Molecular and geographic patterns of tuberculosis transmission after 15 years of directly observed therapy

William Ramses Bishai, Neil M H Graham, Susan Harrington, Diana S. Pope, Nancy Hooper, Jacqueline Astemborski, Laura Sheely, David Vlahov, Gregory E. Glass, Richard E Chaisson

Research output: Contribution to journalArticle

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

Original languageEnglish (US)
Pages (from-to)1679-1684
Number of pages6
JournalJournal of the American Medical Association
Volume280
Issue number19
StatePublished - Nov 18 1998

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Directly Observed Therapy
Tuberculosis
Geographic Information Systems
DNA Fingerprinting
Contact Tracing
Baltimore
DNA Probes
Mycobacterium tuberculosis
Cluster Analysis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Molecular and geographic patterns of tuberculosis transmission after 15 years of directly observed therapy. / Bishai, William Ramses; Graham, Neil M H; Harrington, Susan; Pope, Diana S.; Hooper, Nancy; Astemborski, Jacqueline; Sheely, Laura; Vlahov, David; Glass, Gregory E.; Chaisson, Richard E.

In: Journal of the American Medical Association, Vol. 280, No. 19, 18.11.1998, p. 1679-1684.

Research output: Contribution to journalArticle

Bishai, WR, Graham, NMH, Harrington, S, Pope, DS, Hooper, N, Astemborski, J, Sheely, L, Vlahov, D, Glass, GE & Chaisson, RE 1998, 'Molecular and geographic patterns of tuberculosis transmission after 15 years of directly observed therapy', Journal of the American Medical Association, vol. 280, no. 19, pp. 1679-1684.
Bishai, William Ramses ; Graham, Neil M H ; Harrington, Susan ; Pope, Diana S. ; Hooper, Nancy ; Astemborski, Jacqueline ; Sheely, Laura ; Vlahov, David ; Glass, Gregory E. ; Chaisson, Richard E. / Molecular and geographic patterns of tuberculosis transmission after 15 years of directly observed therapy. In: Journal of the American Medical Association. 1998 ; Vol. 280, No. 19. pp. 1679-1684.
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