Identification of a W Variant Outbreak of Mycobacterium tuberculosis via Population-Based Molecular Epidemiology

• Published in: JAMA : the journal of the American Medical Association Vol. 282; no. 24; pp. 2321 - 2327
• Main Authors: Bifani, Pablo J, Mathema, Barun, Liu, Zhiyuan, Moghazeh, Soraya L, Shopsin, Bo, Tempalski, Barbara, Driscoll, Jeffrey, Frothingham, Richard, Musser, James M, Alcabes, Philip, Kreiswirth, Barry N
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 22-12-1999
• Subjects: Adult; AIDS/HIV; Bacterial diseases; Bacterial Typing Techniques; Biological and medical sciences; Biotechnology; Blotting, Southern; Cross-Sectional Studies; Disease Outbreaks; DNA Fingerprinting; DNA, Bacterial - analysis; Epidemics; Female; Fundamental and applied biological sciences. Psychology; Genetic engineering; Genetic technics; Genotype; Human bacterial diseases; Humans; In vitro gene amplification. Pcr technique; Infectious diseases; Male; Medical research; Medical sciences; Methods. Procedures. Technologies; Molecular Epidemiology; Mycobacterium tuberculosis; Mycobacterium tuberculosis - classification; Mycobacterium tuberculosis - genetics; New Jersey - epidemiology; New York - epidemiology; Population Surveillance; Repetitive Sequences, Nucleic Acid; Surveillance; Tuberculosis; Tuberculosis - epidemiology; Tuberculosis - microbiology; Tuberculosis and atypical mycobacterial infections; USA, New Jersey; United States; North America; New Jersey; America; New York; United States > US; Human; Infection; Typing; Mycobacterium tuberculosis; Mycobacteriales; Cross sectional study; Mycobacteriaceae; Bacteria; Actinomycetes; Molecular biology; Epidemiology
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.282.24.2321

CONTEXT Typing of Mycobacterium tuberculosis could
provide a more sensitive means of identifying outbreaks than use of conventional
surveillance techniques alone. Variants of the New York City W strain of M tuberculosis were identified in New Jersey. OBJECTIVE To describe the spread of the W family of M tuberculosis strains in New Jersey identified by molecular typing and surveillance
data. DESIGN Population-based cross-sectional study. SETTING AND SUBJECTS All incident culture-positive tuberculosis cases reported in New Jersey
from January 1996 to September 1998, for which the W family was defined by
insertion sequence (IS) IS6110 DNA fingerprinting,
polymorphic GC-rich repetitive sequence (PGRS) typing, spacer oligotyping
(spoligotyping), and variable number tandem repeat (VNTR) analysis. MAIN OUTCOME MEASURE Identification and characterization of W family clones supplemented
by surveillance data. RESULTS Isolates from 1207 cases were analyzed, of which 68 isolates (6%) belonged
to the W family based on IS6110 and spoligotype hybridization
patterns. The IS6110 hybridization patterns or fingerprints
revealed that 43 patients (designated group A) shared a unique banding motif
not present in other W family isolates. Strains collected from the remaining
25 patients (designated group B), while related to W, displayed a variety
of IS6110 patterns and did not share this motif.
The PGRS and VNTR typing confirmed the division of the W family into groups
A and B and again showed group A strains to be closely related and group B
strains to be more diverse. The demographic characteristics of individuals
from groups A and B were specific and defined. Group A patients were more
likely than group B patients to be US born (91% vs 24%, P<.001), black (76% vs 16%, P<.001),
human immunodeficiency virus positive (40% vs 0%, P
= .007), and residents of urban northeast New Jersey counties (P<.001). Patients with group B strains were primarily non-US born,
of Asian descent, and more dispersed throughout New Jersey. No outbreak had
been detected using conventional surveillance alone. CONCLUSIONS The implementation of multiple molecular techniques in conjunction with
surveillance data enabled us to identify a previously undetected outbreak
in a defined geographical setting. The outbreak isolates comprise members
of a distinct branch of the W family phylogenetic lineage. The use of molecular
strain typing provides a proactive approach that may be used to initiate,
and not just augment, traditional surveillance outbreak investigations.