Two Simultaneous Outbreaks of Multidrug-Resistant Tuberculosis -- Federated States of Micronesia, 2007--2009

This report describes the investigation by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), which initially identified five confirmed cases of multidrug-resistant tuberculosis (MDR TB) in two distinct clusters, characterized by two distinct geographic locations, genotypes, and drug-susceptibility patterns in the Federated States of Micronesia. Extensive transmission had occurred among household contacts; 16 (8%) of the 205 contacts identified had confirmed or suspected MDR TB disease, and 124 (60%) had latent TB infection. Multiple US government agencies and other organizations assisted local health authorities with resources to obtain second-line drugs, ensure directly observed therapy (DOT), and identify and evaluate contacts.