Original Article

Public Health Response to a Multidrug-Resistant Tuberculosis Outbreak Among Guatemalans in Tennessee, 2007

Authors: Roque Miramontes, PA-C, MPH, Lauren Lambert, MPH, Maryam B. Haddad, MSN, MPH, Valerie Boaz, MD, Stephen Hawkins, MD, Margaret Zylstra, RN, Rachel Allen, BS, Sheliah Rivers, RN, Brenda Ali, RN, Sarah Stuart Chewning, MPH, Erin Holt, MPH, Jon Warkentin, MD, MPH

Abstract

Background: In June 2007, the Tennessee Department of Health notified the Centers for Disease Control and Prevention of four multidrug-resistant tuberculosis (MDR TB) cases in individuals of Guatemalan descent, and requested onsite epidemiologic assistance to investigate this outbreak.


Methods: A case was defined as either culture-confirmed MDR TB with a drug-susceptibility pattern closely resembling that of the index case, or a clinical diagnosis of active TB disease and corroborated contact with a person with culture-confirmed MDR TB. Medical records were reviewed, and patients and their contacts were interviewed.


Results: Five secondary TB cases were associated with the index case. Of 369 contacts of the index case, 189 (51%) were evaluated. Of those, 97 (51%) had positive tuberculin skin test (TST) results, 79 (81%) began therapy for latent TB infection (LTBI), and 38 (48%) completed LTBI therapy.


Conclusion: Despite consistent follow up by public health officials, a low proportion of patients diagnosed with LTBI completed therapy. Clinicians and public health practitioners who serve immigrant communities should be vigilant for MDR TB.


Key Points


* Of the multidrug-resistant (MDR) tuberculosis (TB) cases diagnosed in the United States, 80% are in foreign-born persons.


* Persons with MDR TB require extended treatment, and generally have poorer outcomes than do persons with drug-susceptible TB.


* Mitigating TB outbreaks in foreign-born communities present multiple challenges.


* Clinicians and public health practitioners who serve immigrant communities must remain vigilant for MDR TB.

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