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University of Nebraska Medical Center

Kansas: Multidrug-Resistant TB Outbreak


An outbreak of multidrug-resistant tuberculosis (TB) developed in Kansas in November 2021, and included multiple children who were born in the U.S. and became infected in the state, CDC researchers reported.

The outbreak involved 13 people across four households in Kansas City and spanned 1 year. While a majority of the seven adults identified were born outside the U.S. in a country that had experienced a multidrug-resistant TB outbreak with the same genotype in 2007-2009, most of the six children were U.S.-born, noted Elizabeth Groenweghe, MPH, of the Unified Government Public Health Department in Kansas City, and colleagues in the Morbidity and Mortality Weekly Report

“This outbreak is … a cautionary tale, reminding other low TB incidence jurisdictions that sustained declines in TB incidence are not assured,” they wrote. “Successful TB treatment and prevention requires ongoing identification and treatment of [latent TB infection] and a swift multifaceted public health response for each person newly diagnosed with TB.”

Nine additional people in the four affected households were diagnosed with latent infections, and one child in a neighboring state with an epidemiologic connection to the Kansas outbreak was also identified in July 2022.

All of the active infection isolates were resistant to rifampin, isoniazid, pyrazinamide, and ethambutol — all first-line treatments — but susceptible to second-line therapeutics, Groenweghe and co-authors said.

The outbreak began when an infant was hospitalized with pulmonary and meningeal TB. DNA sequencing confirmed that the infective strain was resistant to all four of the first-line drugs. An investigation by the local health department found four latent infections and four more active infections in the same household (household A), including a severely ill adult with pulmonary cavitary disease, who had exhibited symptoms since June 2021.

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