Authors: A.B. Curtis¹; R. Ridzon²; L.F. Novick³; J. Driscoll⁴; D. Blair³; M. Oxtoby⁵; M. McGarry⁴; B. Hiscox⁶; C. Faulkner⁶; H. Taber⁴; S. Valway²; I.M. Onorato²

Source: The International Journal of Tuberculosis and Lung Disease, Volume 4, Number 4, April 2000 , pp. 308-313(6)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: From July 1997 through May 1998, ten tuberculosis (TB) cases were reported among men in a Syracuse New York homeless shelter for men.

OBJECTIVE AND DESIGN: Investigation to determine extent of, and prevent further, transmission of Mycobacterium tuberculosis.

RESULTS: Epidemiologic and laboratory evidence suggests that eight of the ten cases were related. Seven cases had isolates with matching six-band IS6110 DNA fingerprints; the isolate from another case had a closely related fingerprint pattern and this case was considered to be caused by a variant of the same strain. Isolates from eight cases had identical spoligotypes. The source case had extensive cavitary disease and stayed at the shelter nightly, while symptomatic, for almost 8 months before diagnosis. A contact investigation was conducted among 257 shelter users and staff, 70% of whom had a positive tuberculin skin test, including 21 with documented skin test conversions.

CONCLUSIONS: An outbreak of related TB cases in a high-risk setting was confirmed through the use of IS6110 DNA fingerprinting in conjunction with spoligotyping and epidemiologic evidence. Because of the high rate of infection in the homeless population, routine screening for TB and preventive therapy for eligible persons should be considered in shelters.

Keywords: tuberculosis; homeless; outbreak; DNA fingerprinting

Document Type: Regular paper

Affiliations: 1: Epidemic Intelligence Service, Epidemiology Program Office, Atlanta, Georgia, USA; and the Division of Tuberculosis Elimination, National Center for STD, HIV, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: Division of Tuberculosis Elimination, National Center for STD, HIV, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 3: Onondaga County Health Department, Syracuse, New York, USA 4: Wadsworth Center, New York State Department of Health, Albany, New York, USA 5: Division of Tuberculosis Elimination, National Center for STD, HIV, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and New York State Department of Health, Albany, New York, USA 6: New York State Department of Health, Albany, New York, USA

Publication date: 2000-04-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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