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JAMA. 1999 Dec 22-29;282(24):2321-7.

Identification of a W variant outbreak of Mycobacterium tuberculosis via population-based molecular epidemiology.

Author information

1
Public Health Research Institute Tuberculosis Center, Department of Microbiology, New York University School of Medicine, NY 10016, USA.

Abstract

CONTEXT:

Typing of Mycobacterium tuberculosis could provide a more sensitive means of identifying outbreaks than use of conventional surveillance techniques alone. Variants of the New York City W strain of M tuberculosis were identified in New Jersey.

OBJECTIVE:

To describe the spread of the W family of M tuberculosis strains in New Jersey identified by molecular typing and surveillance data.

DESIGN:

Population-based cross-sectional study.

SETTING AND SUBJECTS:

All incident culture-positive tuberculosis cases reported in New Jersey from January 1996 to September 1998, for which the W family was defined by insertion sequence (IS) IS6110 DNA fingerprinting, polymorphic GC-rich repetitive sequence (PGRS) typing, spacer oligotyping (spoligotyping), and variable number tandem repeat (VNTR) analysis.

MAIN OUTCOME MEASURE:

Identification and characterization of W family clones supplemented by surveillance data.

RESULTS:

Isolates from 1207 cases were analyzed, of which 68 isolates (6%) belonged to the W family based on IS6110 and spoligotype hybridization patterns. The IS6110 hybridization patterns or fingerprints revealed that43 patients (designated group A) shared a unique banding motif not present in other W family isolates. Strains collected from the remaining 25 patients (designated group B), while related to W, displayed a variety of IS6110 patterns and did not share this motif. The PGRS and VNTR typing confirmed the division of the W family into groups A and B and again showed group A strains to be closely related and group B strains to be more diverse. The demographic characteristics of individuals from groups A and B were specific and defined. Group A patients were more likely than group B patients to be US born (91 % vs 24%, P<.001), black (76% vs 16%, P<.001), human immunodeficiency virus positive (40% vs 0%, P = .007), and residents of urban northeast New Jersey counties (P<.001). Patients with group B strains were primarily non-US born, of Asian descent, and more dispersed throughout New Jersey. No outbreak had been detected using conventional surveillance alone.

CONCLUSIONS:

The implementation of multiple molecular techniques in conjunction with surveillance data enabled us to identify a previously undetected outbreak in a defined geographical setting. The outbreak isolates comprise members of a distinct branch of the W family phylogenetic lineage. The use of molecular strain typing provides a proactive approach that may be used to initiate, and not just augment, traditional surveillance outbreak investigations.

PMID:
10612319
DOI:
10.1001/jama.282.24.2321
[Indexed for MEDLINE]

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