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The largest prison outbreak of TB in Western Europe investigated using whole-genome sequencing

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BACKGROUND: In March 2011, the Department of Public Health East in Ireland were notified of two cases of TB in two prisoners sharing a cell. We define the resulting outbreak and highlight the role of public health and laboratory-based molecular epidemiology in mapping and control of a prison outbreak.

METHODS: Cases were identified through clinical presentation, contact tracing, case-finding exercise or enhanced laboratory surveillance. Mycobacterium tuberculosis isolates were genotyped and underwent whole-genome sequencing (WGS).

RESULTS: Of the 34 cases of TB linked to the outbreak, 27 were prisoners (79%), 4 prison officers (12%) and 3 community cases (9%). M. tuberculosis was isolated from 31 cases (culture positivity: 91%). A maximum of six single-nucleotide polymorphisms separated the isolates, with 22 being identical, suggestive of a highly infectious ‘super-spreader´ within the prison. Isolates belonged to the Beijing sub-lineage, and were susceptible to first-line anti-TB agents. A case-finding exercise incidentally detected a prisoner with multidrug-resistant TB. Of the 143 prison officers screened, 52% had latent TB infection. Litigation costs exceeded five million euros.

CONCLUSION: This constitutes the largest prison outbreak of TB in Western Europe investigated using WGS. A robust prison entry TB screening and education programme is required to effect better TB control, and prevent future outbreaks and attendant litigation.

Keywords: molecular epidemiology; occupational health; public health; screening

Document Type: Research Article

Affiliations: 1: Irish Mycobacteria Reference Laboratory, St James´s Hospital, Dublin, Ireland, Department of Clinical Microbiology, Trinity College Dublin, St James´s Hospital Campus, Dublin, Ireland 2: Department of Public Health East, Health Service Executive, Dublin, Ireland 3: Department of Respiratory Medicine, St James´s Hospital, Dublin, Ireland 4: UCD School of Veterinary Medicine and Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland

Publication date: June 1, 2021

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