Endemic or Outbreak? Differentiating recent transmission of an historic tuberculosis strain in New Y...
Sponsored Links
This presentation is the property of its rightful owner.
1 / 19

I have no known conflicts of interest to disclose PowerPoint PPT Presentation


  • 104 Views
  • Uploaded on
  • Presentation posted in: General

Endemic or Outbreak? Differentiating recent transmission of an historic tuberculosis strain in New York City IUATLD-NAR 16 th Annual Meeting February 23-25, 2012 Jeanne Sullivan Meissner, MPH New York City Department of Health and Mental Hygiene Bureau of Tuberculosis Control.

Download Presentation

I have no known conflicts of interest to disclose

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Endemic or Outbreak? Differentiating recent transmission of an historic tuberculosis strain in New York City IUATLD-NAR 16th Annual MeetingFebruary 23-25, 2012Jeanne Sullivan Meissner, MPHNew York City Department of Health and Mental HygieneBureau of Tuberculosis Control


Disclosure statements

  • I have no known conflicts of interest to disclose

  • Funding source: New York City Tuberculosis Control Program funds


Background


Tuberculosis cases and rates, New York City

1980-2010*

1991: Selective genotyping begins in NYC

2001: Universal genotyping implemented

Number of Cases

Rate/100,000

*Rates since 2000 are based on population estimates.


  • A tuberculosis (TB) strain first detected in New York City (NYC) in 1995 has continued to cause disease through 2011

  • Recently-diagnosed cases with this strain were investigated to identify epidemiologic links and assess recent transmission


Methods


Cluster investigation

  • NYC TB cluster: two or more cases with matching IS6110-basedrestriction fragment length polymorphism analysis (RFLP) pattern and spacer oligonucleotide type (spoligotype) result

    • 12-loci mycobacterial interspersed repetitive-unit variable-number tandem repeat analysis (MIRU-12) results were obtained for cluster cases counted since January 1, 2004

  • Cluster cases are routinely investigated to identify epidemiologic links and develop transmission hypotheses

  • Recently-diagnosed cases for this investigation: Cluster cases counted between Jan 1, 2006 - Jul 1, 2011


Cluster investigation

Steps in a routine cluster investigation, New York City

Collect and analyze existing data

Generatefinal report

Assign cluster

Develop cluster questionnaire

Communicate with case managers

Develop transmissionhypotheses

Re-interview

patient

Communicate results

* When indicated, intervention(s) are developed to stop transmission


Cluster investigation

  • Epidemiological links are categorized as possible, probable or definite

POSSIBLE

(weakest)

DEFINITE

(strongest)

EPIDEMIOLOGIC LINK

  • DEFINITE

  • Cases name each other as contacts

  • Cases share common contact without naming each other

  • Cases frequent same location during infectious period of at least one of the cases

  • POSSIBLE

  • Cases live/spend time in area within approximately 0.5 miles of each other (regardless of infectious period)

  • Cases have similar social environment (e.g., similar social networks)

  • PROBABLE

  • Cases frequent same location during same date range, exclusive of infectious period of either case


Results


29 cases

54 recently diagnosed

121 cases

Number of cluster cases counted by year and drug resistance, January 1, 1995 - July 1, 2001 (n=150)

Drug susceptible

Other-drug-resistant

Universal genotyping

Multidrug-resistant

Number of Cases

Year


Patient characteristics

  • Among all cluster cases (n=149*):

    • 62% male

    • Median age: 45 (Range: 16-95)

    • 76% US-born

      • 78% of foreign-born in US >5 years when diagnosed

  • 37% HIV-positive (125 cases with known HIV status)

  • Among cases counted since 2001 (n=120*):

    • 20% known history of homelessness

    • 28% known history of drug use

    • 23% known history of incarceration

    • Cases commonly had more than one of above

  • * One individual was a counted cluster case in two different years. This individual’s patient characteristics were only counted once


    Genotyping

    • Spoligotype:

      • Octal Code: 777776777760601

    • 2-band RFLP pattern

    • All cluster cases counted since January 1, 2004 (n=78) have MIRU-12 results

      • 19 MIRU-12 patterns

        • 11 unique patterns

    RFLP


    MIRU-12 results among cluster cases and corresponding PCR type* (n=78)

    * PCR type: CDC definition of complete genotype using spoligotype and MIRU-12 results


    Select epidemiologic links identified for recently-diagnosed cluster cases

    1990

    Recently diagnosed cluster case

    Cluster case; not recently diagnosed

    NYC case with incomplete genotype; same RFLP

    NYC case; no genotype information available

    Definite epidemiologic link

    Same person

    Probable epidemiologic link

    Possible epidemiologic link

    2003

    2005

    2007

    2009

    2011


    Select epidemiologic links identified for recently-diagnosed cluster cases by MIRU-12 and drug susceptibility results

    1990

    S

    S

    MIRU-12 pattern:

    M

    223325153323

    224325153324

    224325153323

    S

    NA

    NA

    I

    224325143323

    224325183325

    224325163323

    S

    224325153314

    224325153322

    No MIRU-12

    Definite link

    Probable link

    Possible link

    S

    S

    Drug susceptibility: S: Drug-susceptible I: Isoniazid-resistant R: Rifampin-resistant M: Multidrug-resistant NA: No results available

    I,P: Isoniazid- and pyrazinamide-resistant P: Pyrazinamide-resistant

    R

    2003

    S

    S

    S

    M

    2005

    S

    S

    S

    M

    M

    S

    I

    I

    S

    S

    S

    M

    M

    S

    S

    S

    M

    S

    S

    I,P

    2007

    S

    I

    I

    S

    S

    I

    I

    S

    2009

    S

    I

    R

    S

    S

    S

    P

    S

    S

    S

    2011


    Conclusions


    • Transmission of this endemic TB strain is ongoing in NYC, while disease among remotely-infected persons continues

    • Identification of multiple links across different years and patient characteristics highlights the difficulty of differentiating recent transmission of endemic TB strains

      • Common characteristics, activities and geographic locations among cases suggest social networks and community transmission

    • Implications of epidemiologic links across different MIRU-12 results warrants further investigation

    • New genotyping and investigative tools may help further differentiate large, endemic clusters such as this one


    Acknowledgements

    • NYC Department of Health and Mental Hygiene, Bureau of Tuberculosis Control staff

      • Co-authors: Janelle A. Anderson, Bianca R. Perri, Shama D. Ahuja

      • Cluster investigators: A. Regner, R. Espinoza, R. Fernandez, J. Abdelwahab, J. Park, M. Macaraig

      • Clinic and field staff

    • Lab partners: NYC Public Health Lab, New York State Wadsworth Center, Public Health Research Institute

    • New Jersey Department of Health

    • New York State Department of Health

    • Centers for Disease Control and Prevention


  • Login