Powell Krista M, VanderEnde Daniel S, Holland David P, Haddad Maryam B, Yarn Benjamin, Yamin Aliya S, Mohamed Omar, Sales Rose-Marie F, DiMiceli Lauren E, Burns-Grant Gail, Reaves Erik J, Gardner Tracie J, Ray Susan M
1 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA.
2 Fulton County Department of Health and Wellness, Atlanta, GA, USA.
Public Health Rep. 2017 Mar/Apr;132(2):231-240. doi: 10.1177/0033354917694008.
Our objective was to describe and determine the factors contributing to a recent drug-resistant tuberculosis (TB) outbreak in Georgia.
We defined an outbreak case as TB diagnosed from March 2008 through December 2015 in a person residing in Georgia at the time of diagnosis and for whom (1) the genotype of the Mycobacterium tuberculosis isolate was consistent with the outbreak strain or (2) TB was diagnosed clinically without a genotyped isolate available and connections were established to another outbreak-associated patient. To determine factors contributing to transmission, we interviewed patients and reviewed health records, homeless facility overnight rosters, and local jail booking records. We also assessed infection control measures in the 6 homeless facilities involved in the outbreak.
Of 110 outbreak cases in Georgia, 86 (78%) were culture confirmed and isoniazid resistant, 41 (37%) occurred in people with human immunodeficiency virus coinfection (8 of whom were receiving antiretroviral treatment at the time of TB diagnosis), and 10 (9%) resulted in TB-related deaths. All but 8 outbreak-associated patients had stayed overnight or volunteered extensively in a homeless facility; all these facilities lacked infection control measures. At least 9 and up to 36 TB cases outside Georgia could be linked to this outbreak.
This article highlights the ongoing potential for long-lasting and far-reaching TB outbreaks, particularly among populations with untreated human immunodeficiency virus infection, mental illness, substance abuse, and homelessness. To prevent and control TB outbreaks, health departments should work with overnight homeless facilities to implement infection control measures and maintain searchable overnight rosters.
我们的目的是描述并确定导致格鲁吉亚近期耐药结核病（TB）暴发的因素。
我们将暴发病例定义为2008年3月至2015年12月期间在格鲁吉亚居住且在诊断时被确诊为结核病的患者，对于这些患者，（1）结核分枝杆菌分离株的基因型与暴发菌株一致，或（2）临床上诊断为结核病但无基因分型分离株，且与另一名与暴发相关的患者建立了联系。为了确定导致传播的因素，我们对患者进行了访谈，并查阅了健康记录、无家可归者收容所过夜人员名单和当地监狱登记记录。我们还评估了暴发涉及的6家无家可归者收容所的感染控制措施。
在格鲁吉亚的110例暴发病例中，86例（78%）经培养确诊且对异烟肼耐药，41例（37%）发生在合并人类免疫缺陷病毒感染的患者中（其中8例在结核病诊断时正在接受抗逆转录病毒治疗），10例（9%）导致了与结核病相关的死亡。除8例与暴发相关的患者外，所有患者都在无家可归者收容所过夜或大量志愿服务；所有这些收容所都缺乏感染控制措施。格鲁吉亚以外至少9例至多36例结核病病例可能与此次暴发有关。
本文强调了结核病长期持久且影响深远的暴发的持续可能性，特别是在未治疗的人类免疫缺陷病毒感染、精神疾病、药物滥用和无家可归者人群中。为预防和控制结核病暴发，卫生部门应与无家可归者过夜收容所合作，实施感染控制措施并维护可搜索的过夜人员名单。
