# Multidisciplinary Effort Leading to Effective Tuberculosis Community Outbreak Containment in Israel

## TL;DR

A multidisciplinary team in Israel successfully contained a tuberculosis outbreak using whole genome sequencing and collaboration across health sectors.

## Contribution

Demonstrates how WGS and cross-sector collaboration can effectively manage complex TB outbreaks in diverse populations.

## Key findings

- Whole genome sequencing identified overlooked patients and transmission chains in the outbreak.
- Collaboration among health organizations led to effective TB containment in a socially diverse region.
- Two distinct TB clusters were uncovered within the same neighborhood.

## Abstract

Tuberculosis (TB) is the second-most prevalent cause of mortality resulting from infectious diseases worldwide. It is caused by bacteria belonging to the Mycobacterium tuberculosis complex (MTBC). In Israel, TB incidence is low, acknowledged by the WHO as being in a pre-elimination phase. Most cases occur among immigrants from high TB incidence regions like the Horn of Africa and the former Soviet Union (FSU), with occasional outbreaks. The outbreak described in this report occurred between 2018 and 2024, increasing the incidence rate of TB in the region. Control of this outbreak posed challenges due to factors including a diverse population (including Ethiopian immigrants, Israeli-born citizens, and immigrants from other countries), economic and social barriers, and hesitancy to disclose information. The unique multidisciplinary team formed to address these challenges, involving the local TB clinic, district health ministry, health maintenance organization (HMO) infectious disease consultant, neighborhood clinic, and National Mycobacterium Reference Laboratory (NMRL), achieved effective treatment and containment. Whole genome sequencing (WGS) proved pivotal in unraveling patient connections during the outbreak. It pinpointed those patients overlooked in initial field investigations, established connections between patients across different health departments, and uncovered the existence of two distinct clusters with separate transmission chains within the same neighborhood. This study underscores collaborative efforts across sectors that successfully contained a challenging outbreak.