transmission probably was centered
at a single homeless shelter in Raleigh (McElroy 2003).
Subsequently, the investigators conducted a careful record review
and genotyped isolates from all 72 Wake County patients who had
culture-confirmed TB from January 1998 through April 2002. The genotyping
results showed that the outbreak-associated genotyping cluster consisted
of 25 patients. As shown in the epidemic curve, if universal genotyping
had been in place at the time this outbreak began, the outbreak
might have been recognized as early as August 1999, rather than
in April of the following year (Figure 2.2). If aggressive control
measures had been instituted in August 1999, TB in many of the 18
subsequent patients, most of whom were HIV-infected, might have
been prevented.
Figure 2.2. Epidemic curve of cases investigated
during an outbreak at a homeless shelter in North Carolina. If
universal genotyping had been available before the outbreak, it
might have been recognized as in August 1999 or even before and
subsequent cases might have been prevented (McElory 2003).
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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