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Surveillance and outbreak report Open Access
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Abstract

An outbreak of isoniazid-resistant tuberculosis first identified in London has now been ongoing for 20 years, making it the largest drug-resistant outbreak of tuberculosis documented to date worldwide. We identified culture-confirmed cases with indistinguishable molecular strain types and extracted demographic, clinical, microbiological and social risk factor data from surveillance systems. We summarised changes over time and used kernel-density estimation and k-function analysis to assess geographic clustering. From 1995 to 2014, 508 cases were reported, with a declining trend in recent years. Overall, 70% were male (n = 360), 60% born in the United Kingdom (n = 306), 39% white (n = 199), and 26% black Caribbean (n = 134). Median age increased from 25 years in the first 5 years to 42 in the last 5. Approximately two thirds of cases reported social risk factors: 45% drug use (n = 227), 37% prison link (n = 189), 25% homelessness (n = 125) and 13% alcohol dependence (n = 64). Treatment was completed at 12 months by 52% of cases (n = 206), and was significantly lower for those with social risk factors (p < 0.05), but increased over time for all patients (p < 0.05). The outbreak remained focused in north London throughout. Control of this outbreak requires continued efforts to prevent and treat further active cases through targeted screening and enhanced case management.

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/content/10.2807/1560-7917.ES.2017.22.8.30467
2017-02-23
2017-10-19
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2017.22.8.30467
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References

  1. European Centre for Disease Prevention and Control (ECDC) / WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe in 2014. Stockholm: ECDC; 2014. Available from: http://ecdc.europa.eu/en/publications/Publications/tuberculosis-surveillance-monitoring-Europe-2014.pdf
  2. Public Health England (PHE). Tuberculosis in England: 2015 report. London: PHE; 2015. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/564649/TB_annual_report_2015.pdf
  3. Van Rie A, Warren R, Richardson M, Gie RP, Enarson DA, Beyers N, et al. Classification of drug-resistant tuberculosis in an epidemic area. Lancet. 2000;356(9223):22-5.  https://doi.org/10.1016/S0140-6736(00)02429-6  PMID: 10892760 
  4. Public Health England (PHE). Tuberculosis in the UK 2014 report. London: PHE; 2014. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/360335/TB_Annual_report__4_0_300914.pdf
  5. Ruddy MC, Davies AP, Yates MD, Yates S, Balasegaram S, Drabu Y, et al. Outbreak of isoniazid resistant tuberculosis in north London. Thorax. 2004;59(4):279-85.  https://doi.org/10.1136/thx.2003.010405  PMID: 15047945 
  6. Public Health England (PHE). Tuberculosis in London: Annual review (2013 data). London: PHE; 2014. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/385823/2014_10_30_TB_London_2013_data__1_.pdf
  7. Maguire H, Brailsford S, Carless J, Yates M, Altass L, Yates S, et al. Large outbreak of isoniazid-monoresistant tuberculosis in London, 1995 to 2006: case-control study and recommendations. Euro Surveill. 2011;16(13):19830. PMID: 21489373 
  8. Neely F, Maguire H, Le Brun F, Davies A, Gelb D, Yates S. High rate of transmission among contacts in large London outbreak of isoniazid mono-resistant tuberculosis. J Public Health (Oxf). 2010;32(1):44-51.  https://doi.org/10.1093/pubmed/fdp056  PMID: 19542269 
  9. Davies A, Ruddy MC, Neely F, Ruggles R, Maguire H. Outbreak of isoniazid resistant Mycobacterium tuberculosis in north London 1999-2004. Executive summary report key points and recommendations. London: Health Protection Agency. [Accessed 8 Dec 2014]. Available from: http://webarchive.nationalarchives.gov.uk/20140714084352/http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947410877
  10. Jit M, Stagg HR, Aldridge RW, White PJ. Abubakar. Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation. BMJ. 2011;343(sep13 5):d5376.  https://doi.org/10.1136/bmj.d5376  PMID: 22067473 
  11. Diggle PJ. Statistical analysis of spatial point patterns. 2nd ed. London: Arnold; 2003.
  12. Ripley BD. Modelling spatial patterns (with discussion). Journal of the Royal Statistical Society. 1977;Series B(39):172-212.
  13. Baddeley A, Turner R. spatstat: An R Package for Analyzing Spatial Point Patterns. J Stat Softw. 2005;12(6):1-42.  https://doi.org/10.18637/jss.v012.i06 
  14. World Health Organization (WHO). Tuberculosis Fact Sheet. Geneva: WHO; 2014 [Accessed 10 Feb 2015]. Available from: http://www.who.int/mediacentre/factsheets/fs104/en/
  15. National Institute for Health and Clinical Excellence (NICE). Identifying and managing tuberculosis among hard-to-reach groups. Manchester: NICE; 2012. Available from: https://www.nice.org.uk/guidance/ng33/evidence/appendix-n-ph37-80851860866
  16. Satta G, Witney AA, Shorten RJ, Karlikowska M, Lipman M, McHugh TD. Genetic variation in Mycobacterium tuberculosis isolates from a London outbreak associated with isoniazid resistance. BMC Med. 2016;14(1):117.  https://doi.org/10.1186/s12916-016-0659-6  PMID: 27530812 
  17. Walker TM, Ip CLC, Harrell RH, Evans JT, Kapatai G, Dedicoat MJ, et al. Whole-genome sequencing to delineate Mycobacterium tuberculosis outbreaks: a retrospective observational study. Lancet Infect Dis. 2013;13(2):137-46.  https://doi.org/10.1016/S1473-3099(12)70277-3  PMID: 23158499 
  18. Frieden TR, Sherman LF, Maw KL, Fujiwara PI, Crawford JT, Nivin B, et al. A multi-institutional outbreak of highly drug-resistant tuberculosis: epidemiology and clinical outcomes. JAMA. 1996;276(15):1229-35.  https://doi.org/10.1001/jama.1996.03540150031027  PMID: 8849750 
  19. Edlin BR, Tokars JI, Grieco MH, Crawford JT, Williams J, Sordillo EM, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med. 1992;326(23):1514-21.  https://doi.org/10.1056/NEJM199206043262302  PMID: 1304721 
  20. Centers for Disease Control. Outbreak of hospital acquired multidrug resistant tuberculosis. Commun Dis Rep CDR Wkly. 1995;5(34):161. PMID: 7550589 
  21. Moodley P, Shah NS, Tayob N, Connolly C, Zetola N, Gandhi N, et al. Spread of extensively drug-resistant tuberculosis in KwaZulu-Natal province, South Africa. PLoS One. 2011;6(5):e17513.  https://doi.org/10.1371/journal.pone.0017513  PMID: 21655324 
  22. Gandhi NR, Moll A, Sturm AW, Pawinski R, Govender T, Lalloo U, et al. Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet. 2006;368(9547):1575-80.  https://doi.org/10.1016/S0140-6736(06)69573-1  PMID: 17084757 
  23. Ghebremichael S, Petersson R, Koivula T, Pennhag A, Romanus V, Berggren I, et al. Molecular epidemiology of drug-resistant tuberculosis in Sweden. Microbes Infect. 2008;10(6):699-705.  https://doi.org/10.1016/j.micinf.2008.03.006  PMID: 18485780 
  24. Kan B, Berggren I, Ghebremichael S, Bennet R, Bruchfeld J, Chryssanthou E, et al. Extensive transmission of an isoniazid-resistant strain of Mycobacterium tuberculosis in Sweden. Int J Tuberc Lung Dis. 2008;12(2):199-204. PMID: 18230254 
  25. Goodburn A, Drennan V. The use of directly observed therapy in TB: a brief pan-London survey. Nurs Stand. 2000;14(46):36-8.  https://doi.org/10.7748/ns2000.08.14.46.36.c2892  PMID: 11974132 
  26. van Hest NA, Aldridge RW, de Vries G, Sandgren A, Hauer B, Hayward A, et al. Tuberculosis control in big cities and urban risk groups in the European Union: a consensus statement. Euro Surveill. 2014;19(9):20728.  https://doi.org/10.2807/1560-7917.ES2014.19.9.20728  PMID: 24626210 
  27. Public Health England (PHE). NHS England. Collaborative Tuberculosis Strategy for England 2015 to 2020. London: PHE; 2015. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/403231/Collaborative_TB_Strategy_for_England_2015_2020_.pdf
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