CDC logo Tuberculosis Information CD-ROM   Image of people
   
1
spacer image

Guide to the Application of Genotyping to Tuberculosis Prevention and Control

Appendix B:
References and Useful Resources

Chapter Preview

  1. References Cited in the Guide
  2. NTGSN Special Issue References
  3. Information on Packaging and Shipping Infectious Substances
  4. Core Steps of an Outbreak Investigation
  5. Consultants Available to Offer Guidance

1. References Cited in the Guide

Barnes 2003 Barnes PF, Cave MD. Molecular Epidemiology of Tuberculosis. N Engl J Med 2003;349:1149-56.
Bennett 2002 Bennett DE, Onorato IM, Ellis BA, et al. DNA fingerprinting of Mycobacterium tuberculosis isolates from epidemiologically linked case pairs. Emerg Infect Dis 2002;8:1224-9.
Bifani 1996 Bifani P, Plikaytis BB, Kapur V, et al. Origin and spread of a New York City multidrug-resistant Mycobacterium tuberculosis close family. JAMA 1996;275:452-7.
Braden 1997 Braden CR, Templeton GL, Cave MD, et al. Interpretation of restriction fragment length polymorphism analysis of Mycobacterium tuberculosis isolates from a state with a large rural population. J Infect Dis 1997;175:1446-52.
Castro 2002 Castro KG, Jaffe HW. Rationale and methods for the National Tuberculosis Genotyping and Surveillance Network. Emerg Infect Dis 2002;8:1188-91.
Cronin 2002 Cronin WA, Golub JE, Lathan MJ, et al. Molecular epidemiology of tuberculosis in a low-to moderate-incidence state: are contact investigations enough? Emerg Infect Dis 2002;8:1271-9.
Jasmer 2002 Jasmer RM, Roemer M, Hamilton J, et al. A prospective, multicenter study of laboratory cross-contamination of Mycobacterium tuberculosis cultures. Emerg Infect Dis 2002;8:1260-3.
Kamerbeek 1997 Kamerbeek J, Schouls L, Kolk A, et al. Simultaneous detection and strain differentiation of Mycobacterium tuberculosis for diagnosis and epidemiology. J Clin Microbiol 1997; 35:907-14
Kong 2002 Kong PM, Tapy J, Calixto P, et al. Skin-test screening and tuberculosis transmission among the homeless. Emerg Infect Dis 2002;8:1280-4.
Mazars 2001 Mazars E, Lesjean S, Banuls L, et al. High-resolution minisatellite-based typing as a portable approach to global analysis of Mycobacterium tuberculosis molecular epidemiology. Proc Nat Acad Sci USA 2001;98:1901-6.
McElroy 2002 McElroy PD, Sterling TR, Driver CR, Kreiswirth B, et al. Use of DNA fingerprinting to investigate a multiyear, multistate tuberculosis outbreak. Emerg Infect Dis 2002;8:1251-8.
McElroy 2003 McElroy PD, Southwick KL, Fortenberry ER, Levine EC, Diem LA, Woodley CL. Outbreak of tuberculosis among homeless persons coinfected with human immunodeficiency virus. Clin Infect Dis 2003;36:1305-12.
McNabb 2004 McNabb SJN, Kammerer JS, Hickey AC, et al. Added epidemiologic value to tuberculosis prevention and control of the investigation of clustered genotypes of Mycobacterium tuberculosis isolates. Amer J Epi 2004 (in press).
Miller 2002 Miller AC, Sharnprapai S, Suruki R, et al. Impact of genotyping of Mycobacterium tuberculosis on public health practice in Massachusetts. Emerg Infect Dis 2002;8:1285-9.
Munsiff 2002 Munsiff SS, Bassoff T, Nivin B, et al. Molecular epidemiology of multidrug-resistant tuberculosis, New York City, 1995-1997. Emerg Infect Dis 2002;81230-8.
Small 1994 Small PA, Hopewell PC, Singh SP, et al. The epidemiology of tuberculosis in San Francisco, a population-based study using conventional and molecular methods. N Engl J Med 1994;330:1703-9.
van Embden 1993 van Embden JDA, Cave MD, Crawford JT, et al. Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol 1993;31:406-9.
Vynnycky 2003 Vynnycky E, Borgdorff MW, van Soolingen D, Fine EM. Annual Mycobacterium tuberculosis infection risk and interpretation of clustering statistics. Emerg Infect Dis 2003;9:176-83.
Yeh 1999 Yeh RW, Hopewell PC, Daley CL. Simultaneous infection with two strains of Mycobacterium tuberculosis identified by restriction fragment length polymorphism analysis. Int J Tuberc Lung Dis 1999;3:537-9.

2. NTGSN Special Issue References

In response to the increase in the number of reported tuberculosis cases in the United States, CDC funded regional laboratories to provide genotyping services to support TB prevention and control programs in outbreak investigations and to conduct studies on using genotyping in TB epidemiology and control. This network was expanded to include sentinel surveillance sampling in 1996 when CDC established the National Tuberculosis Genotyping and Surveillance Network (NTGSN) as a 5-year project. NTGSN comprised CDC and seven laboratories and seven sentinel surveillance sites in the United States. Sentinel surveillance sites included the states of Arkansas, Maryland, Massachusetts, Michigan, and New Jersey and six counties in California (Alameda, Contra Costa, Marin, San Mateo, Santa Clara, and Solano); and four counties in Texas (Dallas, Tarrant, Cameron, and Hidalgo). The November 2002 special issue of Emerging Infectious Diseases contains the following reports of the studies resulting from the NTGSN. The special issue of the journal is available at http://www.cdc.gov/ncidod/EID/vol8no11/contents_v8n11.htm.

Navin TR, McNabb SJN, Crawford, JT. The continued threat of tuberculosis. Emerg Infect Dis 2002;8:1187.

Castro KG, Jaffe HW. Rationale and methods for the National Tuberculosis Genotyping and Surveillance Network. Emerg Infect Dis 2002;8:1188-91.

Crawford JT, Braden R, Schable BA, Onorato IM. National Tuberculosis Genotyping and Surveillance Network: design and methods. Emerg Infect Dis 2002;8:1192-5.

Ellis BA, Crawford JT, Braden CR, et al. Molecular epidemiology of tuberculosis in a sentinel surveillance population. Emerg Infect Dis 2002;8:1197-209.

Braden CR, Crawford JT, Schable BA. Quality assessment of Mycobacterium tuberculosis genotyping in a large laboratory network. Emerg Infect Dis 2002;8:1210-5.

Sun SJ, Bennett DE, Flood J, Loeffler AM, Kammerer S, Ellis BA. Identifying the sources of tuberculosis in young children: a multistate investigation. Emerg Infect Dis 2002;8:1216-23.

Bennett DE, Onorato IM, Ellis BA, et al. DNA fingerprinting of Mycobacterium tuberuclosis isolates from epidemiologically linked case pairs. Emerg Infect Dis 2002;8:1224-9.

Munsiff SS, Bassoff T, Nivin B, et al. Molecular epidemiology of multidrug-resistant tuberculosis, New York City, 1995-1997. Emerg Infect Dis 2002;8:1230-8.

Sharnprapai S, Miller AC, Suruki R, et al. Genotyping analyses of tuberculosis cases in U.S.- and foreign-born Massachusetts residents. Emerg Infect Dis 2002;8:1239-45.

Dillaha JA, Zhenhua Y, Ijaz K, et al. Transmission of Mycobacterium tuberculosis in a rural community, Arkansas, 1945-2000. Emerg Infect Dis 2002;8:1246-8.

Latha M, Mukasa LN, Hooepr N, et al. Cross-jurisdictional transmission of Mycobacterium tuberculosis in Maryland and Washington, D.C., 1996-2000 linked to the homeless. Emerg Infect Dis 2002;8:1249-51.

McElroy PD, Sterling TR, Driver CR, et al. Use of DNA fingerprinting to investigate a multiyear, multistate tuberculosis outbreak. Emerg Infect Dis 2002;8:1251-8.

Ijaz K, Yang Z, Matthews S, Bates JH, Cave MD. Mycobacterium tuberculosis transmission between cluster members with similar fingerprint patterns. Emerg Infect Dis 2002;8:1257-9.

Northrus JM, Miller AC, Nardell E, et al. Estimated costs of false laboratory diagnoses of tuberculosis in three patients. Emerg Infect Dis 2002;8:1264-70.

Cronin, WA, Golub JE, Lathan MJ, et al. Molecular epidemiology of tuberculosis in a low- to moderate-incidence state: are contact investigations enough? Emerg Infect Dis 2002;8:1271-9.

Kong P, Tapy J, Calixto P, et al. Skin-test screening and tuberculosis transmission among the homeless. Emerg Infect Dis 2002;8:1280-4.

Miller AC, Sharnprapai S, Suruki R, Corkren E, Nardell EA, Driscoll JR. Impact of genotyping of Mycobacterium tuberculosis on public health practice in Massachusetts. Emerg Infect Dis 2002;8:1285-9.

Oh P, Granich R, Scott J, et al. Human exposure following Mycobacterium tuberculosis infection of multiple animal species in a metropolitan zoo. Emerg Infect Dis 2002;8:1290-3.

Cowan LS, Crawford JT. Genotype analysis of Mycobacterium tuberculosis isolates from a sentinel surveillance population. Emerg Infect Dis 2002;8:1294-1302.

Lok KH, Benjamin WH, Kimerling ME, et al. Molecular typing of Mycobacterium tuberculosis strains with a common two-band IS6110 pattern. Emerg Infect Dis 2002;8:1303-5.

Driscoll JR, Bifani PJ, Mathema B, et al. Spoligologos: a bioinformatic approach to displaying and analyzing Mycobacterium tuberculosis data. Emerg Infect Dis 2002;8:1306-9.

Lok KH, Benjamin WH, Kimerling ME, et al. Molecular differentiation of Mycobacterium tuberculosis strains without IS6110 insertions. Emerg Infect Dis 2002;8:1310-3.

McNabb SJN, Braden CR, Navin TR. DNA fingerprinting of Mycobacterium tuberculosis: Lessons learned and implications for the future. Emerg Infect Dis 2002;8:1314-9.

Drobniewski F, Balabanova Y, Ruddy M, et al. Rifampin- and multidrug-resistant tuberculosis in Russian civilians and prison inmates: Dominance of the Beijing strain family. Emerg Infect Dis 2002;8:1320-6.

Garcia-Garcia ML, Ponce-de-Leon A, Garcia-Sancho MC, Ferreyra-Reyes L, Palacios-Martinez M, Fuentes J. Tuberculosis-related deaths within a well-functioning DOTS control program. Emerg Infect Dis 2002;8:1327-33.

Drake WP, Pei Z, Pride DT, Collins RD, Cover TL, Blaser MJ. Molecular analysis of sarcoidosis tissues for Mycobacterium species DNA. Emerg Infect Dis 2002;8:1334-41.

Hughes AL, Friedman R, Murray M. Genomewide pattern of synonymous nucleotide substitution in two complete genomes of Mycobacterium tuberculosis. Emerg Infect Dis 2002;8:1342-6.

Filliol I, Driscoll JR, Soolingen D, et al. Global distribution of Mycobacterium tuberculosis spoligotypes. Emerg Infect Dis 2002;8:1347-9.

Miltgen, J, Morillon M, Koeck JL, et al. Two cases of pulmonary tuberculosis caused by Mycobacterium tuberculosis subsp. Canetti. Emerg Infect Dis 2002;8:1350-2.

Morens DM. At the deathbed of consumptive art. Emerg Infect Dis 2002;8:1353-8.K

3. Information on Packaging and Shipping Infectious Substances

Cultures of Mycobacterium tuberculosis are considered “infectious substances” according to regulations of the U.S. Department of Transportation (DOT) and the International Air Transport Association (IATA). Shipping of infectious substances must follow regulations established by both organizations.

Useful information can be obtained at the following websites:

1. http://hazmat.dot.gov/pubtrain/infect.pdf

Graphic summary of acceptable packaging containers for infectious substances.

2. http://www.myregs.com/dotrspa/

DOT regulations that pertain to the shipment of hazardous substances.

3. http://www.cdc.gov/od/ohs/biosfty/shipregs.htm

General information about shipping regulations for infectious substances.

Some of the salient regulations:

  • Personnel who prepare and ship specimens must receive specific training and pass a competence examination. Training must be repeated every 2 years (refresher and update).
  • Infectious substances must be packaged according to IATA Packing Instruction 602 and a shipper’s declaration for dangerous goods form must be prepared.
  • The genotyping laboratory must be notified by fax or e-mail when a package is shipped.
  • Packages must be sent by a carrier that has tracking capability so that lost packages can be located.

Note: Dry ice must not be used unless other IATA precautions and regulations are followed.

4. Core Steps of an Outbreak Investigation

  1. Confirm that it meets epidemiologic definition of an outbreak (any one of the following)
    1. More cases than expected (surveillance)
    2. Cases epidemiologically clustered by time, space, or common behaviors
  2. 2. Consider whether there is ongoing transmission (one of the following)
    1. Did regular contact investigations reveal epidemiologic links or similarities among cases?
    2. Did the laboratory identity a genotyping cluster that confirms the epidemiologic links identified by regular contact investigation?
    3. Did the laboratory identify a genotyping or epidemiologic cluster of lab isolates clustered in time and space where there is discordance between the clinical course of the patient and the laboratory results (false-positive culture)?
  3. Define an outbreak-related case
  4. Confirm existing number of outbreak-related cases
  5. Investigate existing outbreak-related cases by reviewing
    1. Medical records (history, physical, clinical chart, and notes)
    2. Laboratory records (serial results of smears, cultures, drug sensitivities, and other testing)
    3. Review genotyping results for all culture-positive cases (if not already done, submit isolates for genotyping)
      1. If lab results are implausible and the clinical course of the patient does not support TB diagnosis or the clinician does not think that there is concordance between lab results and clinical course of the patient to support TB diagnosis, consider possibility of false-positive cultures
    4. Chest radiographs (including old baseline films, if possible)
    5. Tuberculosis clinic and other pertinent public health records
    6. Cross match outbreak-related cases with county jail, state prison, and STD registries
    7. All data from regularly conducted contact investigations (re-interview case-patients and their contacts as necessary)
  6. Determine the infectious period for each outbreak-related case based on
    1. Laboratory results (e.g., sputum smear-positive patients are thought to be more infectious)
    2. Serial chest radiographs (e.g., patients with cavitary lung lesions are thought to be more infectious)
    3. Date of onset and duration of signs and symptoms
    4. Results of screening of named contacts (e.g., a high percentage of TST-positive contacts)
  7. Determine the sites and facilities frequented and family and social groups exposed by outbreak-related patients during their infectious periods
    1. Information from case-patient interviews and contact investigations
    2. Information from medical and public health records
    3. Information from the facility logs or records
  8. Determine the exposed cohort of persons at each site/facility who may have been present when an outbreak-related case-patient was present during his/her infectious period
    1. Information from case-patient interviews and contact investigations
    2. Information from medical and public health records
    3. Information from the facility logs or records
  9. Determine the duration by number of hours, days, or weeks. for the exposed cohort of persons who may have spent around an infectious outbreak-related patient
    1. Information from case-patient interviews and contact investigations
    2. Information from medical and public health records
    3. Information from the facility logs or records
  10. Prioritize exposed cohorts for screening (active case finding and latent TB infection) based on:
    1. Type (e.g., indoor versus outdoor, intimate versus casual), frequency, and duration of exposure
    2. Risk of progression to active disease
  11. Define elements of and action plan for screening, implementation, and follow-up
  12. Identify resources necessary for action plan to be carried out
  13. Create a media plan to respond to possible inquiries
  14. Assign responsibilities and set deadlines
  15. If necessary, expand screening to include low-priority cohorts after screening high-priority cohorts based on evidence of transmission
  16. Evaluate, treat, and follow up additional TB disease case-patients and latent TB infected persons associated with this outbreak
  17. Make and implement recommendations to prevent future outbreaks for particular populations or settings involved
  18. Evaluate outbreak response
  19. Determine whether interventions have effectively stopped TB transmission in this situation.
  20. Identify the lessons learned that could improve the public health response to the next outbreak.

5. Consultants Available to Offer Guidance

TB Program Consultants

Wendy A. Cronin, MT (ASCP), PhD
Epidemiologist
Division of TB Control, Refugee and Migrant Health
Maryland Department of Health and Mental Hygiene
201 W. Preston St., Room 307-A
Baltimore, MD 21201
Phone: 410-767-6693
Fax: 410-669-4215
E-mail: croninw@dhmh.state.md.us

Cynthia R. Driver, RN, MPH
Director, Epidemiology Office
Bureau of Tuberculosis Control
New York City Department of Health and Mental Hygiene
E-mail: cdriver@health.nyc.gov

Sue Etkind, RN, MS
Director, Division of Tuberculosis Prevention and Control
Massachusetts Department of Public Health
Phone: 617-983-6970
Fax: 617- 983-6990
E-mail: sue.etkind@state.ma.us

Tanya Oemig, RM (NRM)
Director
Wisconsin Tuberculosis Program
Phone: 608-261-6319
Fax: 608-266-0049
E-mail: oemigtv@dhfs.state.wi.us

CDC Consultants

For Guidance on Programmatic and Epidemiologic Components

Thomas Navin, MD
Chief, Surveillance, Epidemiology, and Outbreak Investigation Branch
Division of Tuberculosis Elimination
Phone: 404-639-5300
Fax: 404-639-8959
E-mail: tnavin@cdc.gov

Lisa Rosenblum, MD, MPH
Senior Medical Officer
Surveillance, Epidemiology, and Outbreak Investigation Branch
Division of Tuberculosis Elimination
E-mail: lrosenblum@cdc.gov

For Guidance on Laboratory Components of CDC Program

Jack Crawford, PhD
Tuberculosis/Mycobacteriology Branch
Division of AIDS, STD, and TB Laboratory Research (DASTLR)
Phone: 404-639-1281
E-mail: jcrawford@cdc.gov

Association of Public Health Laboratories Consultant

Guidance for Laboratory Networking and Outreach

Martha(Marty) Boehme, MT (ASCP)
QA Outreach Microbiologist
Michigan Department of Community Health
3350 N. Martin Luther King Jr. Blvd.
P. O. Box 30035
Lansing, MI 48909
Phone: 517-335-9654
Fax: 517-335-9631
E-mail: boehmem@michigan.gov

 

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

Please send comments/suggestions/requests to: hsttbwebteam@cdc.gov, or to
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333