Cross-border outbreak of extensively drug-resistant tuberculosis linked to a university in Romania.

O Popovici,Ph Monk,R Groenheit,P.J Freidlin,G Smith,D Chemtob,D Homorodean,E Rorman,M Haanperä,E Robinson,D Chiotan,M Mansjö,M J Van Der Werf,H Soini

doi:10.1017/s095026881800047x

Abstract

Extensively drug-resistant (XDR) tuberculosis (TB) poses a threat to public health due to its complicated, expensive and often unsuccessful treatment. A cluster of three XDR TB cases was detected among foreign medical students of a Romanian university. The contact investigations included tuberculin skin testing or interferon gamma release assay, chest X-ray, sputum smear microscopy, culture, drug susceptibility testing, genotyping and whole-genome sequencing (WGS), and were addressed to students, personnel of the university, family members or other close contacts of the cases. These investigations increased the total number of cases to seven. All confirmed cases shared a very similar WGS profile. Two more cases were epidemiologically linked, but no laboratory confirmation exists. Despite all the efforts done, the source of the outbreak was not identified, but the transmission was controlled. The investigation was conducted by a team including epidemiologists and microbiologists from five countries (Finland, Israel, Romania, Sweden and the UK) and from the European Centre for Disease Prevention and Control. Our report shows how countries can collaborate to control the spread of XDR TB by exchanging information about cases and their contacts to enable identification of additional cases and transmission and to perform the source investigation.

Highlights

Drug-resistant (XDR) tuberculosis (TB) was first described in a study using samples from different geographical areas from the period 2000–2004 [1]
The case was notified to the Romanian NCCDSC on 20 October 2015, by the IHR National Focal Point (NFP) for Israel
The close collaboration between countries coordinated by European Centre for Disease Prevention and Control (ECDC) enabled robust contact tracing and the prevention of further transmission across the European Union (EU)

Summary

Introduction

Drug-resistant (XDR) tuberculosis (TB) was first described in a study using samples from different geographical areas from the period 2000–2004 [1]. According to the World Health Organization (WHO) case definition, XDR TB strains are resistant to most anti TB drugs, to isoniazid and rifampicin, to at least one fluoroquinolone and to at least one of the injectable drugs amikacin, capreomycin or kanamycin [2]. Following established procedures [4], a cross-border cluster of XDR TB, including one Israeli and two British medical students, was notified by the Romanian National Centre for Communicable Diseases Surveillance and Control (NCCDSC) to the European Centre for Disease Prevention and Control (ECDC) on October 10, 2016. Contact investigations were implemented in all countries involved, i.e. Finland, Israel, Romania and the UK. We report on the results of contact investigations and the efforts to identify the source of this outbreak

Methods

Results

Conclusion