Using routinely reported tuberculosis genotyping and surveillance data to predict tuberculosis outbreaks

PLoS One. 2012;7(11):e48754. doi: 10.1371/journal.pone.0048754. Epub 2012 Nov 7.


We combined routinely reported tuberculosis (TB) patient characteristics with genotyping data and measures of geospatial concentration to predict which small clusters (i.e., consisting of only 3 TB patients) in the United States were most likely to become outbreaks of at least 6 TB cases. Of 146 clusters analyzed, 16 (11.0%) grew into outbreaks. Clusters most likely to become outbreaks were those in which at least 1 of the first 3 patients reported homelessness or excess alcohol or illicit drug use or was incarcerated at the time of TB diagnosis and in which the cluster grew rapidly (i.e., the third case was diagnosed within 5.3 months of the first case). Of 17 clusters with these characteristics and therefore considered high risk, 9 (53%) became outbreaks. This retrospective cohort analysis of clusters in the United States suggests that routinely reported data may identify small clusters that are likely to become outbreaks and which are therefore candidates for intensified contact investigations.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Alcohol Drinking
  • Decision Trees
  • Disease Outbreaks*
  • Drug Users
  • Forecasting
  • Genotype
  • Ill-Housed Persons
  • Mycobacterium tuberculosis / genetics*
  • Prisons
  • Retrospective Studies
  • Risk Factors
  • Tuberculosis / epidemiology*
  • Tuberculosis / transmission
  • United States

Grants and funding

The Centers for Disease Control and Prevention (CDC) provides funding to state and local health departments to conduct surveillance of TB disease in accordance with their own disease reporting regulations. CDC provides technical guidance for the collection of data by the state and local health departments and data are sent to CDC for national-level analyses. The analysis methods for this manuscript were developed by CDC. CDC makes all decisions regarding the publication of national surveillance data as a means to describe the TB epidemic. Northrop Grumman Corporation, Atlanta, Georgia, United States of America, employs JSK and provided scientific analysis services as directed by CDC through a contract with CDC.