This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (92)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Bacterial Infections  • Tuberculosis/ Other Mycobacterium  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

William R. Bishai, MD, PhD; Neil M. H. Graham, MD, MPH; Susan Harrington, MPH; Diana S. Pope, RN, MS; Nancy Hooper, BA; Jacqueline Astemborski, MHS; Laura Sheely, MSN, CRNP; David Vlahov, PhD; Gregory E. Glass, PhD; Richard E. Chaisson, MD

JAMA. 1998;280:1679-1684.

Context.— Recent studies suggest that one third of tuberculosis cases in urban areas result from recent transmission. Improved tuberculosis control measures such as uniform implementation of directly observed therapy might reduce the proportion of cases resulting from recent transmission.

Objective.— To determine patterns of tuberculosis transmission in Baltimore, Md, after 15 years of community-based directly observed therapy.

Design.— A 30-month (January 1994-June 1996), prospective, city-wide study of all cases of tuberculosis using traditional contact investigations, geographic information systems data, and molecular epidemiologic comparison of Mycobacterium tuberculosis isolates with 2 DNA probes.

Patients.— One hundred eighty-two patients with culture-positive tuberculosis.

Main Outcome Measures.— Proportion of disease defined as recently transmitted based on epidemiologic linkage by traditional contact tracing and molecular linkage by DNA fingerprint analysis of isolates; geographic foci of transmission based on linkage of residences by geographic information systems data.

Results.— Of the 182 patients who had isolates of M tuberculosis available, 84 (46%) showed molecular clustering with 58 (32%) defined as being recently transmitted. Only 20 (24%) of 84 cases with clustered DNA fingerprints had epidemiologic evidence of recent contact. Geographic analysis showed significant spatial aggregation of the 20 clustered cases with epidemiologic links (P<.001), occurring in areas of low socioeconomic status and high drug use. The 64 cases with clustered DNA fingerprints but without epidemiologic links shared common risk factors and demographic features with the 20 clustered patients who did have epidemiologic links.

Conclusions.— Recently transmitted tuberculosis accounts for a high proportion of tuberculosis cases in Baltimore. Recently transmitted cases occur in geographically distinct areas of Baltimore, and location-based control efforts may be more effective than contact tracing for the early identification of cases.

From the Departments of International Health (Drs Bishai and Chaisson), Molecular Microbiology and Immunology (Drs Bishai and Glass), and Epidemiology (Drs Graham, Vlahov, and Chaisson and Mss Astemborski and Sheely), Johns Hopkins University School of Hygiene and Public Health, the Departments of Medicine (Drs Bishai, Vlahov, and Chaisson) and Pathology (Ms Harrington), Johns Hopkins University School of Medicine, the Baltimore City Health Department (Ms Pope), and the Maryland Department of Health and Mental Hygiene (Ms Hooper), Baltimore, Md.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

Reducing Ongoing Transmission of Tuberculosis
Peter F. Barnes
JAMA. 1998;280(19):1702-1703.
EXTRACT | FULL TEXT  

Fighting TB
JAMA. 1998;280(19):1724.
PDF  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Epidemiologic Characterization of Culture Positive Mycobacterium tuberculosis Patients by katG-gyrA Principal Genetic Grouping
Grimes et al.
J. Mol. Diagn. 2009;11:472-481.
ABSTRACT | FULL TEXT  

Activation of the eis gene in a W-Beijing strain of Mycobacterium tuberculosis correlates with increased SigA levels and enhanced intracellular growth
Wu et al.
Microbiology 2009;155:1272-1281.
ABSTRACT | FULL TEXT  

Immune Function in Young Children With Previous Pulmonary or Miliary/Meningeal Tuberculosis and Impact of BCG Vaccination
Sterling et al.
Pediatrics 2007;120:e912-e921.
ABSTRACT | FULL TEXT  

Molecular Epidemiology of Tuberculosis: Current Insights
Mathema et al.
Clin. Microbiol. Rev. 2006;19:658-685.
ABSTRACT | FULL TEXT  

Which Patients' Factors Predict the Rate of Growth of Mycobacterium tuberculosis Clusters in an Urban Community?
Driver et al.
Am J Epidemiol 2006;164:21-31.
ABSTRACT | FULL TEXT  

American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Controlling Tuberculosis in the United States
Am. J. Respir. Crit. Care Med. 2005;172:1169-1227.
FULL TEXT  

Long-Term Molecular Analysis of Tuberculosis Strains in Alabama, a State Characterized by a Largely Indigenous, Low-Risk Population
Kempf et al.
J. Clin. Microbiol. 2005;43:870-878.
ABSTRACT | FULL TEXT  

High Rates of Clustering of Strains Causing Tuberculosis in Harare, Zimbabwe: a Molecular Epidemiological Study
Easterbrook et al.
J. Clin. Microbiol. 2004;42:4536-4544.
ABSTRACT | FULL TEXT  

To control and beyond: moving towards eliminating the global tuberculosis threat
Brewer and Heymann
J. Epidemiol. Community Health 2004;58:822-825.
ABSTRACT | FULL TEXT  

Tuberculosis Contact Investigations: Please Don't Fail Me Now
Daley
Am. J. Respir. Crit. Care Med. 2004;169:779-781.
FULL TEXT  

Clustered Tuberculosis Cases: Do They Represent Recent Transmission and Can They Be Detected Earlier?
van Deutekom et al.
Am. J. Respir. Crit. Care Med. 2004;169:806-810.
ABSTRACT | FULL TEXT  

Tuberculosis in the Inuit Community of Quebec, Canada
Nguyen et al.
Am. J. Respir. Crit. Care Med. 2003;168:1353-1357.
ABSTRACT | FULL TEXT  

Molecular Epidemiology of Tuberculosis
Barnes and Cave
NEJM 2003;349:1149-1156.
FULL TEXT  

Widespread Pyrazinamide-Resistant Mycobacterium tuberculosis Family in a Low-Incidence Setting
Nguyen et al.
J. Clin. Microbiol. 2003;41:2878-2883.
ABSTRACT | FULL TEXT  

Molecular and Conventional Epidemiology of Tuberculosis in Hong Kong: a Population-Based Prospective Study
Chan-Yeung et al.
J. Clin. Microbiol. 2003;41:2706-2708.
ABSTRACT | FULL TEXT  

Genome-Wide Analysis of Synonymous Single Nucleotide Polymorphisms in Mycobacterium tuberculosis Complex Organisms: Resolution of Genetic Relationships Among Closely Related Microbial Strains
Gutacker et al.
Genetics 2002;162:1533-1543.
ABSTRACT | FULL TEXT  

Transmission Dynamics of Tuberculosis in Tarrant County, Texas
Weis et al.
Am. J. Respir. Crit. Care Med. 2002;166:36-42.
ABSTRACT | FULL TEXT  

Transmission of Mycobacterium tuberculosis Through Casual Contact With an Infectious Case
Golub et al.
Arch Intern Med 2001;161:2254-2258.
ABSTRACT | FULL TEXT  

Epidemiologic Usefulness of Spoligotyping for Secondary Typing of Mycobacterium tuberculosis Isolates with Low Copy Numbers of IS6110
Cronin et al.
J. Clin. Microbiol. 2001;39:3709-3711.
ABSTRACT | FULL TEXT  

Neighborhood Poverty and the Resurgence of Tuberculosis in New York City, 1984-1992
Barr et al.
AJPH 2001;91:1487-1493.
ABSTRACT | FULL TEXT  

Paradoxical Worsening of Tuberculosis in HIV-Infected Persons
Wendel et al.
Chest 2001;120:193-197.
ABSTRACT | FULL TEXT  

Postsanatorium Pattern of Antituberculous Drug Resistance in the Canadian-born Population of Western Canada: Effect of Outpatient Care and Immigration
Long et al.
Am J Epidemiol 2001;153:903-911.
ABSTRACT | FULL TEXT  

Molecular and Conventional Epidemiology of Mycobacterium tuberculosis in Botswana: a Population-Based Prospective Study of 301 Pulmonary Tuberculosis Patients
Lockman et al.
J. Clin. Microbiol. 2001;39:1042-1047.
ABSTRACT | FULL TEXT  

Molecular Epidemiology and Tuberculosis Control
Braden et al.
JAMA 2000;284:305-307.
FULL TEXT  

Spread of Mycobacterium tuberculosis in a Community Implementing Recommended Elements of Tuberculosis Control
Chin et al.
JAMA 2000;283:2968-2974.
ABSTRACT | FULL TEXT  

Transmission of Mycobacterium tuberculosis from a Cadaver to an Embalmer
Sterling et al.
NEJM 2000;342:246-248.
FULL TEXT  

Identification of a W Variant Outbreak of Mycobacterium tuberculosis via Population-Based Molecular Epidemiology
Bifani et al.
JAMA 1999;282:2321-2327.
ABSTRACT | FULL TEXT  

More financial resources must be provided for multidrug resistant TB
Schmid et al.
BMJ 1999;318:1076a-1076.
FULL TEXT  

Does Long-Term DOT Change Patterns of TB Transmission?
JWatch Infect. Diseases 1999;1999:9-9.
FULL TEXT  

Even with Directly Observed Therapy, TB Is Still Contagious
JWatch General 1998;1998:4-4.
FULL TEXT  

Reducing Ongoing Transmission of Tuberculosis
Barnes
JAMA 1998;280:1702-1703.
FULL TEXT  

Determinants of cluster distribution in the molecular epidemiology of tuberculosis
Murray
Proc. Natl. Acad. Sci. USA 2002;99:1538-1543.
ABSTRACT | FULL TEXT