Finding TB transmission: An assessment of CDC’s prioritization of TB genotype clusters in the United States, 2016-2019 Open Access

Abstract

      The Division of Tuberculosis Elimination (DTBE) at the Centers for Disease Control and Prevention conducts routine surveillance of tuberculosis (TB) clusters in the United States and collaborates with local and state partners to control spread. The DTBE cluster priority assignment, on a scale of Priority 1 to 4, is a tool that allows for DTBE to systematically review and respond to TB clusters based on perceived risk of recent or ongoing transmission. While this process, in its current state, has occurred since 2016, no study has evaluated genotype-matched TB cluster growth following DTBE priority assignment or identified case characteristics associated with cluster growth with the context of DTBE priority assignment. Therefore, we aimed to 1) identify difference in cluster growth by DTBE cluster priority assignment level, 2) identify patient characteristics associated with DTBE cluster priority assignment, and 3) identify patient characteristics that were associated with clusters attaining at least one additional case during the two-year follow up. This analysis utilized National TB Surveillance System and TB Genotyping Information Management System data from 2013-2021 and 2016-2019, respectively. We identified a statistically significant difference (p-value<0.0001) in both cluster growth and number of cases added in a two-year follow up by DTBE cluster priority assignment. Among clusters assigned Priority 1 by DTBE, 53% gained at least one additional case in the two years following a cluster alert. Alternatively, among clusters assigned Priority 4 by DTBE, only 20% gained at least one additional case in the two-year follow up. Analysis of case characteristics showed HIV coinfection as a significant predictor for cluster growth in a multivariate model [aOR=1.7; 95% CI= (1.1, 2.5)] but was not significant in a model for DTBE priority assignment. This analysis validates the effectiveness of DTBE cluster priority assignment in identifying TB clusters likely to gain additional cases but indicates that HIV status may be given additional weight when assigning cluster priority.

Table of Contents

Introduction …………………………………………………………………………. 1

Methods ……………………………………………………………………………... 5

Results ………………………………………………………………………………. 7

Discussion ..………………………………………………………………………… 11

Conclusion …………….…………………………………………………………… 15

References ………………………………………………………………………….. 16

Tables and Figures …………………………………………………………………. 19

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Health Sciences, General
Keyword	TB evaluation transmission CDC Centers for Disease Control and Prevention tuberculosis
Committee Chair / Thesis Advisor	Kristin Nelson, PhD, MPH, Emory University Kala Marks Raz, MPH, Centers for Disease Control and Prevention Clinton McDaniel, MPH, Centers for Disease Control and Prevention

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