PT  - JOURNAL ARTICLE
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
TI  - The use of whole-genome sequencing in cluster investigation of a multidrug-resistant tuberculosis outbreak
AID  - 10.1183/13993003.02313-2017
DP  - 2018 Jun 01
TA  - European Respiratory Journal
PG  - 1702313
VI  - 51
IP  - 6
4099  - http://erj.ersjournals.com/content/51/6/1702313.short
4100  - http://erj.ersjournals.com/content/51/6/1702313.full
SO  - Eur Respir J2018 Jun 01; 51
AB  - We used whole-genome sequencing (WGS) to delineate transmission networks and investigate the benefits of WGS during cluster investigation.We included clustered cases of multidrug-resistant (MDR) tuberculosis (TB)/extensively drug-resistant (XDR) TB linked by mycobacterial interspersed repetitive unit variable tandem repeat (MIRU-VNTR) strain typing or epidemiological information in the national cluster B1006, notified between 2007 and 2013 in the UK. We excluded from further investigation cases whose isolates differed by greater than 12 single nucleotide polymorphisms (SNPs). Data relating to patients' social networks were collected.27 cases were investigated and 22 had WGS, eight of which (36%) were excluded as their isolates differed by more than 12 SNPs to other cases. 18 cases were ruled into the transmission network based on genomic and epidemiological information. Evidence of transmission was inconclusive in seven out of 18 cases (39%) in the transmission network following WGS and epidemiological investigation.This investigation of a drug-resistant TB cluster illustrates the opportunities and limitations of WGS 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 outbreaks with WGS was useful but it was often inconclusive whether transmission occurred http://ow.ly/Qk7130jPP5C