Exploring genotype concordance in epidemiologically linked cases of tuberculosis in New York City.

Comparing genotype results of tuberculosis (TB) isolates from individuals diagnosed with TB can support or refute transmission; however, these conclusions are based upon the criteria used to define a genotype match. We used a genotype-match definition which allowed for variation in IS6110 restriction fragment length polymorphism (RFLP) to support transmission between epidemiologically linked persons. Contacts of individuals with infectious TB (index cases) diagnosed in New York City from 1997 to 2003 who subsequently developed TB (contact cases) from 1997 to 2007 were identified. For each contact case and index case (case-pair), isolate genotypes (spoligotype and RFLP results) were evaluated. Isolates from case-pairs were classified as exact or non-exact genotype match. Genotypes from non-exact match case-pairs were reviewed at the genotyping laboratory to determine if the isolates met the near-genotype-match criteria (exactly matching spoligotype and similar RFLP banding patterns). Of 118 case-pairs identified, isolates from 83 (70%) had exactly matching genotypes and 14 (12%) had nearly matching genotypes (supporting transmission), while the remaining 21 (18%) case-pairs had discordant genotypes (refuting transmission). Using identical genotype-match criteria for isolates from case-pairs epidemiologically linked through contact investigation may lead to underestimation of transmission. TB programmes should consider the value of expanding genotype-match criteria to more accurately assess transmission between such cases.

Characteristics and TB treatment outcomes in TB patients with viral hepatitis, New York City, 2000-2010.

Literature surrounding the burden of and factors associated with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in persons with tuberculosis (TB) disease remains limited and focused on populations outside the USA. Cross-matched New York City (NYC) TB and viral hepatitis surveillance data were used to estimate the proportion of NYC adults diagnosed with TB from 2000 to 2010 with a report of viral hepatitis infection and to describe the impact of viral hepatitis infection on TB treatment completion and death. For 9512 TB patients, HCV infection was reported in 4.2% and HBV infection in 3.7%; <1% of TB patients had both HCV and HBV infection. The proportion of TB patients with HCV infection to die before TB treatment completion was larger than in TB patients without a viral hepatitis report (21% vs. 9%); this association remained when stratified by HIV status. There was no significant difference in death before treatment completion for TB patients with HBV infection compared to TB patients without a viral hepatitis report when stratified by HIV status. These findings reinforce the importance of hepatitis testing and providing additional support to TB patients with viral hepatitis infection.

Epidemiology of tuberculosis among healthcare personnel in New York City.

BACKGROUND: We have updated the epidemiology of tuberculosis (TB) among healthcare personnel (HCP) in New York City (NYC), USA, during a period of declining TB burden.METHODS: Using routinely collected Health Department data for NYC TB cases from 2001 to 2014, we conducted a retrospective descriptive analysis. P values were calculated using Pearson's χ² or Fisher's exact test for categorical data; Wilcoxon rank-sum test was used to compare medians. We used the Cochran-Armitage test for trend and linear regression for trend analyses.RESULTS: HCP accounted for 6% of adults with TB throughout the study period and were more likely than other adults to be female (68% vs. 37%, P ≤ 0.0001), have extrapulmonary-only disease (31% vs. 23%, P ≤ 0.0001), have an isolate with multidrug resistance (4% vs. 2%, P = 0.0211), and report a previous history of latent TB infection (LTBI) (51% vs. 23%, P ≤ 0.0001). Compared to non-US-born HCP, US-born HCP were more likely to have HIV infection (18% vs. 8%, P = 0.0011) or a genotypically clustered isolate (67% vs. 37%, P ≤ 0.0001) and less likely to report history of prior LTBI (43% vs. 54%, P = 0.0128).CONCLUSIONS: Further research is needed to explore transmission and occupational risk among HCP. New approaches are needed to optimize completion of prophylaxis for HCP with LTBI.