A network-informed approach to investigating a tuberculosis outbreak: implications for enhancing contact investigations
SETTING: A TB outbreak in a US low incidence state.
OBJECTIVE: To evaluate whether social network analysis can provide insights into transmission settings that might otherwise go unrecognized by routine practices.
DESIGN: All adult outbreak-associated cases (n = 19) and a convenience sample of their contacts with and without latent TB infection (LTBI) (n = 26) were re-interviewed in 2001 using a structured questionnaire. Network analysis software was used to create diagrams illustrating important persons within the outbreak network, as well as types of activities TB cases engaged in with their contacts.
RESULTS: Drug use and drug sharing were more commonly reported among cases and their infected contacts than among contacts without LTBI. TB cases central to the outbreak network used crack cocaine, uncovering the need to focus control efforts on specific sites and persons involved in illicit drug use.
CONCLUSION: Outbreaks occur even in areas with low TB incidence, frequently among groups whose drug use or other illegal activities complicate control efforts. TB programs should consider the use of network analysis as a supplement to routine contact investigations to identify unrecognized patterns of M. tuberculosis transmission.
Document Type: Regular Paper
Affiliations: 1: Surveillance and Epidemiology Branch, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA 3: Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 4: Department of Community Health, Wichita-Sedwick County, Wichita, Kansas, USA 5: Quintus-ential Solutions, Colorado Springs, Colorado, USA
Publication date: 2003-12-01
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