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Rural Indiana Outbreak County/State and CDC Response



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Rural Indiana Outbreak County State and CDC Response Shameer Poonja MPH CDC Assignee Indiana State Department of Health TB Program TB Incidence United States 2005 3 5 cases per 100 000 3 5 cases per 100 000 Indiana Small Rural County Recent outbreaks 2002 School setting linked to four secondary cases One additional case linked to previous investigation in 1990 s Social setting four cases genetically linked to past case in three other counties 2003 African American Community 25 cases in cluster TB Cases County A 1999 2004 1999 2000 2001 2002 2003 2004 2005 Do we have a problem County Spring 2005 Noticed increase in cases Placed call to state for recommendations State September October 2005 Noticed problem with DOT Patient interviews revealed 3 potential sites of exposure genotyping CDC TB news articles in 09 30 Called State for update on issue Initial Response State Health Department Communicated with county health nurse Provided staff persons Provided emergency funding Requested Epi Aid team CDC Epi Aid team arrives 11 9 05 12 16 05 to re interview identify additional sites of exposure screening contacts 10 06 Requested 1999 2004 isolates be sent for genotyping CDC Epi Aid Team Pre Investigation Data October 2005 10 cases detected All 10 genotypes matched Archived isolate 1999 2004 genotypes matched TB Cases County A 1999 2005 Outbreak related Not outbreak related 1999 2000 2001 2002 2003 2004 2005 Outbreak Related Cases 1999 2005 N 23 Genotype matched and epi linked Epi linked only Genotype matched only 1999 2000 2001 2002 2003 2004 2005 Outbreak Response State Continued to have staff available to interview provide education Medical residents Pulmonary and ID consultation Press release CDC Reviewed patient records Interviewed patients diagnosed in 2005 and their contacts Reviewed national TB genotyping data Patient Characteristics N 23 Characteristic n Median age range 46 years 4 70 Male 17 White and US born HIV infected Diabetes 23 0 8 Heavy alcohol use 18



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