Table 1.
Characteristics of patients involved in 110 TB outbreak cases,a by outbreak phase, Georgia, March 2008 to December 2015
| Patient Characteristics | Phase, No. (%) or Median (IQR) | ||
|---|---|---|---|
| Initial Outbreak, 2008-2009 (n = 27) | Quiescent, 2010-2013 (n = 26) | Recrudescent, 2014-2015 (n = 57) | |
| Fulton County resident at TB diagnosis | 24 (89) | 19 (73) | 51 (89) |
| Sex | |||
| Male | 26 (96) | 24 (92) | 55 (96) |
| Female | 1 (4) | 1 (4) | 0 (0) |
| Transgender | 0 (0) | 1 (4) | 2 (4) |
| Age group, y | |||
| 15-24 | 2 (7) | 0 (0) | 1 (2) |
| 25-44 | 11 (41) | 4 (15) | 17 (30) |
| 45-64 | 14 (52) | 22 (85) | 37 (65) |
| ≥65 | 0 (0) | 0 (0) | 2 (4) |
| Race/ethnicity | |||
| Non-Hispanic black | 24 (89) | 25 (96) | 48 (84) |
| Non-Hispanic white | 1 (4) | 1 (4) | 8 (14) |
| Hispanic | 2 (7) | 0 (0) | 1 (2) |
| Born in the United States | 27 (100) | 25 (96) | 54 (95) |
| TB culture confirmed | 22 (81) | 18 (69) | 46 (81) |
| TB isoniazid resistant (of those with TB susceptibility results) | 22 (100) | 18 (100) | 46 (100) |
| Method of TB case detection | |||
| TB contact investigation | 2 (7) | 0 (0) | 0 (0) |
| Other TB screening | 2 (7) | 5 (19) | 4 (7) |
| Incidental CXR or laboratory finding | 3 (11) | 8 (31) | 15 (26) |
| Non–health department evaluation for TB-related symptoms | 20 (74) | 13 (50) | 38 (67) |
| Documented test for TB infection | 19 (71) | 16 (62) | 44 (77) |
| Location of diagnostic evaluation leading to TB diagnosis | |||
| Health department TB clinic | 5 (19) | 5 (19) | 7 (12) |
| Hospital | 19 (70) | 16 (62) | 47 (83) |
| Other | 3 (11) | 5 (19) | 3 (5) |
| Pulmonary TB | 25 (96) | 23 (88) | 54 (54) |
| Sputum AFB smear–positive disease or cavitary disease on CXR (of those with pulmonary TB) | 19 (76) | 13 (57) | 32 (59) |
| Contacts named (by those with pulmonary TB) | |||
| 0 | 16 (64) | 17 (74) | 27 (50) |
| Total (if named) | 2 (1-7) | 6 (1-7) | 2 (1-4) |
| Infectious period (of those with pulmonary TB), d | 136 (100-197) | 106 (97-122) | 142 (123-172) |
| Homeless | |||
| During year before TB diagnosis | 27 (100) | 19 (73) | 49 (86) |
| Ever | 27 (100) | 23 (89) | 52 (91) |
| Mental illnessb | 10 (37) | 6 (23) | 22 (39) |
| Substance use (during year before TB diagnosis) | |||
| Any substance use | 20 (74) | 11 (42) | 20 (35) |
| Excessive alcohol use | 13 (48) | 8 (31) | 11 (19) |
| Non–injection drug use | 17 (63) | 9 (35) | 12 (21) |
| Injection drug use | 1 (4) | 1 (4) | 0 (0) |
| In a prison or local jail | |||
| At time of diagnosis | 2 (7) | 5 (19) | 4 (7) |
| During year before TB diagnosis | 22 (81) | 11 (42) | 18 (32) |
| Prior to year before TB diagnosis | 21 (78) | 17 (65) | 36 (63) |
| Connection to outbreak (same TB genotype results) | |||
| Stayed overnight in homeless facility | 27 (100) | 21 (81) | 51 (89) |
| Volunteer, homeless facility | 0 (0) | 0 (0) | 3 (6) |
| Homeless, exposed in other location | 0 (0) | 1 (4) | 1 (2) |
| Undetermined | 0 (0) | 4 (15) | 2 (4) |
| HIV coinfection, total | 15 (56) | 9 (35) | 17 (30) |
| Newly recognized HIV infection (of total) | 1 (7) | 1 (11) | 1 (6) |
| HIV diagnosis before TB presentation | 14 (93) | 8 (89) | 16 (94) |
| Not receiving antiretroviral treatment (of those with known treatment status) | 13 (93) | 4 (67) | 11 (69) |
| Receiving antiretroviral treatment (of those with known treatment status) | 1 (7) | 2 (33) | 5 (31) |
| CD4+ count, cells/μL | 163 (94-417) | 148 (29-227) | 50 (35-132) |
| Housing support received during anti-TB treatment | 20 (74) | 12 (46) | 41 (72) |
| Hospitalizations | |||
| Hospitalized during diagnostic evaluation of or treatment for TB | 21 (78) | 19 (73) | 51 (89) |
| Hospitalized for unrelated reasons | 6 (24) | 2 (11) | 12 (24) |
| Duration of hospitalization, d | 15 (7-29) | 13 (8-45) | 12 (7-20) |
| Total duration of hospitalizations, person-days | 540 | 651 | 993 |
| Clinical outcomes as of October 24, 2016 | |||
| Completed anti-TB treatment | 23 (85) | 23 (88) | 50 (88) |
| Died before TB diagnosis recognized | 0 (0) | 1 (4) | 2 (4) |
| Died during anti-TB treatment | 3 (11) | 1 (4) | 5 (9) |
| Incomplete anti-TB treatment or status unknown | 1 (4) | 1 (4) | 0 (0) |
Abbreviations: AFB, acid-fast bacilli; CXR, chest x-ray; HIV, human immunodeficiency virus; IQR, interquartile range; TB, tuberculosis.
aPer National Tuberculosis Surveillance System instructions, recurrences in 2 patients 1 year after treatment counted as separate cases.
bMedical record documentation of American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revision) Axis I conditions (other than substance use disorders).20