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. 2022 Jan-Feb;137(1):94-101.
doi: 10.1177/0033354921999167. Epub 2021 Mar 17.

Tuberculosis Outbreak Associated With Delayed Diagnosis and Long Infectious Periods in Rural Arkansas, 2010-2018

Sarah M Labuda  1   2 , Clinton J McDaniel  3 , Amish Talwar  2   3 , Anthwan Braumuller  3 , Sarah Parker  1 , Stephanie McGaha  1 , Carolynne Blissett  1 , Jonathan M Wortham  3 , Leonard Mukasa  1 , Rebekah J Stewart  3
Affiliations

Tuberculosis Outbreak Associated With Delayed Diagnosis and Long Infectious Periods in Rural Arkansas, 2010-2018

Sarah M Labuda et al. Public Health Rep. 2022 Jan-Feb.

Abstract

Objectives: During 2010-2018, the Arkansas Department of Health reported 21 genotype-matched cases of tuberculosis (TB) among residents of a rural county in Arkansas with a low incidence of TB and in nearby counties. The Arkansas Department of Health and the Centers for Disease Control and Prevention investigated to determine the extent of TB transmission and provide recommendations for TB control.

Methods: We reviewed medical and public health records, interviewed patients, and reviewed patients' social media posts to describe patient characteristics, identify epidemiologic links, and establish likely chains of transmission.

Results: We identified 21 cases; 11 reported during 2010-2013 and 10 during 2016-2018. All case patients were US-born non-Hispanic Black people. Eighteen case patients had the outbreak genotype, and 3 clinically diagnosed (non-culture-confirmed) case patients had epidemiologic links to patients with the outbreak genotype. Social media reviews revealed epidemiologic links among 10 case patients not previously disclosed during interviews. Eight case patients (38%) had ≥1 health care visit during their infectious period, and 7 patients had estimated infectious periods of >12 months.

Conclusions: Delayed diagnoses and prolonged infectiousness led to TB transmission in this rural community. TB education and awareness is critical to reducing transmission, morbidity, and mortality, especially in areas where health care providers have limited TB experience. Use of social media can help elucidate people at risk, especially when traditional TB investigation techniques are insufficient.

Keywords: outbreak response; rural health; tuberculosis.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Tuberculosis (TB) outbreak–associated cases in rural Arkansas, 2010-2018. A confirmed outbreak case was defined as TB in a person with culture-confirmed disease reported during January 1, 2010–July 1, 2018, in the United States with (1) the outbreak genotype defined by spacer oligonucleotide typing and 24-locus mycobacterial interspersed repetitive units variable-number tandem repeat and (2) whole-genome sequencing results within 5 single nucleotide polymorphisms of an isolate of another outbreak case. A probable outbreak case was defined as TB in a person with culture-negative disease reported during the same period and an epidemiologic link to a person meeting the definition of a confirmed outbreak case.
Figure 2.
Figure 2.
Social network diagram of confirmed or probable tuberculosis (TB) outbreak–associated cases (N = 21), rural Arkansas, 2010-2018. Social network diagram made using MicrobeTrace version 0.5.3 (Centers for Disease Control and Prevention).
Figure 3.
Figure 3.
Estimated infectious period for tuberculosis outbreak–associated adult patients (n = 14) with pulmonary tuberculosis disease, rural Arkansas, 2010-2018.
See this image and copyright information in PMC

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