Document Detail

Outbreak of isoniazid resistant tuberculosis in north London.
MedLine Citation:
PMID:  15047945     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: A description is given of a major outbreak of isoniazid monoresistant tuberculosis (TB) chiefly in north London, including prisons. The earliest case was diagnosed in 1995 with most cases appearing after 1999. METHODS: Confirmation of a local cluster of cases was confirmed by restriction fragment length polymorphism (RFLP IS6110) typing or "rapid epidemiological typing" (RAPET). Further cases were found by retrospective analysis of existing databases, prospective screening of new isolates, and targeted epidemiological case detection including questionnaire analysis. RESULTS: By the end of 2001, 70 confirmed cases in London had been linked with a further 13 clinical cases in contacts and nine epidemiologically linked cases outside London. The epidemic curve suggests that the peak of the outbreak has not yet been reached. Cases in the outbreak largely belong to a social group of young adults of mixed ethnic backgrounds including several individuals from professional/business backgrounds. Compared with other cases of TB reported to the enhanced surveillance scheme in London during 1999-2001, the cases are more likely to be of white (26/70 (37%) v 1308/7666 (17%)) or black Caribbean ethnicity (17/70 (24%) v 312/7666 (4%)), born in the UK (41/70 (59%) v 1335/7666 (17%)), and male (52/70 (74%) v 4195/7666 (55%)). Drug misuse and/or prison detention are factors common to many cases. CONCLUSIONS: The investigation of the outbreak revealed significant problems on an individual patient and population based level including difficulties with contact tracing, compliance, and the risk of developing multidrug resistance. This incident has demonstrated the value of molecular strain typing in investigating an extensive outbreak of TB. This is the first documented outbreak involving a UK prison.
M C Ruddy; A P Davies; M D Yates; S Yates; S Balasegaram; Y Drabu; B Patel; S Lozewicz; S Sen; M Bahl; E James; M Lipman; G Duckworth; J M Watson; M Piper; F A Drobniewski; H Maguire
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Thorax     Volume:  59     ISSN:  0040-6376     ISO Abbreviation:  Thorax     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-03-29     Completed Date:  2004-05-05     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0417353     Medline TA:  Thorax     Country:  England    
Other Details:
Languages:  eng     Pagination:  279-85     Citation Subset:  IM    
HPA Mycobacterium Reference Unit, King's College Hospital (Dulwich), Guy's King's and St Thomas' Medical School, London SE22 8QF, UK.
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MeSH Terms
Antitubercular Agents / therapeutic use*
Contact Tracing
Disease Outbreaks*
Isoniazid / therapeutic use*
London / epidemiology
Middle Aged
Polymorphism, Restriction Fragment Length
Risk Factors
Treatment Outcome
Tuberculosis, Multidrug-Resistant / epidemiology*,  ethnology
Reg. No./Substance:
0/Antitubercular Agents; 54-85-3/Isoniazid
Comment In:
Thorax. 2004 Apr;59(4):273-4   [PMID:  15047942 ]
Thorax. 2004 Dec;59(12):1098; author reply 1098-9   [PMID:  15563712 ]

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