Investigating a tuberculosis cluster among Filipino health care workers in a low-incidence country

J. A. Davidson*, N. Fulton, Helen Thomas, M. K. Lalor, D. Zenner, T. Brown, S. Murphy, L. F. Anderson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


S E T T ING: Nearly 8% of adult tuberculosis (TB) cases in England, Wales and Northern Ireland (EW&NI) occur among health care workers (HCWs), the majority of whom are from high TB incidence countries. OBJ E CTIVE S : To determine if a TB cluster containing multiple HCWs was due to nosocomial transmission. METHODS : A cluster of TB cases notified in EW&NI from 2009 to 2014, with indistinguishable 24-locus mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) profiles, was identified through routine national cluster review. Cases were investigated to identify epidemiological links, and occupational health (OH) information was collected for HCW cases. To further discriminate strains, typing of eight additional loci was conducted. RESULT S : Of the 53 cases identified, 22 were HCWs. The majority (n=43), including 21 HCWs, were born in the Philippines. Additional typing split the cluster into three subclusters and seven unique strains. No epidemiological links were identified beyond one household and a common residential area. HCWs in this cluster received no or inadequate OH assessment. CONC LUS IONS : The MIRU-VNTR profile of this cluster probably reflects common endemic strains circulating in the Philippines, with reactivation occurring in the UK. Furthermore, 32-locus typing showed that 24-locus MIRU-VNTR failed to distinguish strain diversity. The lack of OH assessment indicates that latent tuberculous infection could have been identified and treated, thereby preventing active cases from occurring.

Original languageEnglish
Pages (from-to)252-257
Number of pages6
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number3
Publication statusPublished - 1 Mar 2018

Bibliographical note

Publisher Copyright:
© 2018 The Union.


  • Genotyping
  • Occupational health
  • Transmission


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