Abstract:
: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.
journal_name
Euro Surveilljournal_title
Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletinauthors
Smith CM,Trienekens SC,Anderson C,Lalor MK,Brown T,Story A,Fry H,Hayward AC,Maguire Hdoi
10.2807/1560-7917.ES.2017.22.8.30467subject
Has Abstractpub_date
2017-02-23 00:00:00issue
8eissn
1025-496Xissn
1560-7917pii
30467journal_volume
22pub_type
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