Skip directly to site content Skip directly to search


Español  Other Languages


Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People
 Search

		Submit


Tuberculosis (TB)








Guide to the Application of Genotyping to Tuberculosis Prevention and Control						Print
																Related Pages
										**Appendix B: References and Useful Resources**
**Core Steps of an Outbreak Investigation**
Confirm that it meets epidemiologic definition of an outbreak (any one of the following)
More cases than expected (surveillance)
Cases epidemiologically clustered by time, space, or common behaviors
Consider whether there is ongoing transmission (one of the following)
Did regular contact investigations reveal epidemiologic links or similarities among cases?
Did the laboratory identify a genotyping cluster that confirms the epidemiologic links identified by regular contact investigation?
Did the laboratory identify a genotyping or epidemiologic cluster of lab isolates clustered in time and space where there is discordance between the clinical course of the patient and the laboratory results (false-positive culture)?
Define an outbreak-related case
Confirm existing number of outbreak-related cases
Investigate existing outbreak-related cases by reviewing
Medical records (history, physical, clinical chart, and notes)
Laboratory records (serial results of smears, cultures, drug sensitivities, and other testing)
Review genotyping results for all culture-positive cases (if not already done, submit isolates for genotyping)
If lab results are implausible and the clinical course of the patient does not support TB diagnosis or the clinician does not think that there is concordance between lab results and clinical course of the patient to support TB diagnosis, consider possibility of false-positive cultures
Chest radiographs (including old baseline films, if possible)
Tuberculosis clinic and other pertinent public health records
Cross match outbreak-related cases with county jail, state prison, and STD registries
All data from regularly conducted contact investigations (re-interview case-patients and their contacts as necessary)
Determine the infectious period for each outbreak-related case based on
Laboratory results (e.g., sputum smear-positive patients are thought to be more infectious)
Serial chest radiographs (e.g., patients with cavitary lung lesions are thought to be more infectious)
Date of onset and duration of signs and symptoms
Results of screening of named contacts (e.g., a high percentage of TST-positive contacts)
Determine the sites and facilities frequented and family and social groups exposed by outbreak-related patients during their infectious periods
Information from case-patient interviews and contact investigations
Information from medical and public health records
Information from the facility logs or records
Determine the exposed cohort of persons at each site/facility who may have been present when an outbreak-related case-patient was present during his/her infectious period
Information from case-patient interviews and contact investigations
Information from medical and public health records
Information from the facility logs or records
Determine the duration by number of hours, days, or weeks. for the exposed cohort of persons who may have spent around an infectious outbreak-related patient
Information from case-patient interviews and contact investigations
Information from medical and public health records
Information from the facility logs or records
Prioritize exposed cohorts for screening (active case finding and latent TB infection) based on:
Type (e.g., indoor versus outdoor, intimate versus casual), frequency, and duration of exposure
Risk of progression to active disease
Define elements of and action plan for screening, implementation, and follow-up
Identify resources necessary for action plan to be carried out
Create a media plan to respond to possible inquiries
Assign responsibilities and set deadlines
If necessary, expand screening to include low-priority cohorts after screening high-priority cohorts based on evidence of transmission
Evaluate, treat, and follow up additional TB disease case-patients and latent TB infected persons associated with this outbreak
Make and implement recommendations to prevent future outbreaks for particular populations or settings involved
Evaluate outbreak response
Determine whether interventions have effectively stopped TB transmission in this situation.
Identify the lessons learned that could improve the public health response to the next outbreak.
							
					
							Last Reviewed:  September 1, 2012						Source: 	Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
					Facebook
        Twitter
        LinkedIn
        Syndicate homeGuide to the Application of Genotyping to Tuberculosis Prevention and Control
Acknowledgments
Introduction to Tuberculosis Genotypingplus icon
Introduction to this Guide
Overview of Tuberculosis Genotyping
Overview of the CDC Tuberculosis Genotyping Program
TB Program Eligibility and Application Procedures
Tuberculosis Genotyping Case Studiesplus icon
Investigation of a Genotyping Cluster in a Low-Incidence State
Apparent Genotyping Cluster among Recent Immigrants from the Philippines
False-Positive Culture Investigation
Algorithm to Detect False-Positive Cultures
A Misdiagnosis that was Identified with Genotyping
Genotyping Used to Improve Contact and Cluster Investigations
Identification of Nontraditional Transmission Settings
Investigation of a Multistate Tuberculosis Outbreak
Homeless Shelter Outbreak Investigation
Using Genotyping to Evaluate the Impact of a Screening Program
CDC Tuberculosis Genotyping Laboratory Proceduresplus icon
Science behind Tuberculosis Genotyping
Description of Genotyping Methods
Submission of Isolates
Genotyping Results, Designation of Clusters, and Reporting
Suspected False-Positive Cultures
IS*6110*-based RFLP Analysis
Combining Genotyping and Epidemiologic Data to Improve Our Understanding of TB Transmissionplus icon
Definitions
Reading the Genotyping Laboratory Report
Comparing Genotyping and Epidemiologic Results from Two TB Patients
Comparing Genotyping and Epidemiologic Results from Three or More TB Patients
Clustering as a Surrogate Measure of Recent Transmission
Developing a Tuberculosis Genotyping Programplus icon
Developing a Written Plan
Initial Decisions
Establishing Procedures for:plus icon
Submitting Isolates
Receiving and Acting on Genotyping Results
Requesting RFLP Analysis
Submitting Additional Isolates from the Same Patient
Comparing Genotyping Results between Jurisdictions
False-Positive Cultures
Database Management and Quality Control
Special Issues
Applying Genotyping Results to Tuberculosis Control Practicesplus icon
Evaluating Matching Genotypes
Evaluating Nonmatching Genotypes
Suspected False-Positive Culture Investigations
Expanded Contact Investigations
Outbreak Investigations
Cluster Investigations
Monitoring Trends
Appendicesplus icon
Appendix A: Glossary and Abbreviations
Appendix B: References and Useful Resourcesplus icon
References Cited in the Guide
NTGSN Special Issue References
Information on Packaging and Shipping Infectious Substances
Core Steps of an Outbreak Investigation
Consultants Available to Offer Guidance To receive email updates about this page, enter your email address: Email Address			What's this?				Submit


About CDC
					Contact Us
					800-232-4636
 Facebook Twitter Instagram LinkedIn Youtube Pinterest Snapchat
 CONTACT CDC
				Contact Us
							Call 800-232-4636
							Email Us
			ABOUT CDC
				About CDC
							Jobs
							Funding
			POLICIES
				Accessibility
							External Links
							Privacy
							Policies
							No Fear Act
							FOIA
							OIG
							Nondiscrimination
							Vulnerability Disclosure Policy
			CONNECT WITH US
				Facebook
								Twitter
								Instagram
								LinkedIn
							Youtube
								Pinterest
								Snapchat
								Email
			LANGUAGES
				Español
							繁體中文
							Tiếng Việt
							한국어
							Tagalog
							Русский
							العربية
							Kreyòl Ayisyen
							Français
							Polski
							Português
							Italiano
							Deutsch
							日本語
							فارسی
							English


U.S. Department of Health & Human Services
			Accessibility
			External Links
			Privacy
			Policies
			No Fear Act
			FOIA
			Nondiscrimination
			OIG
			Vulnerability Disclosure Policy
			USA.gov


Exit Notification / Disclaimer Policy Close
 Links with this icon  indicate that you are leaving the CDC website. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
				Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
				You will be subject to the destination website's privacy policy when you follow the link.
				CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Website Disclaimers
 Cancel Continue