Publications by authors named "Julie Higashi"

17 Publications

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Spatial distribution of tuberculosis incidence in Los Angeles County.

BMC Public Health 2020 Sep 21;20(1):1434. Epub 2020 Sep 21.

Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, USA.

Background: In Los Angeles County, the tuberculosis (TB) disease incidence rate is seven times higher among non-U.S.-born persons than U.S.-born persons and varies by country of birth. But translating these findings into public health action requires more granular information, especially considering that Los Angeles County is more than 4000 mile. Local public health authorities may benefit from data on which areas of the county are most affected, yet these data remain largely unreported in part because of limitations of sparse data. We aimed to describe the spatial distribution of TB disease incidence in Los Angeles County while addressing challenges arising from sparse data and accounting for known cofactors.

Methods: Data on 5447 TB cases from Los Angeles County were combined with stratified population estimates available from the 2005-2011 Public Use Microdata Survey. TB disease incidence rates stratified by country of birth and Public Use Microdata Area were calculated and spatial smoothing was applied using a conditional autoregressive model. We used Bayesian Poisson models to investigate spatial patterns adjusting for age, sex, country of birth and years since initial arrival in the U.S.

Results: There were notable differences in the crude and spatially-smoothed maps of TB disease rates for high-risk subgroups, namely persons born in Mexico, Vietnam or the Philippines. Spatially-smoothed maps showed areas of high incidence in downtown Los Angeles and surrounding areas for persons born in the Philippines or Vietnam. Areas of high incidence were more dispersed for persons born in Mexico. Adjusted models suggested that the spatial distribution of TB disease could not be fully explained using age, sex, country of birth and years since initial arrival.

Conclusions: This study highlights areas of high TB incidence within Los Angeles County both for U.S.-born cases and for cases born in Mexico, Vietnam or the Philippines. It also highlights areas that had high incidence rates even when accounting for non-spatial error and country of birth, age, sex, and years since initial arrival in the U.S. Information on spatial distribution provided here complements other descriptions of local disease burden and may help focus ongoing efforts to scale up testing for TB infection and treatment among high-risk subgroups.
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http://dx.doi.org/10.1186/s12889-020-09523-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507739PMC
September 2020

Tuberculosis Screening, Testing, and Treatment of US Health Care Personnel: ACOEM and NTCA Joint Task Force on Implementation of the 2019 MMWR Recommendations.

J Occup Environ Med 2020 07;62(7):e355-e369

American College of Occupational and Environmental Medicine, Elk Grove, Illinois.

: On May 17, 2019, the US Centers for Disease Control and Prevention and National Tuberculosis Controllers Association issued new Recommendations for Tuberculosis Screening, Testing, and Treatment of Health Care Personnel, United States, 2019, updating the health care personnel-related sections of the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. This companion document offers the collective effort and experience of occupational health, infectious disease, and public health experts from major academic and public health institutions across the United States and expands on each section of the 2019 recommendations to provide clarifications, explanations, and considerations that go beyond the 2019 recommendations to answer questions that may arise and to offer strategies for implementation.
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http://dx.doi.org/10.1097/JOM.0000000000001904DOI Listing
July 2020

Not So Fast: Slowing Tuberculosis Decline in California.

Am J Public Health 2019 02;109(2):187-189

Julie Higashi is with the Tuberculosis Control Program, Division of Dental and Medical Affairs, Los Angeles County Department of Public Health, Los Angeles, CA. Pennan Barry is with the Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond.

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http://dx.doi.org/10.2105/AJPH.2018.304886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336042PMC
February 2019

Challenges and solutions to estimating tuberculosis disease incidence by country of birth in Los Angeles County.

PLoS One 2018 18;13(12):e0209051. Epub 2018 Dec 18.

TB Control Program, Los Angeles County Department of Public Health, Los Angeles, California, United States of America.

Background: Among U.S. residents, tuberculosis (TB) disease disproportionally affects non-U.S.-born persons and varies substantially by country of birth. Yet TB disease incidence rates by country of birth are not routinely reported despite these large, known health disparities. This is in part due to the technical challenges of using standard regression analysis with a communicable disease. Here, we estimate tuberculosis disease incidence rates by country of birth and demonstrate methods for overcoming these challenges using TB surveillance data from Los Angeles County which has more than 3.5 million non-U.S.-born residents.

Methods: Cross-sectional data on 5,447 cases of TB disease from Los Angeles County were combined with population estimates from the American Community Survey to calculate TB disease incidence rates for 2005 through 2011. Adjusted incidence rates were modelled using Poisson and negative binomial regressions. Bayesian models were used to account for the uncertainty in population estimates.

Results: The unadjusted incidence rate among non-U.S.-born persons was 15 per 100,000 person-years in contrast to the rate among U.S-born persons, 2 per 100,000. The unadjusted incidence rates were 44 and 12 per 100,000 person-years among persons born in the Philippines and Mexico, respectively. In adjusted analysis, persons born in the Philippines were 2.6 (95% CI: 2.3-3.1) times as likely to be reported as a TB case than persons born in Mexico. Bayesian models showed similar results.

Conclusion: This study confirms substantial disparities in TB disease by country of birth in Los Angeles County. Accounting for age, gender, years in residence and year of diagnosis, persons from the Philippines, Vietnam and several other countries had much higher rates of reported TB disease than other foreign countries. We demonstrated that incidence rates by country of birth can be estimated using available data despite technical challenges.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209051PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298681PMC
May 2019

Tuberculosis Treatment Monitoring by Video Directly Observed Therapy in 5 Health Districts, California, USA.

Emerg Infect Dis 2018 10;24(10):1806-1815

We assessed video directly observed therapy (VDOT) for monitoring tuberculosis treatment in 5 health districts in California, USA, to compare adherence between 174 patients using VDOT and 159 patients using in-person directly observed therapy (DOT). Multivariable linear regression analyses identified participant-reported sociodemographics, risk behaviors, and treatment experience associated with adherence. Median participant age was 44 (range 18-87) years; 61% of participants were male. Median fraction of expected doses observed (FEDO) among VDOT participants was higher (93.0% [interquartile range (IQR) 83.4%-97.1%]) than among patients receiving DOT (66.4% [IQR 55.1%-89.3%]). Most participants (96%) would recommend VDOT to others; 90% preferred VDOT over DOT. Lower FEDO was independently associated with US or Mexico birth, shorter VDOT duration, finding VDOT difficult, frequently taking medications while away from home, and having video-recording problems (p<0.05). VDOT cost 32% (range 6%-46%) less than DOT. VDOT was feasible, acceptable, and achieved high adherence at lower cost than DOT.
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http://dx.doi.org/10.3201/eid2410.180459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6154139PMC
October 2018

Association of Rapid Molecular Testing With Duration of Respiratory Isolation for Patients With Possible Tuberculosis in a US Hospital.

JAMA Intern Med 2018 10;178(10):1380-1388

Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.

Importance: New guidelines recommend that molecular testing replace sputum-smear microscopy to guide discontinuation of respiratory isolation in patients undergoing evaluation for active tuberculosis (TB) in health care settings.

Objective: To evaluate the implementation and impact of a molecular testing strategy to guide discontinuation of isolation.

Design, Setting, And Participants: Prospective cohort study with a pragmatic, before-and-after-implementation design of 621 consecutive patients hospitalized at Zuckerberg San Francisco General Hospital and Trauma Center who were undergoing sputum examination for evaluation for active pulmonary TB from January 2014 to January 2016.

Interventions: Implementation of a sputum molecular testing algorithm using GeneXpert MTB/RIF (Xpert; Cepheid) to guide discontinuation of isolation.

Main Outcomes And Measures: We measured the proportion of patients with molecular testing ordered and completed; the accuracy of the molecular testing algorithm in reference to mycobacterial culture; the duration of each component of the testing and isolation processes; length of stay; mean days in isolation and in hospital; and mean cost. We extracted data from hospital records and compared measures before and after implementation.

Results: Clinicians ordered sputum testing for TB for 621 patients at ZSFG during the 2-year study period. Of 301 patients in the preimplementation period with at least 1 sputum microscopy and culture ordered, clinicians completed the rapid TB testing evaluation process for 233 (77%).Among 320 patients evaluated in the postimplementation period, clinicians ordered molecular testing for 234 (73%) patients and received results for 295 of 302 (98%) tests ordered. Median age was 54 years (interquartile range, 44-63 years), and 161 (26%) were women. The molecular testing algorithm accurately diagnosed all 7 patients with culture-confirmed TB and excluded TB in all 251 patients with Mycobacterium tuberculosis (MTB) culture-negative results. Compared with the preimplementation period, there were significant decreases in median times to final rapid test result (39.1 vs 22.4 hours, P < .001), discontinuation of isolation (2.9 vs 2.5 days, P = .001), and hospital discharge (6.0 vs 4.9 days, P = .003), on average saving $13 347 per isolated TB-negative patient.

Conclusions And Relevance: A sputum molecular testing algorithm to guide discontinuation of respiratory isolation for patients undergoing evaluation for active TB was safe, feasible, widely and sustainably adopted, and provided substantial clinical and economic benefits. Molecular testing may facilitate more efficient, patient-centered evaluation for possible TB in US hospitals.
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http://dx.doi.org/10.1001/jamainternmed.2018.3638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368387PMC
October 2018

Executive Summary: Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis.

Clin Infect Dis 2016 10;63(7):853-67

Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.
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http://dx.doi.org/10.1093/cid/ciw566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366011PMC
October 2016

Tuberculosis progression rates in U.S. Immigrants following screening with interferon-gamma release assays.

BMC Public Health 2016 08 25;16(1):875. Epub 2016 Aug 25.

Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.

Background: Interferon-gamma release assays may be used as an alternative to the tuberculin skin test for detection of M. tuberculosis infection. However, the risk of active tuberculosis disease following screening using interferon-gamma release assays in immigrants is not well defined. To address these uncertainties, we determined the incidence rates of active tuberculosis disease in a cohort of high-risk immigrants with Class B TB screened with interferon-gamma release assays (IGRAs) upon arrival in the United States.

Methods: Using a retrospective cohort design, we enrolled recent U.S. immigrants with Class B TB who were screened with an IGRA (QuantiFERON ® Gold or Gold In-Tube Assay) at the San Francisco Department of Public Health Tuberculosis Control Clinic from January 2005 through December 2010. We reviewed records from the Tuberculosis Control Patient Management Database and from the California Department of Public Health Tuberculosis Case Registry to determine incident cases of active tuberculosis disease through February 2015.

Results: Of 1233 eligible immigrants with IGRA screening at baseline, 81 (6.6 %) were diagnosed with active tuberculosis disease as a result of their initial evaluation. Of the remaining 1152 participants without active tuberculosis disease at baseline, 513 tested IGRA-positive and 639 tested IGRA-negative. Seven participants developed incident active tuberculosis disease over 7730 person-years of follow-up, for an incidence rate of 91 per 100,000 person-years (95 % CI 43-190). Five IGRA-positive and two IGRA-negative participants developed active tuberculosis disease (incidence rates 139 per 100,000 person-years (95 % CI 58-335) and 48 per 100,000 person-years (95 % CI 12-193), respectively) for an unadjusted incidence rate ratio of 2.9 (95 % CI 0.5-30, p = 0.21). IGRA test results had a negative predictive value of 99.7 % but a positive predictive value of only 0.97 %.

Conclusions: Among high-risk immigrants without active tuberculosis disease at the time of entry into the United States, risk of progression to active tuberculosis disease was higher in IGRA-positive participants compared with IGRA-negative participants. However, these findings did not reach statistical significance, and a positive IGRA at enrollment had a poor predictive value for progressing to active tuberculosis disease. Additional research is needed to identify biomarkers and develop clinical algorithms that can better predict progression to active tuberculosis disease among U.S. immigrants.
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http://dx.doi.org/10.1186/s12889-016-3519-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997768PMC
August 2016

Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis.

Clin Infect Dis 2016 10 10;63(7):e147-e195. Epub 2016 Aug 10.

Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.
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http://dx.doi.org/10.1093/cid/ciw376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590850PMC
October 2016

Interferon-Gamma Release Assays and Pediatric Public Health Tuberculosis Screening: The San Francisco Program Experience 2005 to 2008.

J Pediatric Infect Dis Soc 2016 Jun 15;5(2):122-30. Epub 2014 Dec 15.

San Francisco Department of Public Health, Population Health Division, California.

Background: Interferon-gamma release assay utilization in pediatric tuberculosis (TB) screening is limited by a paucity of longitudinal experience, particularly in low-TB burden populations.

Methods: We conducted a retrospective review of QuantiFERON (QFT)-TB Gold results in San Francisco children from 2005 to 2008. Concordance with the tuberculin skin test (TST) was analyzed for a subset of children. Progression to active disease was determined through San Francisco and California TB registry matches.

Results: Of 1092 children <15 years of age, 853 (78%) were foreign-born, and 136 (12%) were exposed to active TB cases (contacts). QuantiFERON tests were positive in 72 of 1092 (7%) children; 15 of 136 (11%) recent contacts; 53 of 807 (7%) foreign-born noncontacts; and 4 of 149 (3%) US-born noncontacts. QuantiFERON-negative/TST-positive discordance was seen more often in foreign-born/bacille Calmette-Guerin (BCG)-vaccinated children <5 years of age (52 of 56, 93%) compared to those ≥ 5 years of age (90 of 123, 73%; P = .003). Foreign-born, BCG-vaccinated children were more than twice as likely to have a discordant (79%) result as US-born, non-BCG-vaccinated children (37%; P < .0001). During 5587 person-years of follow-up of untreated children, including 146 TST-positive/QFT-negative children, no cases of active TB were identified, consistent with a negative predictive value of 100%.

Conclusions: Our experience supports the use of QFT to evaluate latent TB infection in children, particularly young BCG-vaccinated children. The proportion of QFT-positive results correlated with risk of exposure, and none of the untreated QFT-negative children developed TB. The low QFT-positive rate highlights the need for more selective testing based on current epidemiology and TB exposure risk.
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http://dx.doi.org/10.1093/jpids/piu119DOI Listing
June 2016

Tuberculosis Elimination Efforts in the United States in the Era of Insurance Expansion and the Affordable Care Act.

Public Health Rep 2015 Jul-Aug;130(4):349-54

Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Division of Tuberculosis Elimination, Atlanta, GA.

The Patient Protection and Affordable Care Act can enhance ongoing efforts to control tuberculosis (TB) in the United States by bringing millions of currently uninsured Americans into the health-care system. However, much of the legislative and financial framework that provides essential public health services necessary for effective TB control is outside the scope of the law. We identified three key issues that will still need to be addressed after full implementation of the Affordable Care Act: (1) essential TB-related public health functions will still be needed and will remain the responsibility of federal, state, and local health departments; (2) testing and treatment for latent TB infection (LTBI) is not covered explicitly as a recommended preventive service without cost sharing or copayment; and (3) remaining uninsured populations will disproportionately include groups at high risk for TB. To improve and continue TB control efforts, it is important that all populations at risk be tested and treated for LTBI and TB; that testing and treatment services be accessible and affordable; that essential federal, state, and local public health functions be maintained; that private-sector medical/public health linkages for diagnosis and treatment be developed; and that health-care providers be trained in conducting appropriate LTBI and TB clinical care.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547565PMC
http://dx.doi.org/10.1177/003335491513000413DOI Listing
December 2015

Association between diabetes mellitus and tuberculosis in United States-born and foreign-born populations in San Francisco.

PLoS One 2014 5;9(12):e114442. Epub 2014 Dec 5.

Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, United States of America.

Setting: The impact of diabetes on tuberculosis in United States and foreign-born populations in San Francisco has not been studied.

Objective: To determine the characteristics, prevalence and temporal trends of diabetes in US and foreign-born persons attending the San Francisco Tuberculosis Clinic.

Design: We analyzed data from individuals seeking medical attention at the San Francisco Tuberculosis Clinic. We included patients with diagnosis of tuberculosis, latent infection, or not infected with Mycobacterium tuberculosis. We assessed the temporal trend and the characteristics of individuals with and without diabetes.

Result: Between 2005 and 2012, there were 4371 (19.0%) individuals without evidence of tuberculosis infection, 17,856 (77.6%) with latent tuberculosis, and 791 (3.4%) with tuberculosis. 66% were born in the United States, China, Mexico, and the Philippines. The prevalence of diabetes was the highest among individuals with tuberculosis and increased during the study period. Patients with tuberculosis and diabetes were more likely to be male, older than 45 years and born in the Philippines. There was a disproportionate association of TB and DM relative to LTBI and DM among Filipinos in individuals older than 45 years old.

Conclusions: Our data suggest that Filipinos older than 45 years old are more likely to have tuberculosis probably due to a higher prevalence of diabetes. In San Francisco, tuberculosis-screening programs in individuals with diabetes and latent tuberculosis may be beneficial in patients older than 45 years old especially from the Philippines.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0114442PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257695PMC
December 2015

Tuberculin skin test and QuantiFERON performance, and testing of populations at low risk for tuberculosis infection.

Clin Infect Dis 2014 Oct 4;59(8):1187-8. Epub 2014 Jul 4.

Population Health Division, San Francisco Department of Public Health, California.

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http://dx.doi.org/10.1093/cid/ciu518DOI Listing
October 2014

Pyrazinamide resistance, Mycobacterium tuberculosis lineage and treatment outcomes in San Francisco, California.

PLoS One 2014 23;9(4):e95645. Epub 2014 Apr 23.

Division of Pulmonary and Critical Care Medicine, Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America.

Background: Pyrazinamide (PZA) is a first line agent for the treatment of active tuberculosis. PZA is also considered a potent companion drug for newer regimens under development. There are limited data on the demographic, clinical, and pathogen characteristics of PZA resistant tuberculosis.

Methods: Using a retrospective cohort study design, we evaluated all PZA resistant M. tuberculosis (M.tb) and M. bovis cases reported in San Francisco from 1991 to 2011. Demographic, clinical, and molecular data were analyzed. M.tb lineage was determined for all PZA resistant strains and compared to PZA susceptible strains.

Results: PZA resistance was identified in 1.8% (50 of 2,842) of mycobacterial isolates tested, corresponding to a case rate of 0.3 per 100,000 in the population. Monoresistant PZA infection was associated with the Hispanic population ([OR], 6.3; 95% [CI], 1.97-20.16) and 48% of cases were due to M. bovis. Infection with monoresistant PZA was also associated with extrapulmonary disease ([OR], 6.0; 95% [CI], 2.70-13.26). There was no statistically significant difference between treatment failure and mortality rates in patients infected with PZA monoresistance compared to pansusceptible controls (4% vs. 8%, p = 0.51), or those with PZA and MDR resistance (PZA-MDR) compared to MDR controls (18% vs. 29%, p = 0.40). PZA resistance was not associated with M.tb lineage.

Conclusions: Across two decades of comprehensive epidemiologic data on tuberculosis in San Francisco County, PZA resistance was uncommon. PZA resistance caused predominantly extrapulmonary disease and was more common in Hispanics compared to other ethnicities, with nearly half the cases attributed to M. bovis. No association was found between PZA monoresistance and M.tb lineage. Treatment outcomes were not adversely influenced by the presence of PZA resistance.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0095645PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997554PMC
January 2015

Three air travel-related contact investigations associated with infectious tuberculosis, 2007-2008.

Travel Med Infect Dis 2010 Mar 1;8(2):120-8. Epub 2009 Oct 1.

Centers for Disease Control and Prevention, National Center for Preparedness, Detection, and Control of Infectious Diseases, Division of Global Migration and Quarantine, Atlanta, GA, USA.

Background: The potential for transmission of Mycobacterium tuberculosis during air travel has garnered considerable attention in the media and among public health authorities due to high-profile cases of international travelers with infectious tuberculosis (TB).

Methods: During 2007 and 2008, state and local health officials were asked to locate and conduct diagnostic follow-up for airline passengers considered contacts of three travelers, two with multidrug-resistant (MDR) TB and one considered highly contagious, who undertook air travel while infectious with TB disease.

Results: Public health departments in 21 states located and evaluated 79 (60%) of the 131 passenger contacts identified; 52 (40%) were lost to follow-up. Eight (10%) contacts had a history of TB disease or latent TB infection and were not retested. Sixteen (23%) of 71 contacts tested had positive TB test results suggesting latent TB infection, 15 of whom were from countries reporting estimated TB disease rates of greater than 200 cases/100,000 persons.

Conclusions: Passenger contacts' positive test results may represent prior TB infection acquired in their countries of residence or may be a result of new TB infection resulting from exposure during air travel.
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http://dx.doi.org/10.1016/j.tmaid.2009.08.001DOI Listing
March 2010

Genetic diversity of arginine catabolic mobile element in Staphylococcus epidermidis.

PLoS One 2009 Nov 6;4(11):e7722. Epub 2009 Nov 6.

Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa (ITQB/UNL), Oeiras, Portugal.

Background: The methicillin-resistant Staphylococcus aureus clone USA300 contains a novel mobile genetic element, arginine catabolic mobile element (ACME), that contributes to its enhanced capacity to grow and survive within the host. Although ACME appears to have been transferred into USA300 from S. epidermidis, the genetic diversity of ACME in the latter species remains poorly characterized.

Methodology/principal Findings: To assess the prevalence and genetic diversity of ACME, 127 geographically diverse S. epidermidis isolates representing 86 different multilocus sequence types (STs) were characterized. ACME was found in 51% (65/127) of S. epidermidis isolates. The vast majority (57/65) of ACME-containing isolates belonged to the predominant S. epidermidis clonal complex CC2. ACME was often found in association with different allotypes of staphylococcal chromosome cassette mec (SCCmec) which also encodes the recombinase function that facilities mobilization ACME from the S. epidermidis chromosome. Restriction fragment length polymorphism, PCR scanning and DNA sequencing allowed for identification of 39 distinct ACME genetic variants that differ from one another in gene content, thereby revealing a hitherto uncharacterized genetic diversity within ACME. All but one ACME variants were represented by a single S. epidermidis isolate; the singular variant, termed ACME-I.02, was found in 27 isolates, all of which belonged to the CC2 lineage. An evolutionary model constructed based on the eBURST algorithm revealed that ACME-I.02 was acquired at least on 15 different occasions by strains belonging to the CC2 lineage.

Conclusions/significance: ACME-I.02 in diverse S. epidermidis isolates were nearly identical in sequence to the prototypical ACME found in USA300 MRSA clone, providing further evidence for the interspecies transfer of ACME from S. epidermidis into USA300.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0007722PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768820PMC
November 2009
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