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This Article Figures Only Full Text Full Text (PDF) Supplemental Data All Versions of this Article: AJPH.2005.071936v1 AJPH.2005.071936v2 97/3/470    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Andre, M. Articles by McElroy, P. D. Search for Related Content PubMed PubMed Citation Articles by Andre, M. Articles by McElroy, P. D. Related Collections Community Health Epidemiology Tuberculosis

McKenzie Andre, MD, Kashef Ijaz, MD, Jon D. Tillinghast, MD, Valdis E. Krebs, MLIR, Lois A. Diem, BS, Beverly Metchock, DrPH, Theresa Crisp, MPH and Peter D. McElroy, PhD

Kashef Ijaz, Lois A. Diem, and Beverly Metchock are with the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Ga. At the time of this investigation, McKenzie Andre was with the Epidemic Intelligence Service Program and Peter D. McElroy was with the Division of Tuberculosis Elimination, both at the Centers for Disease Control and Prevention. Valdis E. Krebs is with Orgnet.com, Cleveland, Ohio. Jon D. Tilling-hast and Theresa Crisp are with the Tuberculosis Division, Oklahoma State Department of Health, Oklahoma City.

Correspondence: Requests for reprints should be sent to Kashef Ijaz, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Mail Stop E-10, 1600 Clifton Rd, Atlanta, GA 30333 (e-mail: kijaz{at}cdc.gov).

Objective. We examined the feasibility and value of network analysis to complement routine tuberculosis (TB) contact investigation procedures during an outbreak.

Methods. We reviewed hospital, health department, and jail records and interviewed TB patients. Mycobacterium tuberculosis isolates were genotyped. We evaluated contacts of TB patients for latent TB infection (LTBI) and TB, and analyzed routine contact investigation data, including tuberculin skin test (TST) results. Outcomes included number of contacts identified, number of contacts evaluated, and their TST status. We used network analysis visualizations and metrics (reach, degree, betweenness) to characterize the outbreak.

Results.secondary TB patients and more than 1200 contacts. Genotyping detected a 21-band pattern of a strain W variant. No HIV-infected patients were diagnosed. Contacts prioritized by network analysis were more likely to have LTBI than nonprioritized contacts (odds ratio=7.8; 95% confidence interval=1.6, 36.6). Network visualizations and metrics highlighted patients central to sustaining the outbreak and helped prioritize contacts for evaluation.

Conclusions. A network-informed approach to TB contact investigations provided a novel means to examine large quantities of data and helped focus TB control.