Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor
In Reply: Dr Braden and colleagues and Dr Hannan
reiterate 2 points of our article: that molecular and patient demographic
data alone do not demonstrate an occurrence of an outbreak, and that molecular
clustering is not synonymous with epidemiological linkage among cases.
As of a result of this study, the New Jersey Department of Health and
Human Services is reinvestigating the W4 cluster with interviews and chart
reviews. We agree that the lack of additional data limits the inference that
these cases represent an outbreak. However, when demographic and geographic
analyses are in concordance with the molecular data (shown by multiple independent
methods), it is suggestive of a combination of reactivation and recent transmission.
When applied with appropriate caution, molecular methods can improve the accuracy
of conventional surveillance methods. Several reports have used molecular
methods to identify outbreaks that were not connected by specific source cases,
but by common locations (eg, homeless shelters)1
or demographic groups (eg, barhopping homosexual men, transgendered persons).2,3 In each of these investigations,
some direct links were eventually identified, validating the combined molecular
and epidemiological approach.
Fontanarosa PB, Bifani PJ, Shopsin B, Alcabes P, Mathema B, Kreiswirth BN, Liu Z, Driscoll J, Frothingham R, Musser JM. Molecular Epidemiology and Tuberculosis Control—Reply. JAMA. 2000;284(3):305-307. doi:10.1001/jama.284.3.303