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Use of DNA fingerprinting in international source case finding during a large outbreak of tuberculosis in The Netherlands

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Setting: Tuberculosis outbreak in a low prevalence country.

Objective: Description of an international source tracing process in which restriction fragment length polymorphism (RFLP) analysis played an essential role.

Design: In 1993 a large scale source tracing process was initiated in Harlingen, a harbour town in the north of The Netherlands, after a child with tuberculous meningitis was reported for which no source could be identified. Traditional contact tracing followed the detection of sources of infection. RFLP was used to map the tuberculosis transmission and identify the source case.

Results: The investigation extended from the north to several places in the west of The Netherlands. In total 6519 persons were screened; there were 276 infections, among which 49 cases of active tuberculosis were identified. RFLP analysis of Mycobacterium tuberculosis isolates from all 28 culture positive patients showed the ‘Harlingen’ type DNA fingerprint. After 5 months source tracing led to the identification of the source case in the United Kingdom. Up to June 1996 altogether 37 patients (The Netherlands 28; the UK 7; Surinam 1; Morocco 1) were found to have isolates with the Harlingen type DNA pattern. Despite a thorough evaluation, in 5 of the 37 patients no relation to the source case or the outbreak in Harlingen could be established.

Conclusion: RFLP typing proved a very useful instrument in guiding the process of international source tracing and contact investigation.

Keywords: DNA fingerprinting; TB outbreak; low prevalence; source tracing; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Municipal Health Service Noord Friesland, Leeuwarden, The Netherlands 2: Mycobacterial Laboratory, National Institute of Public Health and the Environment, Bilthoven, The Netherlands 3: Royal Netherlands Tuberculosis Association (KNCV), The Hague, The Netherlands

Publication date: June 1, 1997

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