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Task Order 8: An analysis of molecular epidemiology of multi-drug resistant M. tuberculosis in the United States

The purpose of the Task Order 8 research project is to develop a comprehensive national tuberculosis (TB) genotyping registry for TB case-patients with multidrug-resistant M. tuberculosis (MDR-TB ) and to assess the molecular epidemiology of MDR-TB in the United States (U.S.). It is anticipated that this ongoing surveillance of MDR-TB cases through collection of genotyping data and epidemiologic investigations will help clarify the dynamics of MDR-TB transmission, factors contributing to spread, and identify and evaluate potential areas for appropriate interventions.

Sites

American Lung Association of Metropolitan Chicago, California Department of Health Services, Denver Health and Hospital, Emory University (Atlanta, GA), Maryland Department of Health, Massachusetts Department of Health, New York City Department of Health, New York State Department of Health, Seattle-King County Department of Public Health, Tennessee Department of Health, Texas Department of State Health Services, University of Medicine and Dentistry, and University of North Texas Health Science Center at Fort Worth.

Study Objectives

  1. To determine the frequency and the contribution of factors responsible for MDR-TB transmission in the U.S.;
  2. To describe the factors related to transmission of MDR-TB within the U.S.;
  3. To assess factors related to the preventability of MDR-TB (transmitted, acquired and imported MDR-TB) within the U.S.

Study Design

This project will be a 3-year cross-sectional population based study design where the recruitment and data collection are handled prospectively. It will include a large representation of MDR-TB cases located in 14 U.S. sites selected from the TBESC consortium. Cluster investigations will be completed for both MDR-TB and non MDR-TB cases who have a matching genotype to a MDR-TB case, who are named as a contact (in Public Health records) or found on a contact roster of a MDR-TB and are Isoniazid or Rifampin mono-resistant. Clinical culture negative pediatric TB cases (under age 5) who were identified as an exposed contact by the MDR-TB case during the interview or were already listed as a contact to a MDR-TB case by the public health department will also be a part of the cluster investigations. Genotyping will be completed for isolates submitted for MDR-TB and non MDR-TB cases. For this study, isolates from MDR-TB cases in the U.S. will be sent to two regional DNA genotyping laboratories for both spoligotyping and MIRU genotyping followed by IS6110-based RFLP analysis as part of the CDC Universal Genotyping program. In addition to spoligotyping and MIRU typing for all cases, IS6110-based RFLP typing will be completed for all MDR-TB and non MDR-TB cases clustered with MDR-TB cases in order to further differentiate between TB strains and identify clusters.

Study Progress

Data collection is complete. Analysis and manuscript writing is underway.

 
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