Cluster of human tuberculosis caused by Mycobacterium bovis: evidence for person-to-person transmission in the UK

Jason T. Evans, E. Grace Smith, Ashis Banerjee, Robert MM Smith, James Dale, John A. Innes, David Hunt, Alan Tweddell, Annette Wood, Charlotte Anderson, R. Glyn Hewinson, Noel H. Smith, Peter M. Hawkey, Pam Sonnenberg

Research output: Contribution to journalArticlepeer-review

134 Citations (Scopus)

Abstract

Background: Despite a recent resurgence in the incidence of bovine tuberculosis in UK cattle herds, no associated rise in the number of cases in man has been noted. Disease due to human Mycobacterium bovis infection usually occurs in older patients, in whom drinking unpasteurised milk in the past is the probable source of infection. Person-to-person transmission is very rare. Methods: After identification of two epidemiologically-linked cases of human M bovis infection through routine laboratory and surveillance activities, all patients identified with M bovis infection in the Midlands from 2001-05 (n=20) were assessed by DNA fingerprinting (MIRU-VNTR and spoligotyping), with additional interviews for patients with a clustered strain. Findings: A cluster of six cases was identified. All clustered cases were young and UK-born; five patients had pulmonary disease, and one patient died due to M bovis meningitis, with four patients possessing factors predisposing to tuberculosis. All patients had common social links through visits to bars in two different areas. With the exception of the first case, there was an absence of zoonotic links or consumption of unpasteurised dairy products, suggesting that person-to-person transmission had occurred. Interpretation: This report of several instances of M bovis transmission between people in a modern urban setting emphasises the need to maintain control measures for human and bovine tuberculosis. Transmission and subsequent disease was probably due to a combination of host and environmental factors. Prospective surveillance and DNA fingerprinting identified the cluster, enabling health protection teams to set up control measures and prevent further transmission.

Original languageEnglish
Pages (from-to)1270-1276
Number of pages7
JournalThe Lancet
Volume369
Issue number9569
DOIs
Publication statusPublished - 14 Apr 2007

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