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Guide to the Application of Genotyping to Tuberculosis Prevention and Control										Related Pages
										**Tuberculosis Genotyping Case Studies: How TB Programs Have Used Genotyping**
**Homeless Shelter Outbreak Investigation: Universal Genotyping Can Help in the Early Identification of Outbreaks**
In April 2000, staff members of Wake County Human Services in North Carolina became concerned about a recent increase in reports of TB in men at a Raleigh homeless shelter. An extensive investigation lasted several months and included the screening of 620 shelter residents and 26 employees. Initially, the investigation established that a) an outbreak probably was occurring, b) many of the affected persons were HIV-infected, and c) transmission probably was centered at a single homeless shelter in Raleigh (McElroy 2003).
Subsequently, the investigators conducted a careful record review and genotyped isolates from all 72 Wake County patients who had culture-confirmed TB from January 1998 through April 2002. The genotyping results showed that the outbreak-associated genotyping cluster consisted of 25 patients. As shown in the epidemic curve, if universal genotyping had been in place at the time this outbreak began, the outbreak might have been recognized as early as August 1999, rather than in April of the following year (Figure 2.2). If aggressive control measures had been instituted in August 1999, TB in many of the 18 subsequent patients, most of whom were HIV-infected, might have been prevented.
Epidemic curve of cases investigated during an outbreak at a homeless shelter in North Carolina. If universal genotyping had been available before the outbreak, it might have been recognized as in August 1999 or even before and subsequent cases might have been prevented (McElory 2003)**Figure 2.2.** Epidemic curve of cases investigated during an outbreak at a homeless shelter in North Carolina. If universal genotyping had been available before the outbreak, it might have been recognized as in August 1999 or even before and subsequent cases might have been prevented (McElory 2003).
							
					
						Page last reviewed:  September 1, 2012					Content source: 	Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention 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


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