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. 2018 May;146(7):824-831.
doi: 10.1017/S095026881800047X.

Cross-border outbreak of extensively drug-resistant tuberculosis linked to a university in Romania

O Popovici  1 , Ph Monk  2 , D Chemtob  3   4 , D Chiotan  5 , P J Freidlin  6   7 , R Groenheit  8 , M Haanperä  9 , D Homorodean  10 , M Mansjö  8 , E Robinson  11 , E Rorman  12 , G Smith  13 , H Soini  9 , M J Van Der Werf  14
Affiliations

Cross-border outbreak of extensively drug-resistant tuberculosis linked to a university in Romania

O Popovici et al. Epidemiol Infect. 2018 May.

Abstract

Extensively drug-resistant (XDR) tuberculosis (TB) poses a threat to public health due to its complicated, expensive and often unsuccessful treatment. A cluster of three XDR TB cases was detected among foreign medical students of a Romanian university. The contact investigations included tuberculin skin testing or interferon gamma release assay, chest X-ray, sputum smear microscopy, culture, drug susceptibility testing, genotyping and whole-genome sequencing (WGS), and were addressed to students, personnel of the university, family members or other close contacts of the cases. These investigations increased the total number of cases to seven. All confirmed cases shared a very similar WGS profile. Two more cases were epidemiologically linked, but no laboratory confirmation exists. Despite all the efforts done, the source of the outbreak was not identified, but the transmission was controlled. The investigation was conducted by a team including epidemiologists and microbiologists from five countries (Finland, Israel, Romania, Sweden and the UK) and from the European Centre for Disease Prevention and Control. Our report shows how countries can collaborate to control the spread of XDR TB by exchanging information about cases and their contacts to enable identification of additional cases and transmission and to perform the source investigation.

Keywords: Contact tracing; extensively drug-resistant; tuberculosis; whole genome sequencing.

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Figures

Fig. 1.
Fig. 1.
Illustration of a Minimum Spanning Tree with SNP differences indicated on the branches (core genome included in the analysis = 92.93%). Source: The WHO Supranational Reference Laboratory (SRL) for TB in Stockholm, Sweden.
Fig. 2.
Fig. 2.
Epidemiological links between the seven confirmed extensively drug-resistant tuberculosis cases in the outbreak and two other epi-linked cases in UK contacts.
See this image and copyright information in PMC

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