Tuberculosis Transmission Knows No Borders: Genotype Clusters Along Texas- Mexico Border Nicole Evert, MS Genotyping Coordinator Texas Department of State.

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Tuberculosis Transmission Knows No Borders: Genotype Clusters Along Texas- Mexico Border Nicole Evert, MS Genotyping Coordinator Texas Department of State Health Services Collaborators: Ken Jost Jr, Maria Rodriguez, Cindy Tafolla, Ann Tyree and Charles Wallace No funding sources or relationships to disclose and no conflict of interest to disclose

Background ► Three binational programs created to address the high incidence of TB along Texas-Mexico border by serving TB cases in sister-city communities  Services provided include: ► directly observed therapy ► contact investigations ► laboratory services, including genotyping ► TB education ► referrals ► ► Each year an estimated 500 – 750 TB cases require TB case management on both sides of the U.S.- Mexico border (unpublished data)

Genotype Clusters in Texas ► 7,119 Tuberculosis (TB) cases were genotyped in Texas from  1,823 (26%) binational TB cases ► 1,403 (77%) were clustered  5,296 (74%) Texas (TX) TB cases ► 2,777 (52%) were clustered ► Clusters with both Texas and Binational cases were 3 times larger than clusters with only Texas or only Binational cases

Genotype: PCR02252 (Spoligotype: ,24-locus MIRU-VNTR: )

V K LM Jail H R Street A C Street B INH INH RIF INH EMB INH RIF EMB T B INH RIF JN Q E INH RIF EMB F INH RIF SM INH RIF EMB AD INH I INH RIF PZA G INH O P INH RIF S INH INH EMB U Report Year Texas Tamaulipas, MX Known Link Possible Link Genotype: PCR02252 (Spoligotype: , 24-locus MIRU-VNTR: )

Conclusion & Next Steps ► Preliminary cluster analysis of PCR02252 suggests that there may be ongoing transmission among Texas and Binational cases across border communities, but more information is needed ► Improving management for patients and interrupting of TB transmission along the border depends on:  Consistent formats for data collection  Sharing data ► Patient information ► Contact investigations  Centralized Data Analysis  Joint planning and interventions