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Tuberculosis cluster in an immigrant community: case identification issues and a transcultural perspective
A Tardin1, M Dominicé Dao, B Ninet
1Tropical Medicine Unit, Division of International and Humanitarian Health, Geneva University Hospitals, Switzerland. aglae.tardin@hcuge.ch
Tropical Medicine & International Health : TM & IH
|July 1, 2009
Summary
A tuberculosis (TB) cluster was identified in a low-incidence area, linked by identical Mycobacterium tuberculosis genotypes and social connections. Cultural factors significantly hindered contact tracing, necessitating improved strategies to overcome stigma and communication barriers for effective TB control.
Area of Science:
- Epidemiology
- Molecular Biology
- Medical Anthropology
Background:
- A computerized database revealed a disproportionately high number of tuberculosis (TB) cases from a single country in a low-incidence area.
- This prompted an investigation into potential clustering and the effectiveness of contact tracing procedures.
Purpose of the Study:
- To determine if TB cases from a specific country formed a cluster.
- To ascertain if the clustering resulted from recent transmission.
- To understand factors undermining the efficacy of contact tracing.
Main Methods:
- Genotyping of Mycobacterium tuberculosis isolates (RFLP and Rep-PCR) from 15 TB cases.
- Investigation of social links between patients using social worker files, contact databases, and internet searches.
- Transcultural evaluation involving interviews and literature review to assess cultural influences.
Main Results:
- Genotyping confirmed identical Mycobacterium tuberculosis isolates in 11 of 15 patients.
- A complex network of social links was identified among 9 of these patients.
- Transcultural evaluation highlighted social stigma, communication differences, and linguistic barriers as obstacles to contact tracing.
Conclusions:
- Identical genotypes and social links confirmed a TB cluster resulting from recent transmission.
- Cultural factors significantly impacted contact tracing efficacy.
- Strategies were proposed to enhance contact tracing effectiveness by addressing cultural barriers and social stigma.
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