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    The investigation was designed to provide insight about TB among predominantly elderly populations as an aid to countries experiencing an increase in TB cases among the elderly 122 InYamagata Prefecture had 1. Statistical data used in the study was provided by the Statistics Planning Division, Yamagata Prefecture. During —, public health centers routinely delivered collected strains to the Yamagata Prefectural Institute of Public Health within 2 months after notification of TB cases. These collected strains corresponded in part to those described in our earlier works, which mainly analyzed Woman adult date in yamagata features of M.

    We calculated the number of repeats for each locus from the sizes of PCR products, in agreement with published allelic tables We divided the strains Woman adult date in yamagata 6 lineages: Data Collection Public health centers routinely collect demographic age, sex, country of birth, and addressclinical site of disease, acid-fast bacilli sputum smear status, and treatment historyepidemiologic family members, occupation, and contacts during onsetand microbiologic culture and drug-susceptibility status of M. When a preliminary TB cluster is confirmed, public health nurses investigate the behavior history of patients within clusters to determine recent M.

    If patients in a cluster live in dispersed areas, the investigations are performed in cooperation with the responsible public health centers. In addition, after Novemberpublic health centers asked all patients with culture-confirmed TB to complete a long or short version of a self-administered questionnaire that specifically elicits responses associated with residence, travel history, transportation, and places of social aggregation Technical Appendix 2. Public health centers decide which version of the questionnaire to use, depending on patient willingness and ability to fill out the form. Using social interaction data gathered from the case investigations and questionnaires, public health centers graded patients within clusters as epidemiologically linked i.

    Cluster Analysis We defined cases as a cluster when their 24Beijing-VNTR profiles were indistinguishable from each other or when a social interaction was graded as epidemiologically linked or possibly linked in the SLV group. We calculated the proportion of clustered cases resulting from recent M. In addition, we calculated the percentage of cases resulting from epidemiologic links, including only cases and clusters with confirmed links in the calculation [ no. We visualized cluster diagrams displaying epidemiologic links by using Cytoscape 3. To determine the association between cluster formation and epidemiologic features especially age groupswe applied multivariate logistic regression analysis using, for example, age group, sex, and M.

    Residual analysis was used when logistic regression analysis was not applicable. All statistical analyses were conducted using R version 3.

    Results During yamagaat, a total of TB cases were reported in Yamagata Yamqgata of the cases were diagnosed as pulmonary TB, of which were culture-confirmed. We studied No patients were HIV-positive, illicit drug users, or homeless. The remaining cases formed 42 clusters Technical Appendix 1 Table 1each of which contained 2—17 cases; Cases attributable to recent transmission accounted for However, among the M. The odds ratios of ancient Beijing lineages STK and ST3 against the modern Beijing lineage were significant only with univariate analysis. We also determined the risk for infection with the different M.

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