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Free Content A multi-state outbreak of tuberculosis among members of a highly mobile social network: implications for tuberculosis elimination

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SETTING: Baltimore, Maryland.

OBJECTIVE: To describe a tuberculosis (TB) outbreak among a highly mobile population and the efforts required to control it.

DESIGN: Epidemiologic outbreak investigation.

RESULTS: Between June 1998 and January 2000, 20 TB outbreak cases were identified, of which 18 were culture-confirmed. Seventeen isolates of Mycobacterium tuberculosis had an identical 11-band DNA fingerprint; another isolate had one additional band and was considered a match. Two cases were diagnosed in New York City; another patient lived primarily in Atlanta, but was diagnosed in Baltimore. Persons in the outbreak were predominantly young (median age 24 years), black, male, infected with the human immunodeficiency virus (HIV), and gay, transvestite or transsexual. Activities common among many TB cases included attending two nightclubs, membership in one of three social ‘Houses’, attending balls or pageants in East Coast cities, marijuana use, and prostitution. Community outreach, extended contact tracing, DNA fingerprinting, directly-observed therapy, and expanded use of preventive therapy were utilized to assess and control the outbreak. During the outbreak period the Baltimore City TB rate declined by 10%. However, additional public health personnel were required to control the outbreak, resulting in a 17% increase in TB clinic staff.

CONCLUSION: As TB rates decline, remaining cases are likely to occur in difficult-to-reach populations. Increased resources per case of TB treated will be required to eliminate TB.
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Keywords: AIDS; DNA fingerprinting; HIV-1; epidemiology; molecular; restriction fragment length polymorphism; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Baltimore City Health Department Eastern Chest Clinic, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 2: Centers for Disease Control and Prevention, Atlanta, Georgia, USA 3: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 4: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; and Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA 5: Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA

Publication date: 2000-11-01

More about this publication?
  • 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.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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