Cross-border outbreak of extensively drug-resistant tuberculosis linked to a university in Romania

O. Popovici*, Ph Monk, D. Chemtob, D. Chiotan, P. J. Freidlin, R. Groenheit, M. Haanperä, D. Homorodean, M. Mansjö, E. Robinson, E. Rorman, G. Smith, H. Soini, M. J. Van Der Werf

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Extensively drug-resistant (XDR) tuberculosis (TB) poses a threat to public health due to its complicated, expensive and often unsuccessful treatment. A cluster of three XDR TB cases was detected among foreign medical students of a Romanian university. The contact investigations included tuberculin skin testing or interferon gamma release assay, chest X-ray, sputum smear microscopy, culture, drug susceptibility testing, genotyping and whole-genome sequencing (WGS), and were addressed to students, personnel of the university, family members or other close contacts of the cases. These investigations increased the total number of cases to seven. All confirmed cases shared a very similar WGS profile. Two more cases were epidemiologically linked, but no laboratory confirmation exists. Despite all the efforts done, the source of the outbreak was not identified, but the transmission was controlled. The investigation was conducted by a team including epidemiologists and microbiologists from five countries (Finland, Israel, Romania, Sweden and the UK) and from the European Centre for Disease Prevention and Control. Our report shows how countries can collaborate to control the spread of XDR TB by exchanging information about cases and their contacts to enable identification of additional cases and transmission and to perform the source investigation.

Original languageEnglish
Pages (from-to)824-831
Number of pages8
JournalEpidemiology and Infection
Issue number7
Publication statusPublished - 1 May 2018

Bibliographical note

Funding Information:
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. Use of trade names is for identification only and does not imply endorsement by the Public Health Service or by the US Department of Health and Human Services.

Publisher Copyright:
© 2018 Cambridge University Press.


  • Contact tracing
  • extensively drug-resistant
  • tuberculosis
  • whole genome sequencing


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