Molecular and Geographic Patterns of Tuberculosis Transmission After 15 Years of Directly Observed Therapy
CONTEXT.— Recent studies suggest that one third of tuberculosis cases in urban areas result from recent transmission. Improved tuberculosis control measures such as uniform implementation of directly observed therapy might reduce the proportion of cases resulting from recent transmission. OBJECTIVE....
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 1998-11, Vol.280 (19), p.1679-1684 |
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| container_title | JAMA : the journal of the American Medical Association |
| container_volume | 280 |
| creator | Bishai, William R Graham, Neil M. H Harrington, Susan Pope, Diana S Hooper, Nancy Astemborski, Jacqueline Sheely, Laura Vlahov, David Glass, Gregory E Chaisson, Richard E |
| description | CONTEXT.— Recent studies suggest that one third of tuberculosis cases in urban
areas result from recent transmission. Improved tuberculosis control measures
such as uniform implementation of directly observed therapy might reduce the
proportion of cases resulting from recent transmission. OBJECTIVE.— To determine patterns of tuberculosis transmission in Baltimore, Md,
after 15 years of community-based directly observed therapy. DESIGN.— A 30-month (January 1994-June 1996), prospective, city-wide study of
all cases of tuberculosis using traditional contact investigations, geographic
information systems data, and molecular epidemiologic comparison of Mycobacterium tuberculosis isolates with 2 DNA probes. PATIENTS.— One hundred eighty-two patients with culture-positive tuberculosis. MAIN OUTCOME MEASURES.— Proportion of disease defined as recently transmitted based on epidemiologic
linkage by traditional contact tracing and molecular linkage by DNA fingerprint
analysis of isolates; geographic foci of transmission based on linkage of
residences by geographic information systems data. RESULTS.— Of the 182 patients who had isolates of M tuberculosis available, 84 (46%) showed molecular clustering with 58 (32%) defined
as being recently transmitted. Only 20 (24%) of 84 cases with clustered DNA
fingerprints had epidemiologic evidence of recent contact. Geographic analysis
showed significant spatial aggregation of the 20 clustered cases with epidemiologic
links (P |
| doi_str_mv | 10.1001/jama.280.19.1679 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_70093962</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>188175</ama_id><sourcerecordid>36131219</sourcerecordid><originalsourceid>FETCH-LOGICAL-a400t-c665513b9f5d95d82b34d7b1ab815871f361da9225fd0e38d607cebfb6c800eb3</originalsourceid><addsrcrecordid>eNqF0c9LHDEUB_BQLHar3tuDEKT0NmteMpkkR1FrCyt6WA-ehvx4U2eZnVmTGWH_e8O6tODFXEJ4H16S7yPkG7A5MAbnK7u2c67zycyhUuYTmYEUuhDS6AMyY8zoQpW6_EK-prRieYFQh-TQaAHGmBlZ3Q4d-qmzkdo-0Bsc_ka7eWo9vbfjiLFPdGjocnIYsxpSm-gy2j6t25TaoacXTUYUJH1EG3f2qo3ox25L71zC-IKBLp8w99wek8-N7RKe7Pcj8vDrenn5u1jc3fy5vFgUtmRsLHxVSQnCmUYGI4PmTpRBObBOg9QKGlFBsIZz2QSGQoeKKY-ucZXXjKETR-TnW99NHJ4nTGOdH-ux62yPw5RqlVMRpuIfQlA8X1OKDM_ewdUwxT5_ouYAghulVUanezS5NYZ6E9u1jdt6H3Wu_9jXbfK2a3KKvk3_GOSJ8R37_sbyZP8XtQYlxSsp_pWb</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211329787</pqid></control><display><type>article</type><title>Molecular and Geographic Patterns of Tuberculosis Transmission After 15 Years of Directly Observed Therapy</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Bishai, William R ; Graham, Neil M. H ; Harrington, Susan ; Pope, Diana S ; Hooper, Nancy ; Astemborski, Jacqueline ; Sheely, Laura ; Vlahov, David ; Glass, Gregory E ; Chaisson, Richard E</creator><creatorcontrib>Bishai, William R ; Graham, Neil M. H ; Harrington, Susan ; Pope, Diana S ; Hooper, Nancy ; Astemborski, Jacqueline ; Sheely, Laura ; Vlahov, David ; Glass, Gregory E ; Chaisson, Richard E</creatorcontrib><description>CONTEXT.— Recent studies suggest that one third of tuberculosis cases in urban
areas result from recent transmission. Improved tuberculosis control measures
such as uniform implementation of directly observed therapy might reduce the
proportion of cases resulting from recent transmission. OBJECTIVE.— To determine patterns of tuberculosis transmission in Baltimore, Md,
after 15 years of community-based directly observed therapy. DESIGN.— A 30-month (January 1994-June 1996), prospective, city-wide study of
all cases of tuberculosis using traditional contact investigations, geographic
information systems data, and molecular epidemiologic comparison of Mycobacterium tuberculosis isolates with 2 DNA probes. PATIENTS.— One hundred eighty-two patients with culture-positive tuberculosis. MAIN OUTCOME MEASURES.— Proportion of disease defined as recently transmitted based on epidemiologic
linkage by traditional contact tracing and molecular linkage by DNA fingerprint
analysis of isolates; geographic foci of transmission based on linkage of
residences by geographic information systems data. RESULTS.— Of the 182 patients who had isolates of M tuberculosis available, 84 (46%) showed molecular clustering with 58 (32%) defined
as being recently transmitted. Only 20 (24%) of 84 cases with clustered DNA
fingerprints had epidemiologic evidence of recent contact. Geographic analysis
showed significant spatial aggregation of the 20 clustered cases with epidemiologic
links (P<.001), occurring in areas of low socioeconomic
status and high drug use. The 64 cases with clustered DNA fingerprints but
without epidemiologic links shared common risk factors and demographic features
with the 20 clustered patients who did have epidemiologic links. CONCLUSIONS.— Recently transmitted tuberculosis accounts for a high proportion of
tuberculosis cases in Baltimore. Recently transmitted cases occur in geographically
distinct areas of Baltimore, and location-based control efforts may be more
effective than contact tracing for the early identification of cases.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.280.19.1679</identifier><identifier>PMID: 9831999</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adult ; Bacterial diseases ; Baltimore - epidemiology ; Biological and medical sciences ; Cities ; Cluster Analysis ; Contact Tracing ; DNA Fingerprinting ; Drug therapy ; Female ; Human bacterial diseases ; Humans ; Infectious diseases ; Male ; Medical sciences ; Molecular Epidemiology ; Mycobacterium tuberculosis ; Mycobacterium tuberculosis - genetics ; Polymorphism, Restriction Fragment Length ; Prospective Studies ; Regression Analysis ; Risk Factors ; Socioeconomic Factors ; Tuberculosis ; Tuberculosis - epidemiology ; Tuberculosis - prevention & control ; Tuberculosis - transmission ; Tuberculosis and atypical mycobacterial infections</subject><ispartof>JAMA : the journal of the American Medical Association, 1998-11, Vol.280 (19), p.1679-1684</ispartof><rights>1999 INIST-CNRS</rights><rights>Copyright American Medical Association Nov 18, 1998</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a400t-c665513b9f5d95d82b34d7b1ab815871f361da9225fd0e38d607cebfb6c800eb3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.280.19.1679$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.280.19.1679$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,780,784,3338,27922,27923,76259,76262</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1598299$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9831999$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bishai, William R</creatorcontrib><creatorcontrib>Graham, Neil M. H</creatorcontrib><creatorcontrib>Harrington, Susan</creatorcontrib><creatorcontrib>Pope, Diana S</creatorcontrib><creatorcontrib>Hooper, Nancy</creatorcontrib><creatorcontrib>Astemborski, Jacqueline</creatorcontrib><creatorcontrib>Sheely, Laura</creatorcontrib><creatorcontrib>Vlahov, David</creatorcontrib><creatorcontrib>Glass, Gregory E</creatorcontrib><creatorcontrib>Chaisson, Richard E</creatorcontrib><title>Molecular and Geographic Patterns of Tuberculosis Transmission After 15 Years of Directly Observed Therapy</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>CONTEXT.— Recent studies suggest that one third of tuberculosis cases in urban
areas result from recent transmission. Improved tuberculosis control measures
such as uniform implementation of directly observed therapy might reduce the
proportion of cases resulting from recent transmission. OBJECTIVE.— To determine patterns of tuberculosis transmission in Baltimore, Md,
after 15 years of community-based directly observed therapy. DESIGN.— A 30-month (January 1994-June 1996), prospective, city-wide study of
all cases of tuberculosis using traditional contact investigations, geographic
information systems data, and molecular epidemiologic comparison of Mycobacterium tuberculosis isolates with 2 DNA probes. PATIENTS.— One hundred eighty-two patients with culture-positive tuberculosis. MAIN OUTCOME MEASURES.— Proportion of disease defined as recently transmitted based on epidemiologic
linkage by traditional contact tracing and molecular linkage by DNA fingerprint
analysis of isolates; geographic foci of transmission based on linkage of
residences by geographic information systems data. RESULTS.— Of the 182 patients who had isolates of M tuberculosis available, 84 (46%) showed molecular clustering with 58 (32%) defined
as being recently transmitted. Only 20 (24%) of 84 cases with clustered DNA
fingerprints had epidemiologic evidence of recent contact. Geographic analysis
showed significant spatial aggregation of the 20 clustered cases with epidemiologic
links (P<.001), occurring in areas of low socioeconomic
status and high drug use. The 64 cases with clustered DNA fingerprints but
without epidemiologic links shared common risk factors and demographic features
with the 20 clustered patients who did have epidemiologic links. CONCLUSIONS.— Recently transmitted tuberculosis accounts for a high proportion of
tuberculosis cases in Baltimore. Recently transmitted cases occur in geographically
distinct areas of Baltimore, and location-based control efforts may be more
effective than contact tracing for the early identification of cases.</description><subject>Adult</subject><subject>Bacterial diseases</subject><subject>Baltimore - epidemiology</subject><subject>Biological and medical sciences</subject><subject>Cities</subject><subject>Cluster Analysis</subject><subject>Contact Tracing</subject><subject>DNA Fingerprinting</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Molecular Epidemiology</subject><subject>Mycobacterium tuberculosis</subject><subject>Mycobacterium tuberculosis - genetics</subject><subject>Polymorphism, Restriction Fragment Length</subject><subject>Prospective Studies</subject><subject>Regression Analysis</subject><subject>Risk Factors</subject><subject>Socioeconomic Factors</subject><subject>Tuberculosis</subject><subject>Tuberculosis - epidemiology</subject><subject>Tuberculosis - prevention & control</subject><subject>Tuberculosis - transmission</subject><subject>Tuberculosis and atypical mycobacterial infections</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0c9LHDEUB_BQLHar3tuDEKT0NmteMpkkR1FrCyt6WA-ehvx4U2eZnVmTGWH_e8O6tODFXEJ4H16S7yPkG7A5MAbnK7u2c67zycyhUuYTmYEUuhDS6AMyY8zoQpW6_EK-prRieYFQh-TQaAHGmBlZ3Q4d-qmzkdo-0Bsc_ka7eWo9vbfjiLFPdGjocnIYsxpSm-gy2j6t25TaoacXTUYUJH1EG3f2qo3ox25L71zC-IKBLp8w99wek8-N7RKe7Pcj8vDrenn5u1jc3fy5vFgUtmRsLHxVSQnCmUYGI4PmTpRBObBOg9QKGlFBsIZz2QSGQoeKKY-ucZXXjKETR-TnW99NHJ4nTGOdH-ux62yPw5RqlVMRpuIfQlA8X1OKDM_ewdUwxT5_ouYAghulVUanezS5NYZ6E9u1jdt6H3Wu_9jXbfK2a3KKvk3_GOSJ8R37_sbyZP8XtQYlxSsp_pWb</recordid><startdate>19981118</startdate><enddate>19981118</enddate><creator>Bishai, William R</creator><creator>Graham, Neil M. 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H</creatorcontrib><creatorcontrib>Harrington, Susan</creatorcontrib><creatorcontrib>Pope, Diana S</creatorcontrib><creatorcontrib>Hooper, Nancy</creatorcontrib><creatorcontrib>Astemborski, Jacqueline</creatorcontrib><creatorcontrib>Sheely, Laura</creatorcontrib><creatorcontrib>Vlahov, David</creatorcontrib><creatorcontrib>Glass, Gregory E</creatorcontrib><creatorcontrib>Chaisson, Richard E</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bishai, William R</au><au>Graham, Neil M. H</au><au>Harrington, Susan</au><au>Pope, Diana S</au><au>Hooper, Nancy</au><au>Astemborski, Jacqueline</au><au>Sheely, Laura</au><au>Vlahov, David</au><au>Glass, Gregory E</au><au>Chaisson, Richard E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Molecular and Geographic Patterns of Tuberculosis Transmission After 15 Years of Directly Observed Therapy</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>1998-11-18</date><risdate>1998</risdate><volume>280</volume><issue>19</issue><spage>1679</spage><epage>1684</epage><pages>1679-1684</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>CONTEXT.— Recent studies suggest that one third of tuberculosis cases in urban
areas result from recent transmission. Improved tuberculosis control measures
such as uniform implementation of directly observed therapy might reduce the
proportion of cases resulting from recent transmission. OBJECTIVE.— To determine patterns of tuberculosis transmission in Baltimore, Md,
after 15 years of community-based directly observed therapy. DESIGN.— A 30-month (January 1994-June 1996), prospective, city-wide study of
all cases of tuberculosis using traditional contact investigations, geographic
information systems data, and molecular epidemiologic comparison of Mycobacterium tuberculosis isolates with 2 DNA probes. PATIENTS.— One hundred eighty-two patients with culture-positive tuberculosis. MAIN OUTCOME MEASURES.— Proportion of disease defined as recently transmitted based on epidemiologic
linkage by traditional contact tracing and molecular linkage by DNA fingerprint
analysis of isolates; geographic foci of transmission based on linkage of
residences by geographic information systems data. RESULTS.— Of the 182 patients who had isolates of M tuberculosis available, 84 (46%) showed molecular clustering with 58 (32%) defined
as being recently transmitted. Only 20 (24%) of 84 cases with clustered DNA
fingerprints had epidemiologic evidence of recent contact. Geographic analysis
showed significant spatial aggregation of the 20 clustered cases with epidemiologic
links (P<.001), occurring in areas of low socioeconomic
status and high drug use. The 64 cases with clustered DNA fingerprints but
without epidemiologic links shared common risk factors and demographic features
with the 20 clustered patients who did have epidemiologic links. CONCLUSIONS.— Recently transmitted tuberculosis accounts for a high proportion of
tuberculosis cases in Baltimore. Recently transmitted cases occur in geographically
distinct areas of Baltimore, and location-based control efforts may be more
effective than contact tracing for the early identification of cases.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>9831999</pmid><doi>10.1001/jama.280.19.1679</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 1998-11, Vol.280 (19), p.1679-1684 |
| issn | 0098-7484 1538-3598 |
| language | eng |
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| source | MEDLINE; American Medical Association Journals |
| subjects | Adult Bacterial diseases Baltimore - epidemiology Biological and medical sciences Cities Cluster Analysis Contact Tracing DNA Fingerprinting Drug therapy Female Human bacterial diseases Humans Infectious diseases Male Medical sciences Molecular Epidemiology Mycobacterium tuberculosis Mycobacterium tuberculosis - genetics Polymorphism, Restriction Fragment Length Prospective Studies Regression Analysis Risk Factors Socioeconomic Factors Tuberculosis Tuberculosis - epidemiology Tuberculosis - prevention & control Tuberculosis - transmission Tuberculosis and atypical mycobacterial infections |
| title | Molecular and Geographic Patterns of Tuberculosis Transmission After 15 Years of Directly Observed Therapy |
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