769. An Outbreak of Multidrug-Resistant Tuberculosis, Minnesota 2016–2017

作     者：Desilva, Malini Moore, Nora Thai, Dzung Grimm, Mary Beth Sabuwala, Nadya Brueshaber, Milayna Gordon, Sarah Andersen, Laura Hall, Victoria Buuck, Sean Hickman, Cynthia Stinebaugh, Katie Silk, Benjamin Raz, Kayla Talarico, Sarah Wortham, Jonathan Kingdon, Elisabeth Pistulka, Gina Guerard, Krissie Cowan, Lauren Posey, James E Snippes Vagnone, Paula M McCullough, Joel Tsukayama, Dean Mody, Rajal K Ehresmann, Kristen 

作者机构：Infectious Disease Epidemiology Prevention and Control Division Minnesota Department of Health Saint Paul Minnesota Saint Paul – Ramsey County Public Health Saint Paul Minnesota Epidemic Intelligence Service Program Centers for Disease Control and Prevention Atlanta Georgia Centers for Disease Control and Prevention Atlanta Georgia Respiratory Diseases Branch Centers for Disease Control and Prevention Atlanta Georgia Minnesota Department of Health St. Paul Minnesota Hennepin County Medical Center Minneapolis Minnesota Division of State and Local Readiness Office of Public Health Preparedness and Response CDC Atlanta Georgia 

出 版 物：《Open Forum Infectious Diseases》 

年 卷 期：2018年第5卷第SUPPL_1期

页      面：S276–S276页

摘      要：Background Multidrug-resistant tuberculosis (MDR TB) is more difficult to treat and outcomes are worse than for drug-susceptible TB disease. MDR TB cases in Minnesota increased from zero in 2015 to nine in 2016. Case investigations suggested an outbreak. We describe the public health response, challenges of contact investigations (CIs), and ongoing management of contacts. Methods CDC performed whole-genome sequencing (WGS) to evaluate relatedness of MDR TB isolates. We conducted CIs for infectious cases. We created outbreak specific guidelines for screening and management of contacts, and partnered with various agencies to increase MDR TB awareness. Results WGS results were consistent with an MDR TB outbreak that included 10 cases (70% pulmonary) as of April 2018. Limited provider awareness about TB contributed to delayed diagnoses. CIs identified 588 contacts; 8.7% ( n = 51) of contacts had previously documented positive TB infection test results, and 14% ( n = 74) were newly positive for TB infection (median age: 72 years). Eight cases were epidemiologically linked to one Hmong adult day center. Sixty-two contacts started a fluoroquinolone for latent MDR TB infection. Contacts who declined treatment began a 2-year clinical monitoring program. Conclusion In this outbreak, delayed diagnoses resulted in long infectious periods and hundreds of contacts. WGS results were consistent with recent transmission. We discovered adult day centers are an overlooked congregate setting. CIs were complicated by limited public health funding and high underlying TB infection prevalence in the affected community. Increased community and provider awareness and intensified screening of contacts resulted in additional case finding and prevention interventions. Disclosures All authors: No reported disclosures.