769. An outbreak of multidrug-resistant tuberculosis, Minnesota 2016–2017
Session: Poster Abstract Session: Tuberculosis and Other Mycobacterial Infections
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • IDWEEK_2018 v8.pdf (229.2 kB)
  • Background: Multidrug-resistant tuberculosis (MDR TB) is more difficult to treat and outcomes are worse than for drug-susceptible TB disease. MDR TB cases in Minnesota increased from zero in 2015 to nine in 2016. Case investigations suggested an outbreak. We describe the public health response, challenges of contact investigations (CIs), and ongoing management of contacts.

    Methods: CDC performed whole-genome sequencing (WGS) to evaluate relatedness of MDR TB isolates. We conducted CIs for infectious cases. We created outbreak specific guidelines for screening and management of contacts, and partnered with various agencies to increase MDR TB awareness.

    Results: WGS results were consistent with an MDR TB outbreak that included 10 cases (70% pulmonary) as of April, 2018. Limited provider awareness about TB contributed to delayed diagnoses. CIs identified 588 contacts; 8.7% (n=51) of contacts had previously documented positive TB infection test results, and 14% (n=74) were newly positive for TB infection (median age: 72years). Eight cases were epidemiologically-linked to one Hmong adult day center. Sixty-two contacts started a fluoroquinolone for latent MDR TB infection. Contacts who declined treatment began a 2-year clinical monitoring program.

    Conclusion: In this outbreak, delayed diagnoses resulted in long infectious periods and hundreds of contacts. WGS results were consistent with recent transmission. We discovered adult day centers are an overlooked congregate setting. CIs were complicated by limited public health funding and high underlying TB infection prevalence in the affected community. Increased community and provider awareness and intensified screening of contacts resulted in additional case finding and prevention interventions.

    Malini Desilva, MD, MPH1, Nora Moore, MPH2, Dzung Thai, MPH1, Mary Beth Grimm, MPH2, Nadya Sabuwala, RN, MPH1, Milayna Brueshaber, ,1, Sarah Gordon, MPH NREMT-B1, Laura Andersen, MPH2, Victoria Hall, DVM MS1,3, Sean Buuck, MPH1, Cynthia Hickman, MPH1, Katie Stinebaugh, MPH1, Benjamin Silk, PhD, MPH4, Kayla Raz, MPH4, Sarah Talarico, PhD, MPH4, Jonathan Wortham, MD5, Elisabeth Kingdon, MPH1, Gina Pistulka, PhD, RN, MPH, APHN-BC2, Krissie Guerard, MS1, Lauren Cowan, PhD4, James E. Posey, PhD4, Paula M Snippes Vagnone, MT (ASCP)6, Joel McCullough, MD, MPH2, Dean Tsukayama, MD7, Rajal K Mody, MD MPH8 and Kristen Ehresmann, RN, MPH9, (1)Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, MN, (2)Saint Paul – Ramsey County Public Health, Saint Paul, MN, (3)Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, GA, (4)Centers for Disease Control and Prevention, Atlanta, GA, (5)Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (6)Minnesota Department of Health, St. Paul, MN, (7)Hennepin County Medical Center, Minneapolis, MN, (8)Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta, GA, (9)Minnesota Department of Health, Saint Paul, MN

    Disclosures:

    M. Desilva, None

    N. Moore, None

    D. Thai, None

    M. B. Grimm, None

    N. Sabuwala, None

    M. Brueshaber, None

    S. Gordon, None

    L. Andersen, None

    V. Hall, None

    S. Buuck, None

    C. Hickman, None

    K. Stinebaugh, None

    B. Silk, None

    K. Raz, None

    S. Talarico, None

    J. Wortham, None

    E. Kingdon, None

    G. Pistulka, None

    K. Guerard, None

    L. Cowan, None

    J. E. Posey, None

    P. M. Snippes Vagnone, None

    J. McCullough, None

    D. Tsukayama, None

    R. K. Mody, None

    K. Ehresmann, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.