TY - JOUR T1 - The use of whole-genome sequencing in cluster investigation of an MDR-TB outbreak JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.02313-2017 SP - 1702313 AU - Maeve K. Lalor AU - Nicola Casali AU - Timothy M. Walker AU - Laura F. Anderson AU - Jennifer A. Davidson AU - Natasha Ratna AU - Cathy Mullarkey AU - Mike Gent AU - Kirsty Foster AU - Tim Brown AU - John Magee AU - Anne Barrett AU - Derrick W. Crook AU - Francis Drobniewski AU - H. Lucy Thomas AU - Ibrahim Abubakar Y1 - 2018/01/01 UR - http://erj.ersjournals.com/content/early/2018/05/03/13993003.02313-2017.abstract N2 - We used whole-genome sequencing to delineate transmission networks and investigate the benefits of whole-genome sequencing during cluster investigation.We included clustered cases of M/XDR-TB linked by MIRU-VNTR, or epidemiological information in the national cluster B1006, notified between 2007–2013 in the UK. We excluded cases whose isolates differed by >12 SNPs from further investigation. Data relating to patients' social networks were collected.Twenty-seven cases were investigated, 22 had whole-genome sequencing; 8 (36%) of which were excluded as their isolates differed by >12 SNPs to other cases. Eighteen cases were ruled into the transmission network based on genomic and epidemiological information. Evidence of transmission was inconclusive in 39% (7/18) of cases in the transmission network following whole-genome sequencing and epidemiological investigation.This investigation of a drug resistant TB cluster illustrates the opportunities and limitations of whole-genome sequencing in understanding transmission in a setting with a high proportion of migrant cases. The use of WGS should be combined with classical epidemiological methods. However not every cluster will be solvable, regardless of the quality of genomic data.Investigation of MDR-TB TB outbreak with WGS was useful but whether transmission occurred was often inconclusiveFootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Lalor has nothing to disclose.Conflict of interest: Dr. Casali has nothing to disclose.Conflict of interest: Dr. Walker has nothing to disclose.Conflict of interest: Dr. Anderson has nothing to disclose.Conflict of interest: Dr. Davidson has nothing to disclose.Conflict of interest: Miss. Ratna has nothing to disclose.Conflict of interest: Dr. Mullarkey has nothing to disclose.Conflict of interest: Dr. Gent has nothing to disclose.Conflict of interest: Dr. Foster has nothing to disclose.Conflict of interest: Dr. Brown has nothing to disclose.Conflict of interest: Dr. Magee has nothing to disclose.Conflict of interest: Dr. Barrett has nothing to disclose.Conflict of interest: Dr. Crook has nothing to disclose.Conflict of interest: Dr. Drobniewski has nothing to disclose.Conflict of interest: Dr. Thomas has nothing to disclose.Conflict of interest: Dr. Abubakar has nothing to disclose. ER -