National Tuberculosis Genotyping Service
description
Transcript of National Tuberculosis Genotyping Service
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)