National Tuberculosis Genotyping Service

Patrick K. Moonan, DrPH, MPH Surveillance, Epidemiology, and Outbreak Investigation Division of Tuberculosis Elimination Northeast TB Controllers Princeton, NJ October 24, 2006

National Genotyping Service

Richmond, CA Lansing, MI CDC – Atlanta, GA

National Genotyping Service

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Began in January, 2004 CDC contracts with 2 reference laboratories Genotype up to 5,000 isolates/lab/year Genotype at least 1 isolate for each new culture-positive case of TB

National Genotyping Service

Acquiring Isolates Genotyping Isolates Public Health and Clinical Laboratories Contract Reference Laboratories Analysis & Distribution State and Local TB Programs

Isolate and Data Flow

Other Labs CDC isolates & data Genotyping Lab results State Lab TB Program patient names

How are we doing?

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As of October 20, 22,257 isolates have been submitted for typing

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2 Quarterly Reports have been distributed

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CDC Webpage is under construction

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Future home for:

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Genotyping education materials

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Quarterly reports National Database Interface (Kansas Model)

How are we doing?

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34 of 53 (64.2%) participating programs have submitted updated RVCT linking variables through 6/30/2006

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Aberration detection program has been developed to identify outbreak from a national perspective

How are we doing?

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34 of 53 (64.2%) participating programs have submitted updated RVCT linking variables through 6/30/2006

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Aberration detection program has been developed to identify outbreaks from a national perspective

Geography and Genotyping

1 4 4 2 4 1 1 2 1 1 6 2 1 1 1 30 2 3 9 1 1 1 6 1 1 1 Number of isolates as of 10/31/2005 n = 46 IN = 65.2% of isolates

(Note: 1 case in Florida matches on spoligotype and is missing MIRU but is linked epidemiologically)

Spoligo: 777776777760601 MIRU: 224221153323

1 4 4 2 +1 1 1 2 1 1 6 2 +1 1 +1 +4 + 6 +1 0 1 6 1 1 1 1 +2 Net gain in clustered isolates 10/31/2005 to 10/01/2006 Spoligo: 777776777760601 MIRU: 224221153323

Geography and Genotyping

7 25 2 1 1 Number of Indiana isolates as of 10/01/2006 (n = 36) County A (n = 25)

• 69.5% of state total • 40.3% of national total

County B (n = 7)

• all six cases are linked epidemiologically to County A

cases Other Counties

• No clear epidemiologic link has been identified to these

cases through interviews and records review of County A and B cases

Preliminary Analyses NTGS 2004 – 2005

Figure 1. Derivation of genotype isolates 17,653 Isolates (Jan 1, 2004 to Jun 30, 2006) 10,653 Isolates Non-duplicates with RVCT 7,000 (39.6%) Incomplete genotyping results, duplicate results or missing RVCT 323 (3.0%) Non-matching RVCT 10,330 Isolates Included in analysis

NTGS Preliminary Analyses

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6,706 (64.9%) clustered isolates

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1,974 clusters

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Median of 3 members

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Range: 2 – 687

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Key characteristics for clustering

NTGS Preliminary Analyses

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6,706 (64.9%) clustered isolates

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1,974 clusters

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Median of 3 members

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Range: 2 – 687

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Key characteristics for clustering

NTGS Preliminary Analyses

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6,706 (64.9%) clustered isolates

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1,974 clusters

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Median of 3 members

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Range: 2 – 687

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Key characteristics for clustering

NTGS Preliminary Analyses

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181 MDR-TB isolates in database

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100 (55.2%) clustered (within state)

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OR = 1.41 (95% CL 1.05, 1.89)

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1,183 Mono-resistant TB isolates in database

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579 (48.9%) clustered (within state)

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OR = 1.10 (95% CL 0.97, 1.24)

Tell us how we can do better

[email protected]

404.639.5310

[email protected] 404.693.1481