National Tuberculosis Genotyping Service

Patrick K. Moonan, DrPH, MPHSurveillance, Epidemiology, and Outbreak Investigation

Division of Tuberculosis Elimination

Northeast TB ControllersPrinceton, NJ

October 24, 2006

National Genotyping Service

Richmond, CA Lansing, MI CDC – Atlanta, GA

National Genotyping Service

• 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

Analysis & Distribution

Public Health and Clinical Laboratories

Contract Reference Laboratories

State and Local TB Programs

Isolate and Data Flow

Genotyping Lab

Other Labs

State Lab TB Programresults

isolates & data

patient names

CDC

How are we doing?

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

• 2 Quarterly Reports have been distributed

• CDC Webpage is under construction– Future home for:

• Genotyping education materials• Quarterly reports• National Database Interface (Kansas Model)

How are we doing?

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

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

How are we doing?

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

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

Geography and Genotyping

1 1

2 11

6

3

1

1

9

6

4

1

4

Number of isolates as of 10/31/2005n = 46IN = 65.2% of isolates(Note: 1 case in Florida matches on spoligotype and is missing MIRU but is linked epidemiologically)

2

31

1

41

1

1

2

Spoligo: 777776777760601MIRU: 224221153323

303

1

2

1

1 1

2 1

6

3

1

1

+4

6

4

1

4

Net gain in clustered isolates10/31/2005 to 10/01/2006

2

31

1

+11

1

1

2

Spoligo: 777776777760601MIRU: 224221153323

+6

+1

+2

+10

+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

Geography and Genotyping

257

2 1

1

Preliminary AnalysesNTGS 2004 – 2005

17,653 Isolates(Jan 1, 2004 to Jun 30, 2006)

10,653 IsolatesNon-duplicates with RVCT

7,000 (39.6%) Incomplete genotyping results, duplicate results or missing RVCT

323 (3.0%) Non-matching RVCT

10,330 IsolatesIncluded in analysis

Figure 1. Derivation of genotype isolates

NTGS Preliminary Analyses

• 6,706 (64.9%) clustered isolates

• 1,974 clusters– Median of 3 members– Range: 2 – 687

• Key characteristics for clustering

NTGS Preliminary Analyses

• 6,706 (64.9%) clustered isolates

• 1,974 clusters– Median of 3 members– Range: 2 – 687

• Key characteristics for clustering

NTGS Preliminary Analyses

• 6,706 (64.9%) clustered isolates

• 1,974 clusters– Median of 3 members– Range: 2 – 687

• Key characteristics for clustering

NTGS Preliminary Analyses

• 181 MDR-TB isolates in database– 100 (55.2%) clustered (within state)– OR = 1.41 (95% CL 1.05, 1.89)

• 1,183 Mono-resistant TB isolates in database– 579 (48.9%) clustered (within state)– OR = 1.10 (95% CL 0.97, 1.24)

Tell us how we can do better

pmoonan@cdc.gov404.639.5310

lcowan@cdc.gov 404.693.1481