lunes, 4 de marzo de 2013

Prioritizing Tuberculosis Clusters by Genotype for Public Health Action, Washington, USA - Vol. 19 No. 3 - March 2013 - Emerging Infectious Disease journal - CDC

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Prioritizing Tuberculosis Clusters by Genotype for Public Health Action, Washington, USA - Vol. 19 No. 3 - March 2013 - Emerging Infectious Disease journal - CDC
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Table of Contents
Volume 19, Number 3– March 2013


Volume 19, Number 3—March 2013



Dispatch



Prioritizing Tuberculosis Clusters by Genotype for Public Health Action, Washington, USA




Scott LindquistComments to Author , Sheanne Allen, Kim Field, Smita Ghosh, Maryam B. Haddad, Masahiro Narita, and Eyal Oren


Author affiliations: Author affiliations: Kitsap County Health District, Bremerton, Washington, USA (S. Lindquist); Washington State Department of Health, Olympia, Washington, USA (S. Lindquist, S. Allen, K. Field); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Ghosh, M.B. Haddad); Public Health–Seattle & King County Tuberculosis Control Program, Seattle, Washington, USA (M. Narita, E. Oren).

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Abstract


Groups of tuberculosis cases with indistinguishable Mycobacterium tuberculosis genotypes (clusters) might represent recent transmission. We compared geospatial concentration of genotype clusters with independent priority rankings determined by local public health officials; findings were highly correlated. Routine use of geospatial statistics could help health departments identify recent disease transmission.

Mycobacterium tuberculosis genotyping has been applied to tuberculosis (TB) control activities for >2 decades, and epidemiologic or genotyping data can confirm or disprove outbreaks (14). Investigation of genotype clusters can identify unrecognized transmission and lead to interventions that interrupt further transmission (5,6). However, cluster investigations are complex, requiring patient interviews and field observations. Focusing resources on clusters that most likely represent recent TB transmission could reduce the number of unnecessary investigations.
Geospatial statistics can identify higher-than-expected concentrations of TB cases with indistinguishable genotypes (7). We describe a comparison of a quantitative geospatial statistic analysis with qualitative expert opinion for prioritizing TB cluster investigations in Washington, USA, a state with moderate TB incidence (3.5 cases/100,000 persons) (8). The comparison was performed for initial and follow-up 3-year periods, 2005–2007 (period 1) and 2008–2010 (period 2).

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