Tracking and responding to an outbreak of tuberculosis using MIRU-VNTR genotyping and whole genome sequencing as epidemiological tools
AT Black, EL Hamblion, H Buttivant… - Journal of Public …, 2018 - academic.oup.com
AT Black, EL Hamblion, H Buttivant, SR Anderson, M Stone, N Casali, F Drobniewski…
Journal of Public Health, 2018•academic.oup.comBackground We describe an outbreak that contributed to a near doubling of the incidence of
tuberculosis in Southampton, UK. We examine the importance of 24 locus mycobacterial
interspersed repetitive unit variable number tandem repeat (MIRU-VNTR) genotyping in its
identification and management and the role of whole genome sequencing (WGS) in tracing
the spread of the strain. Methods Outbreak cases were defined as those diagnosed between
January and December 2011 with indistinguishable 24 locus-MIRU-VNTR genotypes or …
tuberculosis in Southampton, UK. We examine the importance of 24 locus mycobacterial
interspersed repetitive unit variable number tandem repeat (MIRU-VNTR) genotyping in its
identification and management and the role of whole genome sequencing (WGS) in tracing
the spread of the strain. Methods Outbreak cases were defined as those diagnosed between
January and December 2011 with indistinguishable 24 locus-MIRU-VNTR genotypes or …
Background
We describe an outbreak that contributed to a near doubling of the incidence of tuberculosis in Southampton, UK. We examine the importance of 24 locus mycobacterial interspersed repetitive unit variable number tandem repeat (MIRU-VNTR) genotyping in its identification and management and the role of whole genome sequencing (WGS) in tracing the spread of the strain.
Methods
Outbreak cases were defined as those diagnosed between January and December 2011 with indistinguishable 24 locus-MIRU-VNTR genotypes or, cases linked epidemiologically. A cluster questionnaire was administered by TB nurses to identify contacts and social settings.
Results
Overall, 25 patients fulfilled the case definition. No cases with this MIRU-VNTR genotype had been detected in the UK previously. Connections were found between all cases through household contacts or social venues including a football club, Internet cafe and barber’s shop. Public health actions included extended contact tracing, venue screening and TB awareness-raising. The outbreak resulted in a high rate of transmission and high incidence of clinical disease among contacts.
Conclusions
This outbreak illustrates the value of combining active case-finding with prospective MIRU-VNTR genotyping to identify settings to undertake public health action. In addition WGS revealed that the VNTR-defined cluster was a single outbreak and that active TB transmission not reactivation was responsible for this outbreak in non-UK born individuals.
Oxford University Press