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Transmission Dynamics of Tuberculosis in Tarrant County, Texas

Division of Public Health, Department of Medicine, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas; Statology, Rocklin, California; Departments of Medicine and Anatomy, University of Arkansas for Medical Sciences and Medical Research Service, McClellan Memorial Veterans Hospital, Little Rock, Arkansas; Tuberculosis Control Program, Texas Department of Health, and Center for Pulmonary and Infectious Disease Control, Departments of Medicine, Microbiology, and Immunology, University of Texas Health Center, Tyler, Texas

Correspondence and requests for reprints should be addressed to Stephen E. Weis, D.O., University of North Texas Health Science Center, Patient Care Center, 855 Montgomery Street, Fort Worth, TX 76107. E-mail: sweis{at}hsc.unt.edu

To understand the transmission dynamics of tuberculosis in Tarrant County, Texas, we performed a population-based study of 159 patients with culture-proven tuberculosis, combining restriction fragment length polymorphism (RFLP) analysis of Mycobacterium tuberculosis isolates with prospective interviewing to identify epidemiologic links between patients. Patients whose isolates had identical or closely related RFLP patterns were considered a cluster. Seventy-six (48%) of 159 patients were in 19 clusters, suggesting that recent transmission accounted for 36% of tuberculosis morbidity. Unconditional logistic regression showed that birth in the United States, continuous residence in Tarrant County, a history of homelessness, and a history of visiting or working in bars were independent predictors of clustering. Four homeless shelters and five bars were associated with specific clusters, suggesting that they were sites of tuberculosis transmission. Patients in some clusters recognized more photographs of patients in their cluster than did patients outside their cluster. We conclude that (1) homeless shelters and bars are important sites of tuberculosis transmission in Tarrant County, and (2) the use of photograph recognition of patients with tuberculosis, in combination with RFLP analysis, has the potential to enhance tuberculosis control by facilitating identification of epidemiologic links between patients.

Key Words: epidemiology • homeless • restriction fragment length polymorphism • tuberculosis • transmission • urban

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