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Tuberculosis Outbreak in an Educational Institution in Norway
Gunnstein Norheim1, Siri Seterelv2, Trude M Arnesen2
1Norwegian Institute of Public Health, Oslo, Norway gunnstein.norheim@fhi.no.
Journal of Clinical Microbiology
|February 17, 2017
Summary
A 2009-2014 tuberculosis (TB) outbreak in Oslo involved 24 cases of Mycobacterium tuberculosis, Beijing lineage. Whole-genome sequencing confirmed a clonal outbreak, but transmission events remained unclear despite extensive contact tracing.
Area of Science:
- Epidemiology
- Infectious Diseases
- Genomics
Background:
- An educational institution in Oslo, Norway, experienced a significant pulmonary tuberculosis (TB) outbreak.
- The outbreak spanned from 2009 to 2014, with an initial cluster reported in April 2013.
Purpose of the Study:
- To investigate the genetic relatedness and transmission dynamics of a multi-year tuberculosis outbreak.
- To identify the source and reconstruct the transmission chain of the outbreak using molecular and epidemiological methods.
Main Methods:
- Mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) typing was performed on Mycobacterium tuberculosis isolates.
- Whole-genome sequencing (WGS) was employed to analyze the genetic diversity and phylogenetic relationships of the isolates.
- Intensified contact tracing was conducted to supplement molecular data.
Main Results:
- All 22 available Mycobacterium tuberculosis isolates shared identical MIRU-VNTR profiles (MtbC15-9 code 10287-189), belonging to the Beijing lineage.
- Whole-genome sequencing revealed only 20 variable nucleotide positions among the isolates, confirming a clonal outbreak.
- The most likely index case, diagnosed in 2009, was identified as being born in Asia. WGS confirmed all cases belonged to a single transmission chain.
Conclusions:
- The study confirmed a clonal outbreak of tuberculosis caused by the Beijing lineage of Mycobacterium tuberculosis.
- Despite advanced genomic and epidemiological investigations, the complete reconstruction of all TB transmission events within the outbreak was not achieved.
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