XDR-TB transmission in London: Case management and contact tracing investigation assisted by early whole genome sequencing. Issue 3 (September 2016)

• Record Type: Journal Article
• Authors: Arnold, Amber; Witney, Adam A.; Vergnano, Stephania; Roche, Anita; Cosgrove, Catherine A.; Houston, Angela; Gould, Katherine A.; Hinds, Jason; Riley, Peter; Macallan, Derek; Butcher, Philip D.; Harrison, Tom S.
• Is Part Of: Journal of infection. Volume 73:Issue 3(2016)
• Page Start: 210
• Page End: 218
• Publication Date: 2016-09
• Subjects: Tuberculosis -- Drug resistance -- Contact tracing -- Disease outbreaks -- Pathology, molecular; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2016.04.037
• Languages: English
• ISSNs: 0163-4453

Abstract

Summary: Objectives: We describe the first published cluster of extensively drug resistant Tuberculosis (XDR-TB) in the UK and show how early whole genome sequencing (WGS) of Mtb can assist in case management and contact investigations. Methods: We describe the contact tracing investigation undertaken after the presentation of an adult with XDR-TB. Active cases were treated with an XDR-TB drug regimen and contacts underwent a programme of follow-up for 2 years. All isolates of Mycobacterium tuberculosis ( Mtb ) were assessed early using whole genome sequencing (WGS) as well as routine drug susceptibility testing (DST). Results: Thirty-three contacts were screened. In the first year one confirmed and one probable case were identified through contact tracing. A further possible case was identified through epidemiological links. Two confirmed cases were identified through WGS 2 years later. Twenty-five (80%) contacts without evidence of tuberculosis were adherent to 1 year of follow-up and 14 (45%) were adherent to 2 years of follow-up. WGS of Mtb was used to guide drug choices, rapidly identify transmission events, and alter public health management. Conclusion: WGS of Mtb enabled rapid effective individualized treatment and facilitated public health interventions by early identification of transmission events. Highlights: This is the first report in the UK of a complex XDR-TB cluster. Methods for 2-year follow-up of contacts and active cases are presented. Early whole genome sequencing (WGS) enables individualized treatment of cases. WGS identifies transmission events and assists rapid public health interventions.