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Surveillance and outbreak report Open Access
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Abstract

An outbreak of isoniazid-resistant tuberculosis first identified in London has now been ongoing for 20 years, making it the largest drug-resistant outbreak of tuberculosis documented to date worldwide. We identified culture-confirmed cases with indistinguishable molecular strain types and extracted demographic, clinical, microbiological and social risk factor data from surveillance systems. We summarised changes over time and used kernel-density estimation and k-function analysis to assess geographic clustering. From 1995 to 2014, 508 cases were reported, with a declining trend in recent years. Overall, 70% were male (n = 360), 60% born in the United Kingdom (n = 306), 39% white (n = 199), and 26% black Caribbean (n = 134). Median age increased from 25 years in the first 5 years to 42 in the last 5. Approximately two thirds of cases reported social risk factors: 45% drug use (n = 227), 37% prison link (n = 189), 25% homelessness (n = 125) and 13% alcohol dependence (n = 64). Treatment was completed at 12 months by 52% of cases (n = 206), and was significantly lower for those with social risk factors (p < 0.05), but increased over time for all patients (p < 0.05). The outbreak remained focused in north London throughout. Control of this outbreak requires continued efforts to prevent and treat further active cases through targeted screening and enhanced case management.

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/content/10.2807/1560-7917.ES.2017.22.8.30467
2017-02-23
2024-11-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2017.22.8.30467
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Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Catherine+M+Smith&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Smith Catherine M</a>, <a href="/search?value1=Suzan+C+M+Trienekens&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Trienekens Suzan C M</a>, <a href="/search?value1=Charlotte+Anderson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Anderson Charlotte</a>, <a href="/search?value1=Maeve+K+Lalor&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lalor Maeve K</a>, <a href="/search?value1=Tim+Brown&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brown Tim</a>, <a href="/search?value1=Alistair+Story&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Story Alistair</a>, <a href="/search?value1=Hannah+Fry&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fry Hannah</a>, <a href="/search?value1=Andrew+C+Hayward&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hayward Andrew C</a>, <a href="/search?value1=Helen+Maguire&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Maguire Helen</a></span>. Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014. <a href="/content/ecdc">Euro Surveill.</a> 2017;22(8):pii=30467. <a href="https://doi.org/10.2807/1560-7917.ES.2017.22.8.30467" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2017.22.8.30467</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 01 Apr 2016;&nbsp;&nbsp; <span class="generated">Accepted</span>: 19 Sept 2016 </span> </p>
/content/10.2807/1560-7917.ES.2017.22.8.30467
/content/10.2807/1560-7917.ES.2017.22.8.30467
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