Molecular epidemiology of tuberculosis in a sentinel surveillance population. (Tuberculosis Genotyping Network).We conducted a population-based study to assess demographic and risk-factor correlates for the most frequently occurring Mycobacterium tuberculosis Mycobacterium tuberculosis n. Tubercic bacillus. Mycobacterium tuberculosis genotypes from tuberculosis tuberculosis (TB), contagious, wasting disease caused by any of several mycobacteria. The most common form of the disease is tuberculosis of the lungs (pulmonary consumption, or phthisis), but the intestines, bones and joints, the skin, and the genitourinary, (TB) patients. The study included all incident, culture-positive TB patients from seven sentinel sentinel /sen·ti·nel/ (sen´ti-n'l) one who gives a warning or indicates danger. sentinel a recording mechanism, such as an animal, a farm or a veterinarian, posted explicitly to record a possible occurrence or series of surveillance sites in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. from 1996 to 2000. M. tuberculosis M. tuberculosis, n the bacterium responsible for tuberculosis, generally a respiratory infection in man; nonrespiratory tuberculosis is considered an indicator disease for AIDS. See also tuberculosis. isolates were genotyped by IS6110-based restriction fragment length polymorphism restriction fragment length polymorphism n. Abbr. RFLP Intraspecies variations in the length of DNA fragments generated by the action of restriction enzymes and caused by mutations that alter the sites at which these enzymes act, changing and spoligotyping. Genotyping Genotyping refers to the process of determining the genotype of an individual with a biological assay. Current methods of doing this include PCR, DNA sequencing, and hybridization to DNA microarrays or beads. was available for 90% of 11,923 TB patients. Overall, 48% of cases had isolates that matched those from another patient, including 64% of U.S.-born and 35% of foreign-born for·eign-born adj. Foreign by birth; not native to the country in which one resides. Adj. 1. foreign-born - of persons born in another area or country than that lived in; "our large nonnative population" nonnative patients. By logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. analysis, risk factors for clustering of genotypes were being male, U.S.-born, black, homeless, and infected in·fect tr.v. in·fect·ed, in·fect·ing, in·fects 1. To contaminate with a pathogenic microorganism or agent. 2. To communicate a pathogen or disease to. 3. To invade and produce infection in. with HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. ; having pulmonary pulmonary /pul·mo·nary/ (pool´mo-nar?e) 1. pertaining to the lungs. 2. pertaining to the pulmonary artery. pul·mo·nar·y adj. Of, relating to, or affecting the lungs. disease with cavitations on chest radiograph radiograph /ra·dio·graph/ (-graf?) the film produced by radiography. ra·di·o·graph n. and a sputum smear Noun 1. sputum smear - any of several cytologic smears obtained from different parts of the lower respiratory tract; used for cytologic study of cancer and other diseases of the lungs bronchoscopic smear, lower respiratory tract smear with acid-fast acid-fast (as´id-fast) not readily decolorized by acids after staining. acid-fast adj. bacilli bacilli /ba·cil·li/ (bah-sil´i) plural of bacillus. bacilli see bacillus. ; and excessive drug or alcohol use. Molecular characterization A rather long and fancy word for analyzing a system or process and measuring its "characteristics." For example, a Web characterization would yield the number of current sites on the Web, types of sites, annual growth, etc. of TB isolates permitted risk correlates for clusters and specific genotypes to be described and provided information regarding cluster dynamics over time. ********** Since 1990, characterization of Mycobacterium tuberculosis isolates by molecular methods has been useful in confirming suspected laboratory contamination and as an adjunct adjunct (aj´ungkt), n a drug or other substance that serves a supplemental purpose in therapy. adjunct to epidemiology-based contact investigation (1-3). Most studies used the restriction fragment length polymorphism (RFLP RFLP abbr. restriction fragment length polymorphism RFLP restriction fragment length polymorphism. RFLP ) technique, based on IS6110 and specific to the M. tuberculosis complex. This genetic element may be present in different positions on the chromosome, resulting in a unique genotype genotype (jēn`ətīp'): see genetics. genotype Genetic makeup of an organism. The genotype determines the hereditary potentials and limitations of an individual. useful for characterizing the strain of M. tuberculosis infecting a patient. Although RFLP has disadvantages (e.g., cost, time required to culture the organism organism /or·gan·ism/ (or´gan-izm) an individual living thing, whether animal or plant. pleuropneumonia-like organisms any of various bacteria of the genus Mycoplasma, , and specialized spe·cial·ize v. spe·cial·ized, spe·cial·iz·ing, spe·cial·iz·es v.intr. 1. To pursue a special activity, occupation, or field of study. 2. training and laboratory equipment), IS6110-based RFLP is the established method considered most discriminatory dis·crim·i·na·to·ry adj. 1. Marked by or showing prejudice; biased. 2. Making distinctions. dis·crim for genetic characterization of M. tuberculosis strains worldwide (4). In 1996, the Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. (CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation ) established seven sentinel surveillance sites in the United States (National Tuberculosis Genotyping and Surveillance Network) to assess the utility of molecular genotyping for improving tuberculosis (TB) prevention and control. The TB genotyping network used standardized standardized pertaining to data that have been submitted to standardization procedures. standardized morbidity rate see morbidity rate. standardized mortality rate see mortality rate. protocols for molecular characterization of M. tuberculosis isolates from patients in all sentinel sites. The network was designed to address specific epidemiologic ep·i·de·mi·ol·o·gy n. The branch of medicine that deals with the study of the causes, distribution, and control of disease in populations. [Medieval Latin epid questions regarding the natural history, transmission, and potential applicability of molecular genotyping of M. tuberculosis strains to augment aug·ment v. aug·ment·ed, aug·ment·ing, aug·ments v.tr. 1. To make (something already developed or well under way) greater, as in size, extent, or quantity: TB control activities (5). Two objectives were to identify and determine the prevalence of specific M. tuberculosis genotype clustering in populations of sentinel surveillance TB patients and to describe the demographic characteristics of these populations and the genotypic genotypic emanating from or pertaining to genotype. genotypic selection selection of breeding stock on the basis of known inherited characteristics. characteristics of M. tuberculosis strains in clustered and nonclustered TB cases. We describe demographic and risk factor correlates for the most frequently occurring M. tuberculosis genotypes in isolates collected from sentinel TB patients. Methods This population-based sentinel study included all incident culture-positive TB patients from sentinel sites from January January: see month. 1996 to December December: see month. 2000. In brief, the seven sentinel surveillance sites included the states of Arkansas Arkansas, river, United States Arkansas (ärkăn`zəs, är`kənsô'), river, c.1,450 mi (2,330 km) long, rising in the Rocky Mts., central Colo. , Maryland Maryland (mâr`ələnd), one of the Middle Atlantic states of the United States. It is bounded by Delaware and the Atlantic Ocean (E), the District of Columbia (S), Virginia and West Virginia (S, W), and Pennsylvania (N). , Massachusetts Massachusetts (măsəch  `sĭts), most populous of the New England states of the NE United States. , Michigan Michigan (mĭsh`ĭgən), upper midwestern state of the United States. It consists of two peninsulas thrusting into the Great Lakes and has borders with Ohio and Indiana (S), Wisconsin (W), and the Canadian province of Ontario (N,E). , and New
Jersey; Dallas Dallas, city (1990 pop. 1,006,877), seat of Dallas co., N Tex., on the Trinity River near the junction of its three forks; inc. 1871. The second largest Texas city, after Houston, and the eighth largest U.S. , Tarrant Tarrant is the name of two places in the United States:
A peak, 4,342.6 m (14,238 ft) high, in the Rocky Mountains of central Colorado. , and Hidalgo Counties Hidaldo County is the name of several counties in the United States:
American painter noted for his semiabstract watercolors, including Brooklyn Bridge. , San Mateo San Mateo (săn mətā`ō), city (1990 pop. 85,486), San Mateo co., W Calif., on San Francisco Bay; inc. 1894. It is a commercial and retail center with some high-technology manufacturing. San Mateo, Spanish for St. , Santa Clara Santa Clara, city, Cuba Santa Clara (sän`tä klä`rä), city (1994 est. pop. 217,000), capital of Villa Clara prov., central Cuba. , and Solano So`la´no 1. A hot, oppressive wind which sometimes blows in the Mediterranean, particularly on the eastern coast of Spain. Counties in California The U.S. state of California is divided into fifty-eight counties. Counties are responsible for all elections, property-tax collection, maintenance of public records such as deeds, and local-level courts within their borders, as well as providing law enforcement (through the county . A detailed description of the study's design, participants, population, and laboratory and epidemiologic methods is provided elsewhere (6). All patients included in the study were reported to the CDC national TB case registry The configuration database in all 32-bit versions of Windows that contains settings for the hardware and software in the PC it is installed in. The Registry is made up of the SYSTEM.DAT and USER.DAT files. Many settings previously stored in the WIN.INI and SYSTEM. on the form Report of a Verified ver·i·fy tr.v. ver·i·fied, ver·i·fy·ing, ver·i·fies 1. To prove the truth of by presentation of evidence or testimony; substantiate. 2. Case of Tuberculosis, a standardized electronic form submitted for TB surveillance to CDC by all state public health reporting areas. Data reported include patient demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. , laboratory test results, drug susceptibilities, information on chest radiographs, and treatment outcomes (7). Investigators from the sentinel surveillance sites submitted patient isolates to the corresponding regional laboratory for genotyping and conducted routine contact investigations. In addition, participants from the surveillance sites performed detailed epidemiologic investigations on groups of persons with M. tuberculosis isolates that had matching genetic patterns or clusters (see below). The regional genotyping laboratories conducted IS6110 RFLP on isolates from sentinel patients. Since low-copy numbers of IS6110 (i.e., six or fewer copies) reduce test specificity, spacer oligonucleotide Oligonucleotide A deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) sequence composed of two or more covalently linked nucleotides. Oligonucleotides are classified as deoxyribooligonucleotides or ribooligonucleotides. typing (spoligotyping) was conducted on such isolates. A cluster, which was identified by analysis of the entire TB genotyping network database, was defined as two or more isolates with either identical RFLP patterns (at least seven copies of IS6110) or identical RFLP and spoligotype patterns for isolates with RFLP patterns that had six or fewer copies of IS6110. Differences in the proportion of TB patients from the TB genotyping network population living in cities with populations of <100,000, 100,001 to 250,000, 250,001 to 500,000, and >500,000 were compared with those of the national TB patients for the year 2000 only. Statistics were obtained from the U.S. Census Bureau Noun 1. Census Bureau - the bureau of the Commerce Department responsible for taking the census; provides demographic information and analyses about the population of the United States Bureau of the Census (available at: URL URL in full Uniform Resource Locator Address of a resource on the Internet. The resource can be any type of file stored on a server, such as a Web page, a text file, a graphics file, or an application program. : http://www.census.gov/ population/cen2000/phc-t6/tab04.pdf). Correlation of average TB incidence among cases at the seven sentinel sites and percentage of cases with isolates that clustered genetically were examined by year by using the Spearman spear·man n. A man, especially a soldier, armed with a spear. rank correlation In statistics, rank correlation is the study of relationships between different rankings on the same set of items. It deals with measuring correspondence between two rankings, and assessing the significance of this correspondence. statistic statistic, n a value or number that describes a series of quantitative observations or measures; a value calculated from a sample. statistic a numerical value calculated from a number of observations in order to summarize them. . Clustering was determined by examining each year's cases independently. A Mantel-Haenszel chi-square chi-square (ki´skwar) see under distribution and test. chi-square n. or Fisher exact test was used, as appropriate, to ascertain whether the sentinel population was representative of TB patients in the United States in terms of demographic, clinical, behavioral behavioral pertaining to behavior. behavioral disorders see vice. behavioral seizure see psychomotor seizure. , or outcome characteristics. We used multiple logistic regression to assess the importance of demographic, clinical, behavioral, or outcome variables in predicting the occurrence of a given genotype for those genetic clusters Genetic cluster A group of viral strains with very similar, yet distinct, nucleic acid sequences. Mentioned in: Noroviruses that occurred most frequently ([greater than or equal to] 20 isolates). The dependent variable was the presence or absence of a given genotype. The best-fit logistic regression model was determined by the strategy of Hosmer Hosmer may refer to: People
A categorical imperative is a rule, command, or moral obligation that is absolutely and universally binding. Categorical is also used to describe programs limited to or designed for certain classes of people. independent variables was done by using the Mantel-Haenszel chi-square or Fisher exact test, as appropriate; any variable with a significance value of [greater than or equal to] 0.20 was included in a best subset A group of commands or functions that do not include all the capabilities of the original specification. Software or hardware components designed for the subset will also work with the original. , multivariate The use of multiple variables in a forecasting model. logistic regression model. Collinearity collinearity very high correlation between variables. of independent variables was assessed by using the variance/covariance matrix from PROC (language) PROC - The job control language used in the Pick operating system. ["Exploring the Pick Operating System", J.E. Sisk et al, Hayden 1986]. LOGISTIC lo·gis·tic also lo·gis·ti·cal adj. 1. Of or relating to symbolic logic. 2. Of or relating to logistics. [Medieval Latin logisticus, of calculation (SAS Institute SAS Institute Inc., headquartered in Cary, North Carolina, USA, has been a major producer of software since it was founded in 1976 by Anthony Barr, James Goodnight, John Sall and Jane Helwig. , Inc., Cary Car·y A town of east-central North Carolina, an industrial suburb of Raleigh. Population: 98,000. , NC) to generate condition indices and a matrix of variance The discrepancy between what a party to a lawsuit alleges will be proved in pleadings and what the party actually proves at trial. In Zoning law, an official permit to use property in a manner that departs from the way in which other property in the same locality decomposition decomposition /de·com·po·si·tion/ (de-kom?pah-zish´un) the separation of compound bodies into their constituent principles. de·com·po·si·tion n. 1. proportions to detect dependencies among the variables (9). Backward elimination of independent variables was performed if the probability of the independent variable was [greater than or equal to] 0.20. Both the Wald Wald , George 1906-1997. American biologist. He shared a 1967 Nobel Prize for research on the role of vitamin A in vision. statistic and 95% confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. were used on each coefficient coefficient /co·ef·fi·cient/ (ko?ah-fish´int) 1. an expression of the change or effect produced by variation in certain factors, or of the ratio between two different quantities. 2. to assess the significance of variables in each model; the log-likelihood ratio was used to assess the overall significance of the final models, and the Hosmer-Lemeshow statistic was used to evaluate the fit of each of the final models. Data were analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. by SAS (1) (SAS Institute Inc., Cary, NC, www.sas.com) A software company that specializes in data warehousing and decision support software based on the SAS System. Founded in 1976, SAS is one of the world's largest privately held software companies. See SAS System. version 8.0 software (SAS Institute, Inc.) (10). Results Sentinel Population Characteristics The incidence of TB cases in the sentinel surveillance sites varied within and among sites over time (Table 1). From 1996 to 2000, the overall incidence of TB in the United States declined from 8.0 to 5.8 per 100,000 inhabitants
The game is based loosely on the concepts from SameGame. , and similar downward trends were observed in each of the TB genotyping network sites. The California California (kăl'ĭfôr`nyə), most populous state in the United States, located in the Far West; bordered by Oregon (N), Nevada and, across the Colorado River, Arizona (E), Mexico (S), and the Pacific Ocean (W). , New Jersey, Arkansas Jersey, Arkansas, United States of America, is a populated place in Bradley County. It is situated at 161 feet (49 meters) above mean sea level. , and Texas sites had a higher incidence of TB than the overall national rates. The incidence rates in California and Texas (sites that included only six and four counties from each state) were similar to the overall incidence rates for each state (data not shown). In the surveillance area, 15,035 patients with verified TB represented 16% of the TB patients in the United States during the 5-year study period (Table 2). Overall, 11,923 TB patients were culture-positive (721 from Arkansas, 2,842 from California, 1,192 from Maryland, 1,022 from Massachusetts, 1,481 from Michigan, 2,599 from New Jersey, and 2,066 from Texas). Of TB patients in the surveillance areas, 79.3% (11,923) were culture positive, and RFLP results were available for 91.2% (10,883). However, spoligotyping results were not available for 131 of the isolates that had six or fewer copies of IS6110 (5%; n=2,638); thus, these patients were excluded from our analysis. Of 1,171 isolates not genotyped by RFLP or spoligotyping, 12 (1%) were from Michigan, 35 (3%) from Maryland, 40 (3%) from Massachusetts, 110 (9%) from Arkansas, 156 (13%) from Texas, 327 (28%) from California, and 491 (42%) from New Jersey. Primary reasons for lack of genotyping results included inability to obtain cultures from private health-care providers, contamination of cultures, or poorly growing or nonviable nonviable /non·vi·a·ble/ (-vi´ah-b'l) not capable of living. non·vi·a·ble adj. Not capable of living or developing independently. Used especially of an embryo or fetus. cultures. Characteristics of the TB patient population from the genotyping network sentinel sites were comparable with those from the entire United States, with some exceptions (Table 2). Sentinel surveillance populations had higher proportions of women (42% for the genotyping network vs. 37% for the United States overall) and patients in the 15- to 44-year age category, and were more often homeless or lived in correctional or long-term care facilities long-term care facility n. See skilled nursing facility. . Higher proportions of genotyping network patients used intravenous intravenous /in·tra·ve·nous/ (-ve´nus) within a vein or veins.intrave´nously in·tra·ve·nous adj. Abbr. IV Within or administered into a vein. drugs, but fewer patients used noninjecting drugs or alcohol excessively. Of the study population, about 4% reported previous episodes of TB (652 of 15,035; Table 2). Of persons with a previous recent history of TB, 28 had TB after completing >1 year of therapy within the. study period; genotyping data on isolates from both episodes were available for 22 of these persons. A higher number of persons from the TB genotyping network study population lived within city limits (97% vs. 87%). However, when compared with national averages, genotyping network populations were generally from smaller towns and cities: 1,446 (69%) of 2,099 genotyping network patients were from cities and towns with <250,000 inhabitants, compared with 10,093 (62%) of 16,377 TB patients nationwide (Mantel-Haenszel chi square chi square (kī), n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies. =41.8; p<0.0001). The proportion of foreign-born patients was higher in genotyping network populations compared with the overall national average (50% for genotyping network vs. 41% for the United States). Numbers of foreign-born TB patients increased over time at about the same rate for both genotyping network populations and national TB patients. From 1996 to 2000, national proportions of foreign-born TB patients increased from 37% (7,725/21,045) to 47% (7,593/16,281); in the genotyping network populations, the proportions of foreign-born TB patients increased from 44% (1,153/2,642) to 58% (1,222/ 2,092). Characteristics of the genotyping network population between sites were similar, as were culture-positive genotyping network populations compared with the overall genotyping network case population. Analysis of Genotyping Data The distribution and diversity of RFLP and spoligotyping pattern results from the genotyping network have been discussed in detail (11). In contrast to that analysis, we used both RFLP and spoligotyping results to define genetic clusters. Overall, 6,609 distinct patterns were identified, including 1,029 that contained [greater than or equal to] 2 isolates per cluster. When analyzed by site, 1,018 clusters were identified: 71 clusters were from Arkansas (611 cases genotyped, 2-16 cases per cluster), 233 from California (2,511 cases, 2-128 cases per cluster), 104 from Maryland (1,157 cases, 2-36 cases per cluster), 85 from Massachusetts (982 cases, 2-16 cases per cluster), 125 from Michigan (1,469 cases, 2-102 cases per cluster), 196 from New Jersey (2,112 cases, 2-40 cases per cluster), and 204 from Texas (1,910 cases, 2-96 cases per cluster). Overall, 970 distinct genotypes, including 235 representing clusters, had [less than or equal to] 6 copies (2,507 cases, 24% clustered, 2-93 cases per cluster). In contrast, 794 clusters from 5,639 distinct genotypes had [greater than or equal to] 7 IS6110 copies (8,245 cases, 14% clustered, 2-105 cases per cluster). Most clusters included seven or fewer persons (85%; 900/1,029). Longitudinal lon·gi·tu·di·nal adj. Running in the direction of the long axis of the body or any of its parts. Analysis Most clusters occurred in only a single site (66%; 680/ 1,029). However, 260 (25%) were found in two sites, 55 (5%) in three sites, 19 (2%) in four, 8 (1%) in five, and 7 (1%) in six sites. As expected, clusters that spanned multiple sites were larger. Clusters found at a single site averaged four persons per cluster (mean=3.65; standard error [SE] [+ or -] 0.22; n=680), in contrast to 61 persons per cluster for the genotypes found at six sites (mean=61.14; SE [+ or -] 23.6; n=7; Kruskal-Wallis test, p<0.0001). Most (62%) of the 34 clusters that occurred in at least four sites occurred in all 5 years of the study; 26% in 4 years; and 6% each in 3 and 2 years of the study. Changes in proportions of patients with isolates that clustered were observed over time. In the first 2 years of the study, the percentage of the cumulative total number of cases that clustered increased from 28% to 45%; smaller increases occurred thereafter (Figure 1). Overall, the proportion of clustered cases was 48% (5,171/10,752). The percentages of clustered cases by sites were 28% (276/982) for Massachusetts; 34% (393/1,157) for Maryland; 41% (873/2,112) for New Jersey; 42% (1,046/2,511) for California; 44% (266/611) for Arkansas; 49% (720/1,469) for Michigan; and 57% (1,093/ 1,910) for Texas. Maximum cluster size and absolute numbers of cases with isolates that clustered continued to increase through the end of the study. [FIGURE 1 OMITTED] Overall, cases with isolates that clustered showed a concomitant concomitant /con·com·i·tant/ (kon-kom´i-tant) accompanying; accessory; joined with another. concomitant adjective Accompanying, accessory, joined with another decline with average incidence of TB over the 5-year period (Figure 2). A significant positive association was observed between the percentage of cases with clustered genotypes and TB incidence over time (Spearman rho=0.90; p=0.037). [FIGURE 2 OMITTED] Risk Factor Analyses Verb 1. factor analyse - to perform a factor analysis of correlational data factor analyze analyse, analyze - break down into components or essential features; "analyze today's financial market" of Genetic Clusters Compared with persons whose isolates had unique genotypes, persons with isolates that clustered were more likely to be non-Hispanic, black men born in the United States. They were more likely to have pulmonary disease and abnormal chest radiographs with cavities; in addition, they more often had positive sputum smears; were HIV-positive, homeless, or residents of a correctional facility; and used drugs or alcohol excessively (Table 3). Patients with unclustered isolates were 5 years older on the average than those with isolates that clustered (44.8 years vs. 49.4 years, respectively; Table 3). Multiple logistic regression efforts resulted in models that were not robust (data not shown). Except for 4 genotypes, all 34 clusters with [greater than or equal to] 20 isolates per cluster had significant demographic, clinical, and behavioral risk factors (Table 4). Race, ethnicity ethnicity Vox populi Racial status–ie, African American, Asian, Caucasian, Hispanic , and place of birth were frequently significant predictors for a given genotype. Other predictors included gender, age, site of disease, resistance to first-line drugs, and alcohol or drug abuse (Table 4). Twelve (40%) of 30 of these larger clusters were observed in four or more sites over a 5-year period. Lower percentages of foreign-born patients than U.S.-born patients clustered, regardless of the number of IS6110 copies (Figure 3). More than 50% (1,025/1,825) of the foreign-born patients whose isolates clustered had been in the United States for [greater than or equal to] 5 years. Clustering of isolates from foreign-born patients ranged from 15% (49/316) in Michigan to 38% (309/816) in Texas. [FIGURE 3 OMITTED] Discussion This population-based study is the largest that has been conducted in the United States to assess risk factors related to specific M. tuberculosis genotypes. Generally, clustered isolates have been considered recently acquired infections (12). However, this assumption may not always be correct. Clustering does not prove that transmission occurred, and its demonstration depends on adequate sampling of the population, incidence of TB, and characteristics of the study population (e.g., age structure, population mobility, duration of residence, and immune status) (1,13). Only 25%-42% of patients in genetic clusters were shown to have epidemiologic connections with another member of the cluster (14-16). Conventional epidemiologic investigation of these TB patients (including interviews) was conducted, but inclusion in this analysis was outside the scope of this article. Thus, results that indicate clustered genotypes are representative of recent transmission should be interpreted with caution. Given this caveat, our results nevertheless demonstrate several consistent patterns. Differences in demographic and other risk factors for persons with isolates that clustered corroborated cor·rob·o·rate tr.v. cor·rob·o·rat·ed, cor·rob·o·rat·ing, cor·rob·o·rates To strengthen or support with other evidence; make more certain. See Synonyms at confirm. those from smaller studies conducted in the United States and larger surveys in Europe Europe (y  r`əp), 6th largest continent, c.4,000,000 sq mi (10,360,000 sq km) including adjacent islands (1992 est. pop. 512,000,000). .
Extensive surveys from the Netherlands Netherlands (nĕth`ərləndz), Du. Nederland or Koninkrijk der Nederlanden, officially Kingdom of the Netherlands, constitutional monarchy (2005 est. pop. 16,407,000), 15,963 sq mi (41,344 sq km), NW Europe. (17) also demonstrated that
persons with isolates that clustered genetically were younger than those
with unique genotypes. Other risk factors for clustering included being
male, born in the United States, non-Hispanic black, or homeless; using
drags and alcohol excessively; and having pulmonary disease and
cavitations on chest radiograph, a sputum smear with acid-fast bacilli,
and HIV infection. These risk factors have been observed for TB patients
in different communities (12,18,19). The heterogeneity het·er·o·ge·ne·i·tyn. The quality or state of being heterogeneous. heterogeneity the state of being heterogeneous. and diversity of the study population may account for our failure to produce a multivariate logistic model to predict clustering. A third of the foreign-born cases were recent immigrants to the United States, and overall, the percentage of clustered isolates from foreign-born persons was lower than the percent age from nonimmigrants (Figure 3), indicating that at least a portion of these cases resulted from reactivation reactivation to become active after a period of quiescence or, as in bacterial and viral infections, latency. cross reactivation of latent Hidden; concealed; that which does not appear upon the face of an item. For example, a latent defect in the title to a parcel of real property is one that is not discoverable by an inspection of the title made with ordinary care. disease or recent infection in the country of origin. In addition, for foreign-born persons, clustering of M. tuberculosis increased with the duration of residence in the United States. These results suggest that recently imported strains of M. tuberculosis from foreign-born persons may not commonly spread to U.S. residents or that transmission may be occurring after a lag time before the imported strains manifest manifest 1) adj., adv. completely obvious or evident. 2) n. a written list of goods in a shipment. MANIFEST, com. law. A written instrument containing a true account of the cargo of a ship or commercial vessel. 2. as disease in contacts. Similar observations have been published in studies from San Francisco San Francisco (săn frănsĭs`kō), city (1990 pop. 723,959), coextensive with San Francisco co., W Calif., on the tip of a peninsula between the Pacific Ocean and San Francisco Bay, which are connected by the strait known as the Golden , New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , Switzerland Switzerland (swĭt`sərlənd), Fr. Suisse, Ger. Schweiz, Ital. Svizzera, officially Swiss Confederation, federal republic (2005 est. pop. 7,489,000), 15,941 sq mi (41,287 sq km), central Europe. , and Norway Norway, Nor. Norge, officially Kingdom of Norway, constitutional monarchy (2005 est. pop. 4,593,000), 125,181 sq mi (324,219 sq km), N Europe, occupying the western part of the Scandinavian peninsula. (20-24). These data may also reflect gaps in our knowledge of M. tuberculosis genotypes in circulation; a comparison of the U.S. TB genotyping network results with other databases worldwide may be warranted. Logistic regression analysis of the most commonly occurring strains demonstrated that different risk factors were associated with specific genotypes. Several genotypes were associated with ethnic origin (e.g., Asian or Pacific Islander Asian or Pacific Islander Multiculture A person with origins in any of the peoples of the Far East, Southeast Asia, Indian subcontinent, Pacific Islands–eg China, India, Japan, Korea, the Philippine Islands and Samoa and Hispanic Hispanic Multiculture A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race Social medicine Any of 17 major Latino subcultures, concentrated in California, Texas, Chicago, Miam, NY, and elsewhere patients with six and three genotypes, respectively; Table 4). A recent study in Norway showed that several clusters consisted of patients of the same ethnic origin (23). An association has also been observed between the patient's ethnic origin and IS6110 copy number (25). These results, in conjunction with additional epidemiologic data, may be useful in tracking the geographic origin and spread of M. tuberculosis strains of public health importance (26). A small proportion of clustered isolates were from persons from more than four sites spanning 5 years of study (Table 4). Although an in-depth in-depth adj. Detailed; thorough: an in-depth study. in-depth Adjective detailed or thorough: an in-depth analysis analysis of epidemiologic links was not possible in this study, we found no evidence of recent transmission between patients with identical genotypes from the different states (data not shown); this lack of transmission was also noted in a smaller study in the United States (27). Since TB transmission is generally considered a local event, these ubiquitous Found in large quantities everywhere. This English word means "all over the place." genotypes may be widespread because of social factors (e.g., homelessness or alcohol or drug abuse; Table 4). In addition, these genotypes may represent older, endemic endemic /en·dem·ic/ (en-dem´ik) present or usually prevalent in a population at all times. en·dem·ic adj. 1. domestic strains that have been in the United States for centuries and have dispersed dis·perse v. dis·persed, dis·pers·ing, dis·pers·es v.tr. 1. a. To drive off or scatter in different directions: The police dispersed the crowd. b. more widely throughout the United States than the more recently imported strains. Further molecular characterization of these genotypes may show additional differences not detected by RFLP. Nonetheless, the effect of M. tuberculosis virulence Virulence The ability of a microorganism to cause disease. Virulence and pathogenicity are often used interchangeably, but virulence may also be used to indicate the degree of pathogenicity. or host factors on the distribution of these genotypes cannot be ascertained as·cer·tain tr.v. as·cer·tained, as·cer·tain·ing, as·cer·tains 1. To discover with certainty, as through examination or experimentation. See Synonyms at discover. 2. . The proportion of strains that were classified into clusters of identical genotypes (48%) was comparable with proportions in the Netherlands and Denmark Denmark (dĕn`märk), Dan. Danmark, officially Kingdom of Denmark, kingdom (2005 est. pop. 5,432,000), 16,629 sq mi (43,069 sq km), N Europe. (50%) (2,28), but the proportion was considerably higher than in two other countries (17% in Switzerland [29]; 20% in Norway [23]). The cumulative percentage of clustered strains reached a plateau plateau, elevated, level or nearly level portion of the earth's surface, larger in summit area than a mountain and bounded on at least one side by steep slopes, occurring on land or in oceans. by the end of the study's second year (Figure 1), a finding consistent with other molecular epidemiologic TB studies (2). Increases in maximum cluster size were anticipated because, as sample sizes increase with time, the number of isolates in each cluster indicate that the low-copy IS6110 patterns are not specific, even with the addition of spoligotyping. [FIGURE 1 OMITTED] The sensitivity and specificity of IS6110 RFLP in molecular epidemiologic studies epidemiologic study A study that compares 2 groups of people who are alike except for one factor, such as exposure to a chemical or the presence of a health effect; the investigators try to determine if any factor is associated with the health effect have not been quantified and represent a potential limitation of this study. Although the stability of IS6110 is relatively high, the half-life half-life, measure of the average lifetime of a radioactive substance (see radioactivity) or an unstable subatomic particle. One half-life is the time required for one half of any given quantity of the substance to decay. of IS6110 RFLP is estimated to be 3-10 years (29-31) based on typing of serial isolates from individual patients. A study of isolates from patients in confirmed chains of transmission showed little change in IS6110 patterns (32). Calculation of these rates may be influenced by the duration between time of disease onset and time of sampling and may be proportional proportional values expressed as a proportion of the total number of values in a series. proportional dwarf the patient is a miniature without disproportionate reductions or enlargements of body parts. to the effectiveness of the TB control program (30). Because genotyping results were not available for 10% of TB cases in this study, estimates of the degree of clustering and the size of clusters are conservative. Some unique isolates might have clustered if some of the missing isolates had been available or if other cases with the same strain were present outside the study area (33). Sentinel surveillance sites defined by artificial boundaries (i.e., state lines) not entirely representative of TB patients from the United States were included in this study. More than 90% of the isolates from patients from the surveillance areas were genotyped, and these isolates were representative of those culture-positive patients from the sentinel surveillance areas. However, 16% of all TB case-patients reported in the United States were included in these sentinel surveillance sites during the 5-year study period. In addition, the sentinel surveillance population had higher proportions of foreign-born persons than the national average. Because of the propensity of foreign-born persons to have isolates with unique genotypes, the actual rate of clustering may have been underestimated. Nonetheless, sentinel surveillance of TB cases has provided a useful method for documenting genotypes in circulation in the United States and for identifying risk factor correlates of common genotypes. Annual declines in TB incidence were paralleled by similar declines in the proportion of cases with genotypes in clusters (Figure 2), a finding consistent with the hypothesis that decreased clustering is expected with declining incidence (20). Since effort was similar each year, this association is not likely to be an artifact A distortion in an image or sound caused by a limitation or malfunction in the hardware or software. Artifacts may or may not be easily detectable. Under intense inspection, one might find artifacts all the time, but a few pixels out of balance or a few milliseconds of abnormal sound related to sample size (i.e., as sample size or number of cases becomes smaller, the probability of detecting clusters decreases). These findings underscore The underscore character (_) is often used to make file, field and variable names more readable when blank spaces are not allowed. For example, NOVEL_1A.DOC, FIRST_NAME and Start_Routine. (character) underscore - _, ASCII 95. the importance of long-term Long-term Three or more years. In the context of accounting, more than 1 year. long-term 1. Of or relating to a gain or loss in the value of a security that has been held over a specific length of time. Compare short-term. longitudinal molecular studies and the potential usefulness of these methods in evaluating program effectiveness and improving program management. [FIGURE 2 OMITTED]
Table 1. Incidence of tuberculosis cases in the United States and in
the sentinel surveillance areas of the National Tuberculosis
Genotyping Surveillance Network, 1996-2000 (a)
Sentinel surveillance site 1996 1997 1998 1999
Arkansas 9.0 7.9 6.7 7.1
California (b) 16.3 13.9 13.9 12.9
Maryland 6.3 6.7 6.3 5.7
Massachusetts 4.3 4.4 4.6 4.4
Michigan 4.6 3.8 3.9 3.6
New Jersey 10.3 8.9 7.9 7.0
Texas (b) 12.7 12.8 12.5 10.9
United States 8.0 7.4 6.8 6.4
Sentinel surveillance site 2000 Mean
Arkansas 7.4 7.6
California (b) 11.6 13.7
Maryland 5.3 6.1
Massachusetts 4.5 4.4
Michigan 2.9 3.8
New Jersey 6.7 8.2
Texas (b) 9.6 11.7
United States 5.8 6.9
(a) Number per 100,000 inhabitants.
(b) Sentinel surveillance areas for California and Texas did not
include the entire states.
Table 2. Demographic and risk behavior factors and clinical,
laboratory, and treatment outcomes for the sentinel surveillance
patients (National Tuberculosis Genotyping and Surveillance Network)
compared with factors and outcomes of all tuberculosis patients, United
States, 1996-2000 (a,b)
All U.S. TB cases
Variable Category (n=93,097) (%)
Gender Male 58,356 (62.7)
Female 34,734 (37.3)
Unknown 7 (0.0)
Age (yrs) [less than or equal to] 4 3,289 (3.5)
5-14 2,397 (2.6)
15-24 7,988 (8.6)
25-44 32,433 (34.8)
45-64 25,319 (27.2)
>64 21,662 (23.3)
Unknown 9 (0.0)
Race/ethnicity White, non-Hispanic 22,655 (24.3)
Black, non-Hispanic 30,201 (32.4)
Hispanic 20,475 (22.0)
American Indian/Native 1,280 (1.4)
Asian/Pacific Islander 18,346 (19.7)
Unknown 140 (0.2)
Place of birth U.S.-born 54,341 (58.4)
Foreign-born 38,252 (41.1)
Unknown 504 (0.5)
Years in United
States (foreign-
born only) <1 7,425 (19.4)
1 2,612 (6.8)
2 2,073 (5.4)
3 1,827 (4.8)
4 1,676 (4.4)
[greater than or equal to] 5 19,396 (50.7)
Unknown 3,243 (8.5)
Country of
origin (d) Philippines 4,862 (12.7)
Mexico 8,795 (23.0)
Vietnam 3,824 (10.0)
India 2,527 (6.6)
China 1,930 (5.0)
Haiti 1,470 (3.8)
Peru 636 (1.7)
Republic of Korea 1,176 (3.1)
Ethiopia 578 (1.5)
Ecuador 627 (1.6)
Other 11,827 (30.9)
Status at
diagnosis Alive 90,141 (96.8)
Dead 2,925 (3.1)
Unknown 31 (0.0)
Site of disease Pulmonary 68,611 (73.7)
Extrapulmonary 17,406 (18.7)
Pulmonary and Extrapulmonary 7,046 (7.6)
Unknown 34 (0.0)
Primary disease
site Pulmonary 73,157 (78.6)
Lymph: cervical 4,312 (4.6)
Pleural 3,842 (4.1)
Primary disease
site Miliary 1,407 (1.5)
All other 10,345 (11.1)
Unknown 34 (0.0)
Sputum smear for
acid-fast
organisms Negative 36,912 (39.6)
Positive 33,235 (35.7)
Not done/unknown 22,950 (24.6)
TST at diagnosis Negative 13,215 (14.2)
Positive 54,113 (58.1)
Not done/unknown 25,769 (27.6)
Case verification
criteria Positive culture 74,940 (80.5)
Positive smear 765 (0.8)
Clinical case 11,286 (12.1)
Provider diagnosis 6,106 (6.6)
Chest radio-
graph (e) Cavitary 18,742 (24.8)
Noncavitary 50,652 (66.9)
Normal 2,495 (3.3)
Not done/unknown 3,802 (5.0)
Total 75,691
HIV status (f) Positive 6,062 (18.8)
Negative 16,525 (51.2)
Indeterminate 47 (0.1)
Refused 1,959 (6.1)
Not offered 4,130 (12.8)
Test done, unknown 714 (2.2)
Unknown 2,812 (8.7)
Total 32,249
Homeless within
past year Yes 5,789 (6.2)
No 84,873 (91.2)
Unknown 2,435 (2.6)
Resident of
correctional
facility at
diagnosis Yes 3,352 (3.6)
No 89,479 (96.1)
Unknown 266 (0.3)
Correctional
facility type Federal prison 164 (4.9)
State prison 1,036 (30.9)
Total 3,352
Local jail 1,905 (56.8)
Juvenile facility 33 (1.0)
Other 161 (4.8)
Unknown 53 (1.6)
Yes 3,157 (3.4)
Resident, long-
term care faci-
lity at
diagnosis Unknown 284 (0.3)
Long-term care
facility type Nursing home 1,794 (56.8)
Hospital-based 44l (14.0)
Residential 356 (11.3)
All other 504 (16.0)
Unknown 62 (2.0)
Total 3,157
Injecting drug
use (g) Yes 2,569 (2.8)
No 83,141 (89.3)
Unknown 7,387 (7.9)
Noninjecting drug
use (g) Yes 6,557 (7.0)
No 78,622 (84.5)
Unknown 7,918 (8.5)
Excessive alcohol
use (h) Yes 13,646 (14.7)
No 71,924 (77.3)
Unknown 7,527 (8.1)
Drug resis-
tance (i)
First-line drugs Yes 8,456 (11.7)
No 57,029 (79.0)
Not tested/unknown 6,703 (9.3)
Total 72,188
Second-line drugs Yes 1,341 (1.9)
No 175 (0.2)
Not tested/unknown 70,672 (97.9)
Total 72,188
DOT Yes--total DOT 40,511 (43.5)
Yes--both DOT and self-
administered 20,555 (22.1)
No 23,337 (25.1)
Unknown 8,694 (9.3)
Within city limits Yes 80,775 (86.8)
No 10,916 (11.7)
Unknown 1,406 (1.5)
Previous diagnosis
of TB Yes 4,794 (5.1)
No 87,567 (94.1)
Unknown 736 (0.8)
Duration of
therapy (days) Mean 246
Median 217
Std. dev. 135
No. 65,344
All NTGSN cases
Variable Category (n=15,035) (%)
Gender Male 8,767 (58.3)
Female 6,266 (41.7)
Unknown 2 (0.0)
Age (yrs) [less than or equal to] 4 518 (3.4)
5-14 393 (2.6)
15-24 1,462 (9.7)
25-44 5,413 (36.0)
45-64 3,850 (25.6)
>64 3,397 (22.6)
Unknown 2 (0.0)
Race/ethnicity White, non-Hispanic 3,087 (20.5)
Black, non-Hispanic 4,775 (31.8)
Hispanic 2,923 (19.4)
American Indian/Native 38 (0.3)
Asian/Pacific Islander 4,195 (27.9)
Unknown 17 (0.1)
Place of birth U.S.-born 7,530 (50.1)
Foreign-born 7,468 (49.7)
Unknown 37 (0.2)
Years in United
States (foreign-
born only) <1 1,494 (20.0)
1 567 (7.6)
2 477 (6.4)
3 406 (5.4)
4 361 (4.8)
[greater than or equal to] 5 3,688 (49.4)
Unknown 475 (6.4)
Country of
origin (d) Philippines 1,113 (14.9)
Mexico 1,100 (14.7)
Vietnam 968 (13.0)
India 883 (11.8)
China 370 (5.0)
Haiti 225 (3.0)
Peru 207 (2.8)
Republic of Korea 202 (2.7)
Ethiopia 153 (2.0)
Ecuador 115 (1.5)
Other 2,132 (28.5)
Status at
diagnosis Alive 14,611 (97.2)
Dead 422 (2.8)
Unknown 2 (0.0)
Site of disease Pulmonary 10,576 (70.3)
Extrapulmonary 3,210 (21.4)
Pulmonary and Extrapulmonary 1,241 (8.3)
Unknown 8 (0.1)
Primary disease
site Pulmonary 11,365 (75.6)
Lymph: cervical 1,020 (6.8)
Pleural 674 (4.5)
Primary disease
site Miliary 241 (1.6)
All other 1,727 (11.5)
Unknown 8 (0.0)
Sputum smear for
acid-fast
organisms Negative 5,995 (39.9)
Positive 4,735 (31.5)
Not done/unknown 4,305 (28.7)
TST at diagnosis Negative 1,947 (12.9)
Positive 8,799 (58.5)
Not done/unknown 4,289 (28.6)
Case verification
criteria Positive culture 11,967 (79.6)
Positive smear 136 (0.9)
Clinical case 1,858 (12.4)
Provider diagnosis 1,074 (7.1)
Chest radio-
graph (e) Cavitary 2,990 (25.3)
Noncavitary 7,897 (66.8)
Normal 360 (3.0)
Not done/unknown 578 (4.9)
Total 11,825
HIV status (f) Positive 884 (16.7)
Negative 2,406 (45.5)
Indeterminate 6 (0.1)
Refused 325 (6.1)
Not offered 899 (17.0)
Test done, unknown 115 (2.2)
Unknown 658 (12.4)
Total 5,293
Homeless within
past year Yes 646 (4.3)
No 14,185 (94.3)
Unknown 204 (1.4)
Resident of
correctional
facility at
diagnosis Yes 377 (2.5)
No 14,617 (97.2)
Unknown 41 (0.3)
Correctional
facility type Federal prison 6 (1.6)
State prison 97 (25.7)
Total 377
Local jail 231 (61.3)
Juvenile facility 8 (2.1)
Other 34 (9.0)
Unknown 1 (0.3)
Yes 441 (2.9)
Resident, long-
term care faci-
lity at
diagnosis Unknown 42 (0.3)
Long-term care
facility type Nursing home 279 (63.3)
Hospital-based 66 (15.0)
Residential 34 (7.7)
All other 55 (12.5)
Unknown 7 (1.6)
Total 441
Injecting drug
use (g) Yes 515 (3.4)
No 13,771 (91.6)
Unknown 749 (5.0)
Noninjecting drug
use (g) Yes 811 (5.4)
No 13,367 (88.9)
Unknown 857 (5.7)
Excessive alcohol
use (h) Yes 1,661 (11.0)
No 12,552 (83.5)
Unknown 822 (5.5)
Drug resis-
tance (i)
First-line drugs Yes 1,482 (12.6)
No 8,886 (75.5)
Not tested/unknown 1,399 (11.9)
Total 11,767
Second-line drugs Yes 208 (1.8)
No 78 (0.7)
Not tested/unknown 11,481 (97.6)
Total 11,767
DOT Yes--total DOT 4,936 (32.8)
Yes--both DOT and self-
administered 3,648 (24.3)
No 5,326 (35.4)
Unknown 1,125 (7.5)
Within city limits Yes 14,603 (97.1)
No 374 (2.5)
Unknown 58 (0.4)
Previous diagnosis
of TB Yes 652 (4.3)
No 14,336 (95.4)
Unknown 47 (0.3
Duration of
therapy (days) Mean 245
Median 214
Std. dev. 130
No. 10,822
Variable Category Probability (c)
Gender Male <0.001
Female
Unknown
Age (yrs) [less than or equal to] 4 NS
5-14 NS
15-24 <0.001
25-44 0.05
45-64 <0.001
>64 NS
Unknown
Race/ethnicity White, non-Hispanic <0.001
Black, non-Hispanic NS
Hispanic <0.001
American Indian/Native <0.001
Asian/Pacific Islander <0.001
Unknown
Place of birth U.S.-born <0.001
Foreign-born
Unknown
Years in United
States (foreign-
born only) <1 NS
1 NS
2 <0.005
3 <0.05
4 NS
[greater than or equal to] 5 <0.001
Unknown
Country of
origin (d) Philippines <0.0001
Mexico <0.0001
Vietnam <0.0001
India <0.0001
China NS
Haiti <0.0005
Peru <0.0001
Republic of Korea NS
Ethiopia <0.001
Ecuador NS
Other <0.0001
Status at
diagnosis Alive 0.02
Dead
Unknown
Site of disease Pulmonary <0.001
Extrapulmonary <0.001
Pulmonary and Extrapulmonary 0.003
Unknown
Primary disease
site Pulmonary <0.0001
Lymph: cervical <0.0001
Pleural <0.05
Primary disease
site Miliary NS
All other NS
Unknown
Sputum smear for
acid-fast
organisms Negative <0.0001
Positive
Not done/unknown
TST at diagnosis Negative <0.001
Positive
Not done/unknown
Case verification
criteria Positive culture <0.01
Positive smear NS
Clinical case NS
Provider diagnosis <0.01
Chest radio-
graph (e) Cavitary NS
Noncavitary NS
Normal NS
Not done/unknown
Total
HIV status (f) Positive NS
Negative
Indeterminate
Refused
Not offered
Test done, unknown
Unknown
Total
Homeless within
past year Yes <0.001
No
Unknown
Resident of
correctional
facility at
diagnosis Yes <0.001
No
Unknown
Correctional
facility type Federal prison <0.005
State prison <0.05
Total
Local jail NS
Juvenile facility NS
Other <0.001
Unknown
Yes 0.004
Resident, long-
term care faci-
lity at
diagnosis Unknown
Long-term care
facility type Nursing home <0.01
Hospital-based NS
Residential <0.05
All other NS
Unknown
Total
Injecting drug
use (g) Yes <0.001
No
Unknown
Noninjecting drug
use (g) Yes <0.001
No
Unknown
Excessive alcohol
use (h) Yes <0.001
No
Unknown
Drug resis-
tance (i)
First-line drugs Yes <0.001
No
Not tested/unknown
Total
Second-line drugs Yes <0.00l
No
Not tested/unknown
Total
DOT Yes--total DOT <0.001
Yes--both DOT and self-
administered <0.001
No <0.001
Unknown
Within city limits Yes <0.001
No
Unknown
Previous diagnosis
of TB Yes <0.001
No
Unknown
Duration of
therapy (days) Mean NS
Median
Std. dev.
No.
(a) NTGSN, National Tuberculosis Genotyping Surveillance Network;TB,
tuberculosis; DOT, directly observed therapy; TST, tuberculin skin
test; Std. dev., standard deviation; NS, not significant (p>0.05).
(b) Subtotals for each category are listed if different from the total
case numbers.
(c) Probability of significant differences between U.S. TB patients and
all NTGSN surveillance patients (chi-square test; t-test for duration
of therapy); referent group is all other groups combined, excluding not
done or unknown categories, unless otherwise noted.
(d) Top 10 countries for foreign-born patients only.
(e) Excludes cases with extrapulmonary TB only.
(f) HIV cases from California are excluded because this site does not
report HIV results on Report of a Verified Case of Tuberculosis forms;
ages 15-44 years only.
(g) Injecting or noninjecting drug use within last year; includes use
of licensed, prescription, or illegal drugs (not prescribed by a
physician).
(h) Excessive use of alcohol within the past year as indicated by
participation in alcohol treatment programs, diagnosis of alcoholism,
or observation of intoxication during visits to health-care facilities.
(i) Drug resistance on initial testing of isolate. First-line drug
resistance is resistance to at least one of the following: isoniazid,
rifampin, ethambutol, or streptomycin. Second-line drug resistance is
resistance to one or more of the following: ethionamide, kanamycin,
cycloserine, capreomycin, para-amino salicylic acid, amikacin,
rifabutin, ciprofloxacin, ofloxacin, or other drugs. Testing results
for one or more of the drugs could have been missing.
Table 3. Comparison of demographic and behavioral risk factors and
clinical and treatment outcomes of tuberculosis (TB) case-patients who
have genetically clustered genotypes with factors and outcomes of
patients who had unique genotype patterns (a)
Variable (b) Clustered (%)
Total cases (n=10,752) 5.171 (48.1)
Gender Male 3,289 (63.6)
Female 1,881 (36.4)
Unknown 1 (0.0)
Mean age (yrs;
[+ or -] S.E.) 44.8 ([+ or -] 0.26)
Race/ethnicity White, non-Hispanic 1,018 (19.7)
Black, non-Hispanic 2,254 (43.6)
Hispanic 914 (17.7)
American Indian/
Native 17 (0.3)
Asian/Pacific
Islander 961 (18.6)
Unknown 7 (0.1)
Place of birth U.S.-born 3,331 (64.4)
Foreign-born 1,825 (35.3)
Unknown 15 (0.3)
Recent arrival in
United States (d) Yes 535 (29.3)
No 1,181 (64.7)
Unknown 109 (6.0)
Site of disease Pulmonary 3,902 (75.5)
Extrapulmonary 788 (15.2)
Pulmonary and
extrapulmonary 476 (9.2)
Unknown 5 (0.1)
Sputum smear Positive 2,270 (43.9)
Negative 1,802 (34.8)
Not done/unknown 1,099 (21.3)
Chest radiograph (e) Cavitary 1,345 (30.7)
Noncavitary 2,639 (60.2)
Normal 146 (3.3)
Not done/unknown 253 (5.8)
Total 4,383
HIV status (f) Positive 458 (22.2)
Negative 978 (47.4)
Indeterminate 0
Refused 106 (5.1)
Not offered 252 (12.2)
Unknown 270 (13.0)
Total 2,064
Homeless within past
year Yes 370 (7.2)
No 4,724 (91.4)
Unknown 77 (1.5)
Resident of correc-
tional facility at
diagnosis Yes 190 (3.7)
No 4,966 (96.0)
Unknown 15 (0.3)
Injecting drug use (g) Yes 312 (6.0)
No 4,540 (87.8)
Unknown 319 (6.2)
Noninjecting drug
use (g) Yes 460 (8.9)
No 4,335 (83.8)
Unknown 376 (7.3)
Excessive alcohol
use (g) Yes 948 (18.3)
No 3,897 (75.4)
Unknown 326 (6.3)
First-line drugs (h) Yes 622 (12.1)
No 2,718 (53.0)
Not done 1,748 (34.1)
Unknown 45 (0.9
Total 5,133
Variable (b) Unclustered (%)
Total cases (n=10,752) 5,581(51.9)
Gender Male 3,107 (55.7)
Female 2,473 (44.3)
Unknown 1 (0.0)
Mean age (yrs;
[+ or -] S.E.) 49.4 ([+ or -] 0.28)
Race/ethnicity White, non-Hispanic 1,201 (21.5)
Black, non-Hispanic 1,237 (22.2)
Hispanic 1,112 (19.9)
American Indian/
Native 10 (0.2)
Asian/Pacific
Islander 2,014 (36.1)
Unknown 7 (0.1)
Place of birth U.S.-born 2,023 (36.2)
Foreign-born 3,552 (63.6)
Unknown 6 (0.1)
Recent arrival in
United States (d) Yes 1,225 (34.5)
No 2,111 (59.4)
Unknown 216 (6.1)
Site of disease Pulmonary 3,835 (68.7)
Extrapulmonary 1,254 (22.5)
Pulmonary and
extrapulmonary 492 (8.8)
Unknown 0
Sputum smear Positive 2,011 (36.0)
Negative 1,943 (34.8)
Not done/unknown 1,627 (29.1)
Chest radiograph (e) Cavitary 1,172 (27.1)
Noncavitary 2,826 (65.3)
Normal 118 (2.73)
Not done/unknown 211 (4.9)
Total 4,327
HIV status (f) Positive 223 (11.8)
Negative 847 (44.8)
Indeterminate 4 (0.2)
Refused 138 (7.3)
Not offered 354 (18.7)
Unknown 323 (17.1)
Total 1,889
Homeless within past
year Yes 139 (2.5)
No 5,370 (96.2)
Unknown 72 (1.3)
Resident of correc-
tional facility at
diagnosis Yes 69 (1.2)
No 5,503 (98.6)
Unknown 9 (0.2)
Injecting drug use (g) Yes 72 (1.3)
No 5,231 (93.7)
Unknown 278 (5.0)
Noninjecting drug
use (g) Yes 140 (2.5)
No 5,140 (92.1)
Unknown 301 (5.4)
Excessive alcohol
use (g) Yes 371 (6.6)
No 4,893 (87.7)
Unknown 317 (5.7)
First-line drugs (h) Yes 755 (13.7)
No 3,337 (60.5)
Not done 1,356 (24.6)
Unknown 66 (1.2)
Total 5,514
Variable (b) Relative risk (95% CI)
Total cases (n=10,752)
Gender Male 1.19 (1.14% to 1.24%)
Female
Unknown
Mean age (yrs;
[+ or -] S.E.)
Race/ethnicity White, non-Hispanic 0.94 (0.90% to 0.99%)
Black, non-Hispanic 1.61 (1.55% to 1.67%)
Hispanic 0.92 (0.88% to 0.97%)
American Indian/
Native
Asian/Pacific
Islander 0.60 (0.56% to 0.63%)
Unknown
Place of birth U.S.-born 1.83 (1.75% to 1.90%)
Foreign-born
Unknown
Recent arrival in
United States (d) Yes 0.59 (0.55% to 0.63%)
No
Unknown
Site of disease Pulmonary 1.20 (1.14% to 1.26%)
Extrapulmonary 0.77 (0.72% to 0.81%)
Pulmonary and
extrapulmonary
Unknown
Sputum smear Positive 1.22 (1.11% to 1.33%)
Negative
Not done/unknown
Chest radiograph (e) Cavitary 1.09 (1.04% to 1.14%)
Noncavitary
Normal
Not done/unknown
Total
HIV status (f) Positive 1.37 (1.29% to 1.46%)
Negative
Indeterminate
Refused
Not offered
Unknown
Total
Homeless within past
year Yes 1.55 (1.46% to 1.64%)
No
Unknown
Resident of correc-
tional facility at
diagnosis Yes 1.55 (1.43% to 1.67%)
No
Unknown
Injecting drug use (g) Yes 1.73 (1.65% to 1.83%)
No
Unknown
Noninjecting drug
use (g) Yes 1.65 (l.57% to 1.73%)
No
Unknown
Excessive alcohol
use (g) Yes 1.61 (1.54% to 1.67%)
No
Unknown
First-line drugs (h) Yes 0.93 (0.87% to 0.99%)
No
Not done
Unknown
Total
Variable (b) Probability (c)
Total cases (n=10,752)
Gender Male <0.001
Female
Unknown
Mean age (yrs;
[+ or -] S.E.) <0.0001
Race/ethnicity White, non-Hispanic 0.02
Black, non-Hispanic <0.001
Hispanic 0.003
American Indian/
Native
Asian/Pacific
Islander <0.001
Unknown
Place of birth U.S.-born <0.001
Foreign-born
Unknown
Recent arrival in
United States (d) Yes <0.001
No
Unknown
Site of disease Pulmonary <0.001
Extrapulmonary <0.001
Pulmonary and
extrapulmonary NS
Unknown
Sputum smear Positive <0.001
Negative
Not done/unknown
Chest radiograph (e) Cavitary <0.001
Noncavitary
Normal
Not done/unknown
Total
HIV status (f) Positive <0.001
Negative NS
Indeterminate
Refused
Not offered
Unknown
Total
Homeless within past
year Yes <0.001
No
Unknown
Resident of correc-
tional facility at
diagnosis Yes <0.001
No
Unknown
Injecting drug use (g) Yes <0.001
No
Unknown
Noninjecting drug
use (g) Yes <0.001
No
Unknown
Excessive alcohol
use (g) Yes <0.001
No
Unknown
First-line drugs (h) Yes 0.016
No
Not done
Unknown
Total
(a) CI, confidence interval; S.E., standard error.
(b) Only factors that had significant differences are shown.
(c) Probability of chi-square statistic is shown, except for t-test
results from analysis of age from each group.
(d) Foreign-born only; arrived in the United States within 2 years.
(e) Excludes cases with extrapulmonary TB only.
(f) California TB cases not included; ages 15-44 years only.
(g) Excessive drug or alcohol use within last year.
(h) First-line drug resistance is resistance to at least one of the
following: isoniazid, rifampin, ethambutol, or streptomycin.
Second-line drug resistance is resistance to one or more of the
following: ethionamide, kanamycin, cycloserine, capreomycin, para-amino
salicylic acid, amikacin, rifabutin, ciprofloxacin, ofloxacin, or other
drugs. Testing results for one or more of the drugs could have been
missing.
Table 4 Odds ratios from best-fit logistic regression analyses of the
presence or absence of a specific genetic cluster of Mycobacterium
tuberculosis on demographic, clinical, behavioral, or treatment outcome
variables (a)
Designation (c) IS61110 copies Spoligotype (c) N
00003 (c) 1 777777777760771 40
00129 (d) 1 777777777413771 25
00129 (d) 1 777777774413771 83
00129 (d) 1 477777777413071 23
00129 (d) 1 777777777413731 13
00129 1 777776407760601 40
00016 2 701776777760601 129
00016 (c) 2 777776777760771 82
00016 2 037776777760601 30
00016 (d) 2 777776777760601 175
00370 3 700036777760731 13
00017 (d) 4 700076777760771 25
00017 (d) 4 777776777760771 64
01285 4 777776777760771 20
00015 7 28
00768 9 19
00242 (d) 10 95
00028 11 70
00159 11 24
00325 11 20
00673 11 25
00757 11 16
00019 (c) 12 27
00372 12 20
00035 13 33
00867 14 20
01284 17 46
00237 (c) 21 98
01693 21 29
00027 22 78
Odds ratio estimates
Designation (c) Main effect (95% CI) (b)
00003 (c) Asian/Pacific Islander 3.70 (1.51% to 9.02%)
Age 0.98 (0.96% to 0.99%)
Foreign-born 12.4 (3.83% to 39.9%)
00129 (d) Asian/Pacific Islander 73.3 (17.0% to 315.6%)
Extrapulmonary
infection 2.57 (1.10% to 6.03%)
00129 (d) Asian/Pacific Islander 282.8 (88.06% to 908.11%)
00129 (d) Asian/Pacific Islander 6.34 (1.52% to 26.44%)
Foreign-born 10.4 (1.55% to 70.12%)
00129 (d) Asian/Pacific Islander 13.88 (3.71% to 51.92%)
Resistance to first-
line drugs (d) 3.80 (1.22% to 11.86%)
00129 Female 2.73 (1.43% to 5.23%)
Black, non-Hispanic 3.57 (1.47% to 8.68%)
Injecting drug use 3.81 (1.81% to 8.03%)
00016 Male 0.58 (0.40% to 0.84%)
Black, non-Hispanic 10.88 (5.48% to 21.6%)
00016 (c) Hispanic 16.36 (10.15% to 26.37%)
00016 Age 1.03 (1.01% to 1.05%)
Black, non-Hispanic 7.13 (2.36% to 21.53%)
Resident, long-term
care facility 3.67 (1.17% to 11.70%)
00016 (d) U.S.-born 3.12 (1.85% to 5.26%)
Excessive alcohol use 0.55 (0.37% to 0.83%)
00370 White, non-Hispanic 5.20 (1.52% to 17.79%)
HIV positive 5.87 (1.69% to 20.41%)
Noninjecting drug use 3.74 (1.17% to 12.01%)
00017 (d) Hispanic 4.97 (2.16% to 11.44%)
00017 (d) Hispanic 15.7 (9.24% to 26.71%)
01285 Resident, correctional
facility 8.23 (3.08% to 22.01%)
00015 Black, non-Hispanic 7.04 (1.64% to 30.3%)
Injecting drug use 4.84 (2.11% to 11.09%)
Excessive alcohol use 2.28 (1.02% to 5.13%)
00768 Black, non-Hispanic 11.68 (1.54% to 88.87%)
Noninjecting drug use 2.77 (1.11% to 6.92%)
00242 (d) Male 2.12 (1.27% to 3.56%)
Age 0.97 (0.96% to 0.98%)
U.S.-born 8.44 (2.63% to 27.09%)
Homeless 3.60 (2.16% to 5.98%)
Noninjecting drug use 0.46 (0.24% to 0.90%)
00028 Black, non-Hispanic 17.57 (5.50% to 56.12%)
00159 Excessive alcohol use 2.76 (1.23% to 6.22%)
00325 Age 1.03 (1.01% to 1.06%)
Excessive alcohol use 3.08 (1.22% to 7.70%)
00673 Asian/Pacific Islander 84.6 (19.85 to 361.9%)
00757 Age 0.90 (0.85% to 0.94%)
HIV positive 4.86 (1.60% to 14.79%)
00019 (c) Male 3.68 (1.10% to 12.39%)
White, non-Hispanic 5.4 (2.35% to 11.08%)
00372 Homeless 6.09 (2.43% to 15.20%)
Resident, long-term
care facility 5.52 (1.535 to 20.0%)
00035 Black, non-Hispanic 6.96 (2.3% to 21.0%)
Resistance to second-
line drugs (e) 40.59 (16.5% to 99.85%)
00867 Black, non-Hispanic 11.68 (1.54% to 88.87%)
Noninjecting drug use 2.77 (1.11% to 6.92%)
01284 Black, non-Hispanic 2.40 (1.22% to 3.57%)
Pulmonary disease 0.92 (-0.01% to 1.86%)
00237 (c) White, non-Hispanic 2.80 (1.81% to 4.33%)
Excessive alcohol use 2.09 (1.36% to 3.22%)
01693 HIV positive 3.16 (1.39% to 7.18%)
Injecting drug use 3.08 (1.26% to 7.56%)
Extrapulmonary disease 3.99 (1.69, 9.42)
00027 Black, non-Hispanic 1.74 (1.05% to 2.90%)
Sputum-smear positive 3.07 (1.75% to 5.39%)
Designation (c) Wald p (b)
00003 (c) 0.004
0.017
<0.0001
00129 (d) <0.0001
0.03
00129 (d) <0.0001
00129 (d) 0.01
0.02
00129 (d) <0.0001
0.02
00129 0.0025
0.005
0.0004
00016 0.004
0.006
00016 (c) <0.0001
00016 0.006
0.0005
0.026
00016 (d) <0.0001
0.0048
00370 0.0087
0.005
0.03
00017 (d) 0.0002
00017 (d) <0.0001
01285 <0.0001
00015 0.0087
0.0002
0.05
00768 0.02
0.03
00242 (d) 0.004
<0.0001
0.0003
<0.0001
0.02
00028 <0.0001
00159 0.01
00325 0.01
0.02
00673 <0.0001
00757 <0.0001
0.005
00019 (c) 0.03
<0.0001
00372 0.0001
0.009
00035 0.0006
<0.0001
00867 0.02
0.03
01284 <0.0001
0.054
00237 (c) <0.0001
0.0007
01693 0.006
0.014
0.002
00027 0.03
<0.0001
(a) CI, confidence interval.
(b) Only genetic clusters that had [greater than or equal to] 20
isolates were included in the analysis; some samples sizes are <20
because of missing data among independent variables (Wald 95%
confidence intervals given in parentheses). Only genetic clusters with
significant predictors are listed. Age was modeled as a continuous
variable.
(c) The National Tuberculosis Genotyping Surveillance Network (NTGSN)
designation for the IS6110 RFLP pattern is represented; spoligotype
octal code designations are presented only for those genetic clusters
from isolates that had [less than or equal to] 6 copies of IS6110. RFLP
patterns and spoligotypes are detailed elsewhere (11).
(d) isolates observed in [greater than or equal to] 4 sites over 5
years.
(e) First-line drug resistance is resistance to at least one of the
following: isoniazid, rifampin, ethambutol, or streptomycin. S
econd-line drug resistance is resistance to one or more of the
following: ethionamide, kanamycin, cycloserine, capreomycin, para-amino
salicylic acid, amikacin, rifabutin, ciprofloxacin, ofloxacin, or other
drugs.
Acknowledgments See About this product. We thank Ida Onorato, Ken Castro Castro, Greece: see Kástron. , Tom Shinnick, and Thomas (language) Thomas - A language compatible with the language Dylan(TM). Thomas is NOT Dylan(TM). The first public release of a translator to Scheme by Matt Birkholz, Jim Miller, and Ron Weiss, written at Digital Equipment Corporation's Cambridge Research Laboratory runs Navin for their scientific guidance and logistic support Noun 1. logistic support - assistance between and within military commands logistic assistance support - the activity of providing for or maintaining by supplying with money or necessities; "his support kept the family together"; "they gave him emotional ; Elsa Elsa loses Lohengrin on their wedding night when she disobeys his proviso that she never ask him to disclose his identity. [Ger. Legend: “Lohengrin” in Benét, 595] See : Love, Tragic Villarino and James Mills
James Thomas Mills (born June 22, 1914 in Winnipeg, Manitoba; died February 15, 1997) was a politician in Manitoba, Canada. for valuable comments on an earlier version of the manuscript manuscript, a handwritten work as distinguished from printing. The oldest manuscripts, those found in Egyptian tombs, were written on papyrus; the earliest dates from c.3500 B.C. ; Annie Faye Faye may refer to:
Prescott (prĕs`kət), town (1991 pop. 4,512), SE Ont., Canada, on the St. Lawrence River, opposite Ogdensburg, N.Y. Fort Wellington, built during the War of 1812, is now a military museum. for excellent editorial assistance; and the health officials at local and state TB control offices that supported the activities of the National Tuberculosis Genotyping and Surveillance Network. References (1.) Foxman B, Riley L. Molecular epidemiology molecular epidemiology Molecular medicine An evolving field that combines the tools of standard epidemiology–case studies, questionnaires and monitoring of exposure to external factors with the tools of molecular biology–eg, restriction endonucleases, : focus on infection. Am J Epidemiol 2001;153:113541. (2.) van Soolingen D. Molecular epidemiology of tuberculosis and other mycobacterial mycobacterial emanating from or pertaining to mycobacterium. mycobacterial granuloma may be caused by Mycobacterium tuberculosis (see cutaneous tuberculosis), M. infections: main methodologies and achievements. J Intern intern /in·tern/ (in´tern) a medical graduate serving in a hospital preparatory to being licensed to practice medicine. in·tern or in·terne n. Med 2001;249:1-26. (3.) van Embden JD, van Soolingen D, Small PM, Hermans PW. Genetic markers genetic marker n. A gene phenotypically associated with a particular, easily identified trait and used to identify an individual or cell carrying that gene. for the epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause of tuberculosis. Res Microbiol 1992;143:385-91. (4.) Fletcher Fletcher may refer to one of the following: Ideas and companies
(5.) Castro KG, Jaffe Jaffe is a surname, and may refer to:
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(9.) Davis CE, Hyde Hyde, town (1991 pop. 33,657), Tameside metropolitan district, NW England, in the Greater Manchester metropolitan area. It has iron foundries and factories that produce cotton, machinery, rubber, paper, and hats. JE, Bangdiwala SI, Nelson JJ. An example of dependencies among variables in a conditional logistic regression. In: Moolgavkar S, Prentice RL, editors. Modern statistical methods in chronic disease epidemiology. New York: John Wiley and Sons, Inc.; 1986. p. 140-7. (10.) SAS/STAT User's Guide. Cary, NC: SAS Institute Inc.; 2000. (11.) Cowan Cow´an n. 1. One who works as a mason without having served a regular apprenticeship. LS, Crawford JT. Genotype analysis of Mycobacterium tuberculosis isolates from a sentinel surveillance population. Emerg Infect Dis 2002;8;1294-1302. (12.) Small PM, Hopewell Hopewell, city (1990 pop. 23,101), within Prince George co. but independent, at the confluence of the James and Appomattox rivers, SE Va.; founded 1913, inc. 1916. PC, Singh For the fictional global crime syndicate, see . Singh is a Sanskrit word meaning "lion". It is used as a common surname and middle name in North India by many communities, especially by the Sikhs and the Rajputs. SP, Paz A, Parsonnet J, Ruston Ruston (rus`tən), city (1990 pop. 20,027), seat of Lincoln parish, N La.; settled 1884 as a railroad town and inc. the same year. It is the trading center of a farm, logging, and natural-gas region. DC, et al. The epidemiology of tuberculosis in San Francisco: a population-based study using conventional and molecular methods. N Engl ENGL English J Med 1994;330:1703-9. (13.) Jasmer RM, Hahn Hahn , Otto 1879-1968. German chemist. He won a 1944 Nobel Prize for his work on atomic fission. Noun 1. Hahn - German chemist who was co-discoverer with Lise Meitner of nuclear fission (1879-1968) Otto Hahn JA, Small PM, Daley Da·ley , Richard Joseph 1902-1976. American politician who dominated Chicago politics during his years as mayor (1955-1976). Known as one of the last old-time big city bosses, Daley was also an important figure in the national Democratic Party. CL, Behr MA, Moss AR, et al. A molecular epidemiologic analysis of tuberculosis trends in San Francisco, 1991-1997. Ann ANN, Scotch law. Half a year's stipend over and above what is owing for the incumbency due to a minister's relict, or child, or next of kin, after his decease. Wishaw. Also, an abbreviation of annus, year; also of annates. In the old law French writers, ann or rather an, signifies a year. Intern Med 1999;130:971-8. (14.) Lockman S Lock´man n. 1. A public executioner. Noun 1. lockman - a worker in charge of a lock (on a canal) lockkeeper, lockmaster , Sheppard JD, Braden CR, Mwasekaga M J, Woodley CL, Kenyon TA, et al. Molecular and conventional epidemiology of Mycobacterium tuberculosis in Botswana: a population-based prospective study of 301 pulmonary tuberculosis pulmonary tuberculosis n. Tuberculosis of the lungs. pulmonary tuberculosis Infectious disease Infection by Mycobacterium tuberculosis patients. J Clin Microbiol 2001;39:1042-7. (15.) Braden CR, Templeton GL, Cave MD, Valway S, Onorato IM, Castro KG, et al. Interpretation of restriction fragment length polymorphism analysis of Mycobacterium mycobacterium Any of the rod-shaped bacteria that make up the genus Mycobacterium. The two most important species cause tuberculosis and leprosy in humans; another species causes tuberculosis in both cattle and humans. tuberculosis' isolates from a state with a large rural population. J Infect Dis 1997;175:1446-52. (16.) Frieden TR, Woodley CL, Crawford JT, Lew D, Dooley SM. The molecular epidemiology of tuberculosis in New York City New York City: see New York, city. New York City City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. 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An analysis by DNA fingerprinting DNA fingerprinting or DNA profiling, any of several similar techniques for analyzing and comparing DNA from separate sources, used especially in law enforcement to identify suspects from hair, blood, semen, or other biological materials found at and conventional epidemiologic methods. N Engl J Med 1994;330:1710-6. (19.) Friedman CR, Quinn GC, Kreiswirth BN, Perlman DC, Salomon N, Schluger N, et al. Widespread dissemination dissemination Medtalk The spread of a pernicious process–eg, CA, acute infection Oncology Metastasis, see there of a drug-susceptible strain of Mycobacterium tuberculosis. J Infect Dis 1997;176:478-84. (20.) Borgdorff MW, Behr MA, Nagelkerke NJ, Hopewell PC, Small PM. Transmission of tuberculosis in San Francisco and its association with immigration immigration, entrance of a person (an alien) into a new country for the purpose of establishing permanent residence. Motives for immigration, like those for migration generally, are often economic, although religious or political factors may be very important. and ethnicity. Int J Tuberc Lung Dis 2000;4:287-94. (21.) Geng E, Kreiswirth B, Driver C, Li J, Burzynski J, DellaLatta P, et al. Changes in the transmission of tuberculosis in New York City from 1990 to 1999. N Engl J Med 2002;346:1453-8. (22.) Tornieporth NG, Ptachewich Y, Poltoratskaia N, Ravi BS, Katapadi M, Berger JJ, et al. Tuberculosis among foreign-born persons in New York City, 1992-1994: implications for tuberculosis control. Int J Tuberc Lung Dis 1997;1:528-35. (23.) Dahle UR, Sandven P, Heldal E, Caugant DA. Molecular epidemiology of Mycobacterium tuberculosis in Norway. J Clin Microbiol 2001;39:1802-7. (24.) Genewein A, Telenti A, Bernasconi C, Mordasini C, Weiss S, Maurer AM, et al. Molecular approach to identifying route of transmission of tuberculosis in the community. Lancet lancet /lan·cet/ (lan´set) a small, pointed, two-edged surgical knife. lan·cet n. 1993;342:841-4. (25.) Park YK, Bai GH, Kim SJ. Restriction fragment length polymorphism analysis of Mycobacterium tuberculosis isolated from countries in the western pacific region. J Clin Microbiol 2000;38:191-7. (26.) Bifani PJ, Plikaytis BB, Kapur V, Stockbauer K, Pan X, Lutfey ML, et al. Origin and interstate in·ter·state adj. Involving, existing between, or connecting two or more states. n. One of a system of highways extending between the major cities of the 48 contiguous United States. Noun 1. spread of a New York City multidrug-resistant Mycobacterium tuberculosis clone clone, group of organisms, all of which are descended from a single individual through asexual reproduction, as in a pure cell culture of bacteria. Except for changes in the hereditary material that come about by mutation, all members of a clone are genetically family. JAMA JAMA abbr. Journal of the American Medical Association 1996;275:452-7. (27.) Yang yang (yang) [Chinese] in Chinese philosophy, the active, positive, masculine principle that is complementary to yin; see yin, under principle. Z, Barnes PF, Chaves F, Eisenach KD, Weis SE, Bates Bates , Katherine Lee 1859-1929. American educator and writer best known for her poem "America the Beautiful," written in 1893 and revised in 1904 and 1911. JH, et al. Diversity of DNA fingerprints of Mycobacterium tuberculosis isolates in the United States. J Clin Microbiol 1998;36:1003-7. (28.) Bauer J, Yang Z, Poulsen S Poulsen is Surname
(29.) Pfyffer GE, Strassle A, Rose N, Wirth R, Brandli O, Shang H. Transmission of tuberculosis in the metropolitan area of Zurich: a 3 year survey based on DNA fingerprinting. Eur Respir J 1998;11:804-8. (30.) de Boer De Boer or de Boer can refer to: In football:
(31.) Warren RM, van der Spuy GD, Richardson M, Beyers N, Borgdorff MW, Behr MA, et al. Calculation of the stability of the IS6110 banding pattern in patients with persistent Mycobacterium tuberculosis disease. J Clin Microbiol 2002;40:1705-8. (32.) Niemann S Niemann is a surname, and may refer to:
(33.) Murray Murray, river, Australia Murray, principal river of Australia, 1,609 mi (2,589 km) long, rising in the Australian Alps, SE New South Wales, and flowing westward to form the New South Wales–Victoria boundary. M, Alland D. Methodological problems in the molecular epidemiology of tuberculosis. Am J Epidemiol 2002;155:565-71. Barbara A. Ellis ELLIS - EuLisp LInda System. An object-oriented Linda system written for EuLisp. "Using Object-Oriented Mechanisms to Describe Linda", P. Broadbery <pab@maths.bath.ac.uk> et al, in Linda-Like Systems and Their Implementation, G. Wilson ed, U Edinburgh TR 91-13, 1991. , * Jack T. Crawford, * Christopher R. Braden, * Scott J. N. McNabb, * Marisa Moore Moore, city (1990 pop. 40,761), Cleveland co., central Okla., a suburb of Oklahoma City; inc. 1887. Its manufactures include lightning- and surge-protection equipment, packaging for foods, and auto parts. , * Steve Kammerer, * and the National Tuberculosis Genotyping and Surveillance Network Work Group (1) * Centers for Disease Control and Prevention, Atlanta, Georgia Georgia, country, Asia Georgia (jôr`jə), Georgian Sakartvelo, Rus. Gruziya, officially Republic of Georgia, republic (2005 est. pop. 4,677,000), c.26,900 sq mi (69,700 sq km), in W Transcaucasia. , USA (1) Members of the National Tuberculosis Genotyping and surveillance Network Work Group, in addition to the listed authors, included Joseph Bates Joseph Bates may refer to:
Early life Miller was born Johnnie Lucille Ann Collier , Donna Mulcahy, Robert Pratt Robert Pratt (born May 25, 1951 in Richmond, Virginia) is a former American football guard in the National Football League. Pratt attended the University of North Carolina. , Teresa Quitugua, Barbara Schable, Kenneth Shilkret, Harry Taber, Jeffrey Taylor, Sharon Sharnprapai, Sumi SUMI Software Usability Measurement Inventory (measures software quality from the user's point of view) Sun, Zhenhua Yang Dr. Ellis is a senior microbiologist microbiologist a specialist in microbiology. with the National Center for Infectious Diseases infectious diseases: see communicable diseases. , Centers for Disease Control and Prevention. Her research interests focus on the molecular epidemiology of infectious diseases, rodent-borne zoonotic diseases Zoonotic diseases Diseases caused by infectious agents that can be transmitted between (or are shared by) animals and humans. This can include transmission through the bite of an insect, such as a mosquito. Mentioned in: West Nile Virus , and bioterrorism bi·o·ter·ror·ism n. The use of biological agents, such as pathogenic organisms or agricultural pests, for terrorist purposes. Bioterrorism preparedness pre·par·ed·ness n. The state of being prepared, especially military readiness for combat. Noun 1. preparedness - the state of having been made ready or prepared for use or action (especially military action); "putting them . Her work has included disease ecology Disease ecology The interaction of the behavior and ecology of hosts with the biology of pathogens, as it relates to the impact of diseases on populations. studies of rodent-borne hemorrhagic fever hemorrhagic fever (hĕm'ərăj`ĭk), any of a group of viral diseases characterized by sudden onset, muscle and joint pain, fever, bleeding, and shock from loss of blood. viruses, molecular characterization of novel bartonellae, and molecular epidemiologic studies of Mycobacterium tuberculosis. Address for correspondence: Barbara Ellis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop E79, Atlanta, GA 30333, USA; fax: 404-498-2270; e-mail: bae7@cdc.gov |
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