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Challenges and Opportunities in a Tuberculosis Outbreak Investigation in Southern Mississippi, 2005-2007

Emily Bloss, PhD, Kimberly Newbill, RN, Heather Peto, MD, MPH, Michael J. Rice, RN, CCN, Gail Ainsworth, RN, BSN, Robert Travnicek, MD, MPH, Mike Holcombe, MPPA, CPM, Maryam B. Haddad, MSN, MPH,John E. Oeltmann, PhD
Volume: 104 Issue: 11 November, 2011

Abstract:

 

Objective: Between December 2005 and November 2007, a cluster of 11 tuberculosis (TB) cases emerged in Jackson County, Mississippi. We investigated the potential sources of disease transmission and epidemiologic links in this cluster to prevent future transmission in the community.


 

Materials and Methods: Cases of TB reported in Jackson County from December 2005 to November 2007 having matching genotypes or social links to patients with matching genotypes were included in the investigation. We interviewed patients, reviewed medical records, and performed contact investigations.


 

Results: The combined genotyping and epidemiologic data pointed to ongoing TB transmission in this rural community. A combination of patient-specific and programmatic factors, including substance use, delays in TB diagnosis, nonadherence, and TB program staffing cuts, contributed to this outbreak in the context of the 2004 and 2005 Atlantic hurricane seasons.


 

Conclusions: To eliminate Mycobacterium tuberculosis transmission in this setting, recommendations for the TB program include enhanced coordination with substance abuse programs, community and provider education, and increased outreach capacity.


 

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References:

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3. National Tuberculosis Controllers Association; Centers for Disease Control and Prevention. Guidelines for the investigation of contacts of persons with infectious tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC. MMWR Recomm Rep 2005;54:1-47.
 
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6. Oeltmann JE, Kammerer JS, Pevzner ES, et al. Tuberculosis and substance abuse in the United States, 1997-2006. Arch Intern Med 2009;169:189-197.
 
7. Pevzner ES, Robison S, Donovan J, et al. Tuberculosis transmission and use of methamphetamines and other drugs in Snohomish County, WA, 1991-2006. Am J Public Health 2010;100:2481-2486.
 
8. Asghar RJ, Patlan DE, Miner MC, et al. Limited utility of name-based tuberculosis contact investigations among persons using illicit drugs: results of an outbreak investigation. J Urban Health2009;86:776-780.
 
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15. Centers for Disease Control and Prevention. Tuberculosis elimination revisited: obstacles, opportunities, and a renewed commitment-Advisory Council for the Elimination of Tuberculosis (ACET). MMWR 1999;48(RR-9):1-13.

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