[Skip to Content]
[Skip to Content Landing]
Citations 0
July 19, 2000

Molecular Epidemiology and Tuberculosis Control—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;284(3):305-307. doi:10.1001/jama.284.3.303

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.