Skip to main content
SpringerLink
Log in

The Tuberculosis Outbreak Response, Investigation, and Control

  • Chapter
  • First Online:
Handbook of Global Tuberculosis Control

  • 935 Accesses

Abstract

Tuberculosis (TB) is a high-priority infectious disease which is targeted by intensive control programs throughout the world. The TB outbreak represents an opportunity for control through strengthened applications of regular measures including case finding, contact tracing, prompt treatment of TB, and prophylaxis of latent infections. Outbreaks often reveal weaknesses in control programs that need full understanding for correction. In that sense, the investigation of TB outbreaks is an important tool to strengthen standard TB control efforts. This chapter describes the 15 steps taken in an investigation of a TB outbreak. These steps involve the determination of an outbreak using surveillance data and genotyping; verifying the diagnosis; assessing and applying control measures; developing, evaluating, and refining hypotheses epidemiologically; and communicating the findings.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Agerton, T., Valway, S., Gore, B., Pozsik, C., Plikaytis, B., Woodley, C., et al. (1997). Transmission of a highly drug-resistant strain (strain W1) of Mycobacterium tuberculosis: Community outbreak and nosocomial transmission via a contaminated bronchoscope. JAMA, 278(13), 1073–1077.

    Article  CAS  PubMed  Google Scholar 

  • Alonso-Echanove, J., Granich, R. M., Laszlo, A., Chu, G., Borja, N., Blas, R., et al. (2001). Occupational transmission of Mycobacterium tuberculosis to health care workers in a university hospital in Lima, Peru. Clinical Infectious Diseases, 33(5), 589–596.

    Article  CAS  PubMed  Google Scholar 

  • Bearman, G., Vaamonde, C., Larone, D., Drusin, L., & Zuccotti, G. (2002). Pseudo-outbreak of multidrug-resistant Mycobacterium tuberculosis associated with presumed laboratory processing contamination. Infection Control & Hospital Epidemiology, 23(10), 620–622.

    Article  Google Scholar 

  • Bergmire-Sweat, D., Barnett, B. J., Harris, S. L., Taylor, J. P., Mazurek, G. H., & Reddy, V. (1996). Tuberculosis outbreak in a Texas prison, 1994. Epidemiology and Infection, 117(03), 485–492.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Binkin, N. J., Ghersi, G., Boeri, V., Lo, M. R., & Salamina, G. (1993). An epidemic of tuberculosis in an elementary school, Sanremo, Italy, 1993. Revue d'Épidémiologie et de Santé Publique, 42(2), 138–143.

    Google Scholar 

  • Bock, N. N., Mallory, J. P., Mobley, N., DeVoe, B., & Taylor, B. B. (1998). Outbreak of tuberculosis associated with a floating card game in the rural south: Lessons for tuberculosis contact investigations. Clinical Infectious Diseases, 27(5), 1221–1226.

    Article  CAS  PubMed  Google Scholar 

  • Brudney, K., & Dobkin, J. (1991). Resurgent tuberculosis in New York City: Human immunodeficiency virus, homelessness, and the decline of tuberculosis control programs. American Review of Respiratory Disease, 144(4), 745–749.

    Article  CAS  PubMed  Google Scholar 

  • Buff, A., & Raviglione, M. (2008). Tuberculosis. In D. L. Heymann (Ed.), Control of communicable disease manual (19th ed., pp. 639–658). Washington, DC: American Public Health Association.

    Google Scholar 

  • Calder, L., Hampton, L., Prentice, D., Reeve, M., Vaughan, A., Vaughan, R., et al. (2000). A school and community outbreak of tuberculosis in Auckland. New Zealand Medical Journal, 113(1105), 71–74.

    CAS  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (1991a). Nosocomial transmission of multidrug-resistant tuberculosis among HIV-infected persons—Florida and New York, 1988–1991. MMWR. Morbidity and Mortality Weekly Report, 40(34), 585–591.

    Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (1991b). Tuberculosis outbreak among persons in a residential facility for HIV-infected persons—San Francisco. MMWR. Morbidity and Mortality Weekly Report, 40(38), 649–652.

    Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (1993). Outbreak of multidrug-resistant tuberculosis at a hospital—New York City, 1991. MMWR. Morbidity and Mortality Weekly Report, 42(22), 427–433.

    Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (2000). Drug-susceptible tuberculosis outbreak in a state correctional facility housing HIV-infected inmates-South Carolina, 1999–2000. MMWR. Morbidity and Mortality Weekly Report, 49(46), 1041–1044.

    Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (2004). Tuberculosis outbreak in a community hospital—District of Columbia, 2002. Morbidity and Mortality Weekly Report, 53(10), 214–216.

    Google Scholar 

  • Cook, S. A., Blair, I., & Tyers, M. (2000). Outbreak of tuberculosis associated with a church. Communicable Disease and Public Health, 3, 181–183.

    CAS  PubMed  Google Scholar 

  • Cronin, W., Rodriguez, E., Valway, S., Bur, S., Hooper, N., Smithwick, R., et al. (1998). Pseudo-outbreak of tuberculosis in an acute-care general hospital: Epidemiology and clinical implications. Infection Control & Hospital Epidemiology, 19(5), 345–347.

    Article  CAS  Google Scholar 

  • Curtis, A. B., Ridzon, R., Novick, L. F., Driscoll, J., Blair, D., Oxtoby, M., et al. (2000). Analysis of Mycobacterium tuberculosis transmission patterns in a homeless shelter outbreak. The International Journal of Tuberculosis and Lung Disease, 4(4), 308–313.

    CAS  PubMed  Google Scholar 

  • Daley, C. L., Small, P. M., Schecter, G. F., Schoolnik, G. K., McAdam, R. A., Jacobs, W. R., Jr., et al. (1992). An outbreak of tuberculosis with accelerated progression among persons infected with the human immunodeficiency virus: An analysis using restriction-fragment—Length polymorphisms. New England Journal of Medicine, 326(4), 231–235.

    Article  CAS  PubMed  Google Scholar 

  • Dewan, P. K., Banouvong, H., Abernethy, N., Hoynes, T., Diaz, L., Woldemariam, M., et al. (2006). A tuberculosis outbreak in a private-home family child care center in San Francisco, 2002 to 2004. Pediatrics, 117(3), 863–869.

    Article  PubMed  Google Scholar 

  • Díaz, R., Gómez, R. I., GarcÍa, N., Valdivia, J. A., & Van Soolingen, D. (2001). Molecular epidemiological study on transmission of tuberculosis in a hospital for mentally handicapped patients in Havana, Cuba. Journal of Hospital Infection, 49(1), 30–36.

    Google Scholar 

  • Dicker, R., Coronado, F., Koo, D., & Parrish, R. G. (2006). Principles of epidemiology in public health practice: An introduction to applied epidemiology and biostatistics (3rd ed.). Atlanta, GA: US Department of Health Education and Welfare, Centers for Disease Control and Prevention.

    Google Scholar 

  • DiStasio, A. J., II, & Trump, D. H. (1990). The investigation of a tuberculosis outbreak in the closed environment of a US Navy ship, 1987. Military Medicine, 155(8), 347–351.

    PubMed  Google Scholar 

  • Dobbs, K. G., Lok, K. H., Bruce, F., Mulcahy, D., Benjamin, W. H., & Dunlap, N. E. (2001). Value of Mycobacterium tuberculosis fingerprinting as a tool in a rural state surveillance program. CHEST Journal, 120(6), 1877–1882.

    Article  CAS  Google Scholar 

  • Duthie, S., Black, C., Douglas, G., Jackson, A. D., & Webster, D. (2008). Tuberculosis outbreak associated with a mosque: Challenges of large scale contact tracing. Eurosurveillance, 13(51). Retrieved May 7, 2015, from http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19069

  • Dutt, A. K., Mehta, J. B., Whitaker, B. J., & Westmoreland, H. (1995). Outbreak of tuberculosis in a church. CHEST, 107(2), 447–452.

    Article  CAS  PubMed  Google Scholar 

  • Fitzpatrick, L. K., Hardacker, J. A., Heirendt, W., Agerton, T., Streicher, A., Melnyk, H., et al. (2001). A preventable outbreak of tuberculosis investigated through an intricate social network. Clinical Infectious Diseases, 33(11), 1801–1806.

    Article  CAS  PubMed  Google Scholar 

  • Freeman, R., Kato-Maeda, M., Hauge, K. A., Horan, K. L., Oren, E., Narita, M., et al. (2005). Use of rapid genomic deletion typing to monitor a tuberculosis outbreak within an urban homeless population. Journal of Clinical Microbiology, 43(11), 5550–5554.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Frieden, T. R., Sherman, L. F., Maw, K. L., Fujiwara, P. I., Crawford, J. T., Nivin, B., et al. (1996). A multi-institutional outbreak of highly drug-resistant tuberculosis: Epidemiology and clinical outcomes. JAMA, 276(15), 1229–1235.

    Article  CAS  PubMed  Google Scholar 

  • Gardy, J. L., Johnston, J. C., Sui, S. J. H., Cook, V. J., Shah, L., Brodkin, E., et al. (2011). Whole-genome sequencing and social-network analysis of a tuberculosis outbreak. New England Journal of Medicine, 364(8), 730–739.

    Article  CAS  PubMed  Google Scholar 

  • Gillman, A., Berggren, I., Bergström, S. E., Wahlgren, H., & Bennet, R. (2008). Primary tuberculosis infection in 35 children at a Swedish day care center. The Pediatric Infectious Disease Journal, 27(12), 1078–1082.

    Article  PubMed  Google Scholar 

  • Giovanni, D., Danzi, M. C., De Checchi, G., Pizzighella, S., Solbiati, M., Cruciani, M., et al. (1989). Nosocomial epidemic of active tuberculosis among HIV-infected patients. The Lancet, 334(8678), 1502–1504.

    Article  Google Scholar 

  • Haas, D. W., Milton, S., Kreiswirth, B. N., Brinsko, V. L., Bifani, P. J., & Schaffner, W. (1998). Nosocomial transmission of a drug-sensitive W-variant Mycobacterium tuberculosis strain among patients with acquired immunodeficiency syndrome in Tennessee. Infection Control & Hospital Epidemiology, 19(9), 635–639.

    Article  CAS  Google Scholar 

  • Haley, C. E., McDonald, R. C., Rossi, L., Jones, W. D., Haley, R. W., & Luby, J. P. (1989). Tuberculosis epidemic among hospital personnel. Infection Control & Hospital Epidemiology, 10(5), 204–210.

    Article  CAS  Google Scholar 

  • Hannan, M. M., Peres, H., Maltez, F., Hayward, A. C., Machado, J., Morgado, A., et al. (2001). Investigation and control of a large outbreak of multi-drug resistant tuberculosis at a central Lisbon hospital. Journal of Hospital Infection, 47(2), 91–97.

    Article  CAS  PubMed  Google Scholar 

  • Huang, W. L., Jou, R., Yeh, P. F., & Huang, A. (2007). Laboratory investigation of a nosocomial transmission of tuberculosis at a district general hospital. Journal of the Formosan Medical Association, 106(7), 520–527.

    Article  PubMed  Google Scholar 

  • Ijaz, K., Dillaha, J. A., Yang, Z., Cave, M. D., & Bates, J. H. (2002). Unrecognized tuberculosis in a nursing home causing death with spread of tuberculosis to the community. Journal of the American Geriatrics Society, 50(7), 1213–1218.

    Article  PubMed  Google Scholar 

  • Ikeda, R. M., Birkhead, G. S., DiFerdinando, G. T., Bornstein, D. L., Dooley, S. W., Kubica, G. P., et al. (1995). Nosocomial tuberculosis: An outbreak of a strain resistant to seven drugs. Infection Control & Hospital Epidemiology, 16(3), 152–159.

    Article  CAS  Google Scholar 

  • Kearns, A. M., Barrett, A., Marshall, C., Freeman, R., Magee, J. G., Bourke, S. J., et al. (2000). Epidemiology and molecular typing of an outbreak of tuberculosis in a hostel for homeless men. Journal of Clinical Pathology, 53(2), 122–124.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Kiers, A., Drost, A. P., Van Soolingen, D., & Veen, J. (1997). Use of DNA fingerprinting in international source case finding during a large outbreak of tuberculosis in The Netherlands. The International Journal of Tuberculosis and Lung Disease, 1(3), 239–245.

    CAS  PubMed  Google Scholar 

  • Kline, S. E., Hedemark, L. L., & Davies, S. F. (1995). Outbreak of tuberculosis among regular patrons of a neighborhood bar. New England Journal of Medicine, 333(4), 222–227.

    Article  CAS  PubMed  Google Scholar 

  • Klovdahl, A. S., Graviss, E. A., Yaganehdoost, A., Ross, M. W., Wanger, A., Adams, G. J., et al. (2001). Networks and tuberculosis: An undetected community outbreak involving public places. Social Science & Medicine, 52(5), 681–694.

    Article  CAS  Google Scholar 

  • Lamar, J. E., II, & Malakooti, M. A. (2003). Tuberculosis outbreak investigation of a US Navy amphibious ship crew and the Marine expeditionary unit aboard, 1998. Military Medicine, 168(7), 523–527.

    PubMed  Google Scholar 

  • Luby, S., Carmichael, S., Shaw, G., Horan, J., Gamble, W., Jr., & Jones, J. (1994). A nosocomial outbreak of Mycobacterium tuberculosis. The Journal of Family Practice, 39(1), 21–25.

    CAS  PubMed  Google Scholar 

  • Macaraig, M., Agerton, T., Driver, C. R., Munsiff, S. S., Park, J., Kreiswirth, B., et al. (2006). Strain-specific differences in two large Mycobacterium tuberculosis genotype clusters in isolates collected from homeless patients in New York City from 2001 to 2004. Journal of Clinical Microbiology, 44(8), 2890–2896.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Malakmadze, N., González, I. M., Oemig, T., Isiadinso, I., Rembert, D., McCauley, M. M., et al. (2005). Unsuspected recent transmission of tuberculosis among high-risk groups: Implications of universal tuberculosis genotyping in its detection. Clinical Infectious Diseases, 40(3), 366–373.

    Article  PubMed  Google Scholar 

  • Mangura, B. T., Napolitano, E. C., McDonald, R. J., Passannante, M. R., & Reichman, L. B. (1998). Mycobacterium tuberculosis miniepidemic in a church gospel choir. CHEST, 113(1), 234–237.

    Article  CAS  PubMed  Google Scholar 

  • Mazurek, G. H., Jereb, J., Vernon, A., LoBue, P., Goldberg, S., & Castro, K. (2010). Updated guidelines for using interferon gamma release assays to detect Mycobacterium tuberculosis infection—United States, 2010. Recommendations and Reports, 59(RR-5), 1–25.

    PubMed  Google Scholar 

  • McElroy, P. D., Sterling, T. R., Driver, C. R., Kreiswirth, B., Woodley, C. L., Cronin, W. A., et al. (2002). Use of DNA fingerprinting to investigate a multiyear, multistate tuberculosis outbreak. Emerging Infectious Diseases, 8(11), 1152–1156.

    Article  PubMed Central  Google Scholar 

  • McNabb, S. J., Kammerer, J. S., Hickey, A. C., Braden, C. R., Shang, N., Rosenblum, L. S., et al. (2004). Added epidemiologic value to tuberculosis prevention and control of the investigation of clustered genotypes of Mycobacterium tuberculosis isolates. American Journal of Epidemiology, 160(6), 589–597.

    Article  PubMed  Google Scholar 

  • Nivin, B., Nicholas, P., Gayer, M., Frieden, T. R., & Fujiwara, P. I. (1998). A continuing outbreak of multidrug-resistant tuberculosis, with transmission in a hospital nursery. Clinical Infectious Diseases, 26(2), 303–307.

    Article  CAS  PubMed  Google Scholar 

  • Nolan, C. M., Elarth, A. M., Barr, H., Saeed, A. M., & Risser, D. R. (1991). An outbreak of tuberculosis in a shelter for homeless men. American Review of Respiratory Disease, 143, 257–261.

    Article  CAS  PubMed  Google Scholar 

  • Phillips, L., Carlile, J., & Smith, D. (2004). Epidemiology of a tuberculosis outbreak in a rural Missouri high school. Pediatrics, 113(6), e514–e519.

    Article  PubMed  Google Scholar 

  • Reves, R., Blakey, D., Snider, D. E., Jr., & Farer, L. S. (1981). Transmission of multiple drug-resistant tuberculosis: Report of a school and community outbreak. American Journal of Epidemiology, 113(4), 423–435.

    Article  CAS  PubMed  Google Scholar 

  • Ridzon, R., Kent, J. H., Valway, S., Weismuller, P., Maxwell, R., Elcock, M., et al. (1997). Outbreak of drug-resistant tuberculosis with second-generation transmission in a high school in California. The Journal of Pediatrics, 131(6), 863–868.

    Article  CAS  PubMed  Google Scholar 

  • Ruddy, M. C., Davies, A. P., Yates, M. D., Yates, S., Balasegaram, S., Drabu, Y., et al. (2004). Outbreak of isoniazid resistant tuberculosis in north London. Thorax, 59(4), 279–285.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Sacks, J. J., Brenner, E. R., Breeden, D. C., Anders, H. M., & Parker, R. L. (1985). Epidemiology of a tuberculosis outbreak in a South Carolina junior high school. American Journal of Public Health, 75(4), 361–365.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Segal-Maurer, S., Kreiswirth, B. N., Burns, J. M., Lavie, S., Lim, M., Urban, C., et al. (1998). Mycobacterium tuberculosis specimen contamination revisited: The role of laboratory environmental control in a pseudo-outbreak. Infection Control & Hospital Epidemiology, 19(2), 101–105.

    Article  CAS  Google Scholar 

  • Shears, P., Rhodes, L. E., Syed, Q., & Watson, J. (1994). A pseudo outbreak of tuberculosis. Communicable Disease Report CDR Review, 4(1), R9–R10.

    CAS  PubMed  Google Scholar 

  • Sosa, L. E., Lobato, M. N., Condren, T., Williams, M. N., & Hadler, J. L. (2008). Outbreak of tuberculosis in a correctional facility: Consequences of missed opportunities [Short Communication]. The International Journal of Tuberculosis and Lung Disease, 12(6), 689–691.

    CAS  PubMed  Google Scholar 

  • Stein-Zamir, C., Volovik, I., Rishpon, S., Atamna, A., Lavy, A., & Weiler-Ravell, D. (2006). Tuberculosis outbreak among students in a boarding school. European Respiratory Journal, 28(5), 986–991.

    Article  CAS  PubMed  Google Scholar 

  • Sterling, T. R., Stanley, R. L., Thompson, D., Brubach, G. A., Madison, A., Harrington, S., et al. (2000a). HIV-related tuberculosis in a transgender network—Baltimore, Maryland, and New York City area, 1998–2000. Morbidity and Mortality Weekly Report, 49(15), 317–320.

    Google Scholar 

  • Sterling, T. R., Thompson, D., Stanley, R. L., McElroy, P. D., Madison, A., Moore, K., et al. (2000b). A multi-state outbreak of tuberculosis among members of a highly mobile social network: Implications for tuberculosis elimination. The International Journal of Tuberculosis and Lung Disease, 4(11), 1066–1073.

    CAS  PubMed  Google Scholar 

  • Valway, S. E., Richards, S. B., Kovacovich, J., Greifinger, R. B., Crawford, J. T., & Dooley, S. W. (1994). Outbreak of multi-drug-resistant tuberculosis in a New York State prison, 1991. American Journal of Epidemiology, 140(2), 113–122.

    Article  CAS  PubMed  Google Scholar 

  • Zaza, S., Blumberg, H. M., Beck-Sagué, C., Haas, W. H., Woodley, C. L., Pineda, M., et al. (1995). Nosocomial transmission of Mycobacterium tuberculosis: Role of health care workers in outbreak propagation. Journal of Infectious Diseases, 172(6), 1542–1549.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. United States Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E93, Atlanta, GA, 30329, USA

    Robert E. Fontaine M.D.

  2. Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China

    Robert E. Fontaine M.D.

Authors
  1. Robert E. Fontaine M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert E. Fontaine M.D. .

Editor information

Editors and Affiliations

  1. Haikou VTI Biological Institute, Boston, Massachusetts, USA

    Yichen Lu

  2. Chinese Nat’l Ctr Disease Control and Prevention, Nat’l Center for TB Control & Prevention Chinese Nat’l Ctr Disease Control and Prevention, Beijing, China

    Lixia Wang

  3. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

    Hongjin Duanmu

  4. Brookline, Massachusetts, USA

    Chris Chanyasulkit

  5. Vaccine Technologies, Inc., Wellesley, Massachusetts, USA

    Amie J. Strong

  6. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

    Hui Zhang

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer Science+Business Media LLC

About this chapter

Cite this chapter

Fontaine, R.E. (2017). The Tuberculosis Outbreak Response, Investigation, and Control. In: Lu, Y., Wang, L., Duanmu, H., Chanyasulkit, C., Strong, A., Zhang, H. (eds) Handbook of Global Tuberculosis Control. Springer, Boston, MA. https://doi.org/10.1007/978-1-4939-6667-7_22

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-6667-7_22

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4939-6665-3

  • Online ISBN: 978-1-4939-6667-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation