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Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014

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...

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Autores principales: Smith, Catherine M, Trienekens, Suzan C M, Anderson, Charlotte, Lalor, Maeve K, Brown, Tim, Story, Alistair, Fry, Hannah, Hayward, Andrew C, Maguire, Helen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Centre for Disease Prevention and Control (ECDC) 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356435/
https://www.ncbi.nlm.nih.gov/pubmed/28251890
http://dx.doi.org/10.2807/1560-7917.ES.2017.22.8.30467
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author Smith, Catherine M
Trienekens, Suzan C M
Anderson, Charlotte
Lalor, Maeve K
Brown, Tim
Story, Alistair
Fry, Hannah
Hayward, Andrew C
Maguire, Helen
author_facet Smith, Catherine M
Trienekens, Suzan C M
Anderson, Charlotte
Lalor, Maeve K
Brown, Tim
Story, Alistair
Fry, Hannah
Hayward, Andrew C
Maguire, Helen
author_sort Smith, Catherine M
collection PubMed
description 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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spelling pubmed-53564352017-03-24 Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014 Smith, Catherine M Trienekens, Suzan C M Anderson, Charlotte Lalor, Maeve K Brown, Tim Story, Alistair Fry, Hannah Hayward, Andrew C Maguire, Helen Euro Surveill Surveillance and Outbreak Report 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. European Centre for Disease Prevention and Control (ECDC) 2017-02-23 /pmc/articles/PMC5356435/ /pubmed/28251890 http://dx.doi.org/10.2807/1560-7917.ES.2017.22.8.30467 Text en This article is copyright of The Authors, 2017. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made.
spellingShingle Surveillance and Outbreak Report
Smith, Catherine M
Trienekens, Suzan C M
Anderson, Charlotte
Lalor, Maeve K
Brown, Tim
Story, Alistair
Fry, Hannah
Hayward, Andrew C
Maguire, Helen
Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014
title Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014
title_full Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014
title_fullStr Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014
title_full_unstemmed Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014
title_short Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014
title_sort twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in england and wales, 1995 to 2014
topic Surveillance and Outbreak Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356435/
https://www.ncbi.nlm.nih.gov/pubmed/28251890
http://dx.doi.org/10.2807/1560-7917.ES.2017.22.8.30467
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