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Epidemiology

Transmission Classification Model To Determine Place and Time of Infection of Tuberculosis Cases in an Urban Area

G. de Vries, H. W. M. Baars, M. M. G. G. Šebek, N. A. H. van Hest, J. H. Richardus
G. de Vries
1Department of Tuberculosis Control, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, 3000 LP Rotterdam, The Netherlands
2Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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  • For correspondence: devriesg@ggd.rotterdam.nl
H. W. M. Baars
1Department of Tuberculosis Control, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, 3000 LP Rotterdam, The Netherlands
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M. M. G. G. Šebek
3National Mycobacteria Reference Laboratory, National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
4KNCV Tuberculosis Foundation, P.O. Box 146, 2501 CC The Hague, The Netherlands
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N. A. H. van Hest
1Department of Tuberculosis Control, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, 3000 LP Rotterdam, The Netherlands
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J. H. Richardus
2Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
5Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, 3000 LP Rotterdam, The Netherlands
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DOI: 10.1128/JCM.00793-08
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    FIG. 1.

    Classification of time of infection for clustered cases from the Rotterdam area that were probably or confirmed infected in The Netherlands, 1995 to 2006 (n = 994). PTB, pulmonary tuberculosis; EPI link, epidemiological link.

Tables

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  • TABLE 1.

    Selected demographic and disease-related factors of 2,636 TB cases in the Rotterdam region, 1995 to 2006

    Patient characteristicNo. or % of TB cases with indicated type of fingerprint
    UniqueClusteringUnknown
    No.%No.%No.%
    Total no.9191,108609
    Male48552.873866.632252.9
    Age (yr)
        0-14151.6322.910917.9
        15-2925828.138634.814523.8
        30-4427630.040036.115725.8
        45-6416417.822920.712119.9
        ≥6520622.4615.57712.6
    Born in The Netherlands21923.833830.527344.8
    Previous history of TB687.4585.2355.7
    HIV infection515.5504.5132.1
    Illicit drug user or homeless person252.715714.2193.1
    Pulmonary TB57662.781173.227144.5
    Active case found by contact investigation111.21079.712119.9
    Active case found by screening9910.81089.7579.4
  • TABLE 2.

    Classification of place and time period of transmission of TB cases in the Rotterdam region, 1995 to 2006

    CriterionaPlace of infectionTime of infection for patients infected in The Netherlandse
    Infected in a foreign countryIndeterminatebInfected in The Netherlands≤2 yrs>2 yrsUnknown
    ConfirmedProbablyProbablyConfirmed
    Cases with a unique fingerprint (n = 919)
        Cases in immigrants (n = 700)
            Arrived in The Netherlands after 1/1/1993376
            In residence before 1/1/1993 and had documented contact with PTB case in The Netherlands1811c18
            In residence before 1/1/1993 and had documented history of frequent travel to countries where TB is endemic79
            In residence before 1/1/1993 and lived more yrs in foreign country than in The Netherlands in the pregenotyping period170
            In residence before 1/1/1993 without identified risks56
        Cases in nonimmigrants (n = 219)
            Documented contact with PTB case in The Netherlands391c38
            Documented history of frequent travel to countries where TB is endemic32
            No documented risks148148
    Cases with a clustering fingerprint (n = 1,108)
        No preceding PTB in the clusterd (n = 62)2921 12 2 c 10
        Diagnosis within 3 mo of arrival32
        Not in residence in The Netherlands with a clustered TB case32
        Cases with a confirmed epidemiological link 258 195 63
        Cases with a possible epidemiological link 190 185 5
        Cases without an established epidemiological link 534 401 133
    Cases without a DNA fingerprint (n = 609)
        Documented contact with PTB case in The Netherlands19215438
        Documented contact with PTB case in a foreign country13
        Chest X-ray abnormalities or positive TST at entrance screening43
        Cases in immigrants who lived more yrs in a foreign country than in The Netherlands151
        Cases in immigrants without other documented risks70
        Cases in nonimmigrants with documented history of frequent travel to countries where TB is endemic14
        Cases of recurrent TB in nonimmigrants1313
        Cases in nonimmigrants without documented risks113113
    Total (n = 2,636)525467126838680939466113
    %19.917.74.831.825.835.617.74.3
    • ↵ a Dates are given as month/day/year. PTB, pulmonary tuberculosis; TST, tuberculin skin test.

    • ↵ b Twenty-two of 56 and 21 of 70 cases had unknown dates of arrival in The Netherlands.

    • ↵ c Patients were infected by a visiting person later diagnosed with infectious TB shortly after leaving The Netherlands.

    • ↵ d These clustered cases without a preceding PTB were classified according to the trees for unique fingerprints.

    • ↵ e The classification of time of infection for 994 clustered cases infected in The Netherlands, presented in boldface in this table, is explained in Fig. 1.

  • TABLE 3.

    Contribution to cluster size in The Netherlands of clustered cases from the Rotterdam region that were not the first in the cluster and their classification of transmission, 1995 to 2006

    Patient's sequential no. in national clustersTotal no. of regional casesNo. (%) of patients that were:
    Infected in a foreign countryRecently infected in The NetherlandsRemotely infected in The Netherlands
    218455 (29.9)70 (38.0)59 (32.1)
    39818 (18.4)49 (50.0)31 (31.6)
    4-512110 (8.3)76 (62.8)35 (28.9)
    6-1019518 (9.2)144 (73.8)33 (16.9)
    11-201688 (4.8)130 (77.4)30 (17.9)
    21-501974 (2.0)178 (90.4)15 (7.6)
    ≥511451 (0.7)135 (93.8)8 (5.5)
    Total1,108114 (10.3)783 (70.7)211 (19.0)

Additional Files

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  • Supplemental material

    Files in this Data Supplement:

    • Supplemental file 1 - Transmission classification trees for recurrent TB, for immigrant cases, for nonimmigrant cases, for cases with a clustering fingerprint, and for cases with an unknown fingerprint).
      MS Word document, 284K.
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Transmission Classification Model To Determine Place and Time of Infection of Tuberculosis Cases in an Urban Area
G. de Vries, H. W. M. Baars, M. M. G. G. Šebek, N. A. H. van Hest, J. H. Richardus
Journal of Clinical Microbiology Dec 2008, 46 (12) 3924-3930; DOI: 10.1128/JCM.00793-08

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Transmission Classification Model To Determine Place and Time of Infection of Tuberculosis Cases in an Urban Area
G. de Vries, H. W. M. Baars, M. M. G. G. Šebek, N. A. H. van Hest, J. H. Richardus
Journal of Clinical Microbiology Dec 2008, 46 (12) 3924-3930; DOI: 10.1128/JCM.00793-08
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KEYWORDS

Bacterial Typing Techniques
Contact Tracing
Mycobacterium tuberculosis
tuberculosis

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