XDR-TB transmission in London: Case management and contact tracing investigation assisted by early whole genome sequencing

Amber Arnold*, Adam A. Witney, Stephania Vergnano, Anita Roche, Catherine A. Cosgrove, Angela Houston, Katherine A. Gould, Jason Hinds, Peter Riley, Derek Macallan, Philip D. Butcher, Tom S. Harrison

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    23 Citations (Scopus)

    Abstract

    Objectives We describe the first published cluster of extensively drug resistant Tuberculosis (XDR-TB) in the UK and show how early whole genome sequencing (WGS) of Mtb can assist in case management and contact investigations. Methods We describe the contact tracing investigation undertaken after the presentation of an adult with XDR-TB. Active cases were treated with an XDR-TB drug regimen and contacts underwent a programme of follow-up for 2 years. All isolates of Mycobacterium tuberculosis (Mtb) were assessed early using whole genome sequencing (WGS) as well as routine drug susceptibility testing (DST). Results Thirty-three contacts were screened. In the first year one confirmed and one probable case were identified through contact tracing. A further possible case was identified through epidemiological links. Two confirmed cases were identified through WGS 2 years later. Twenty-five (80%) contacts without evidence of tuberculosis were adherent to 1 year of follow-up and 14 (45%) were adherent to 2 years of follow-up. WGS of Mtb was used to guide drug choices, rapidly identify transmission events, and alter public health management. Conclusion WGS of Mtb enabled rapid effective individualized treatment and facilitated public health interventions by early identification of transmission events.

    Original languageEnglish
    Pages (from-to)210-218
    Number of pages9
    JournalJournal of Infection
    Volume73
    Issue number3
    DOIs
    Publication statusPublished - 1 Sep 2016

    Bibliographical note

    Funding Information:
    All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: AA has received a research studentship funding from The Jefferiss Charitable Trust , PB is funded by INNOVATE UK (UK Government Agency) in collaboration with QuantuMDx Ltd, UK, outside the submitted work, Dr. Hinds reports grants from GSK Biologicals , grants from Pfizer , grants from Sanofi Pasteur , outside the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

    Publisher Copyright:
    © 2016 The British Infection Association

    Keywords

    • Contact tracing
    • Disease outbreaks
    • Drug resistance
    • Pathology, molecular
    • Tuberculosis

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