Mary R Reichler1, Awal Khan1, Timothy R Sterling2, Hui Zhao1, Bin Chen1, Yan Yuan1, Joyce Moran3, James McAuley4, Bonita Mangura5. 1. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. 2. Vanderbilt University Medical Center, Nashville, Tennessee. 3. New York City Department of Health and Charles P. Felton Tuberculosis Center, New York. 4. Respiratory Lung Association and Rush University, Chicago, Illinois. 5. New Jersey Medical School National Tuberculosis Center, Newark.
Abstract
BACKGROUND: Close contacts of persons with pulmonary tuberculosis (TB) have high rates of TB disease. METHODS: We prospectively enrolled TB patients and their close contacts at 9 US/Canadian sites. TB patients and contacts were interviewed to identify index patient, contact, and exposure risk factors for TB. Contacts were evaluated for latent TB infection (LTBI) and TB, and the effectiveness of LTBI treatment for preventing contact TB was examined. RESULTS: Among 4490 close contacts, multivariable risk factors for TB were age ≤5 years, US/Canadian birth, human immunodeficiency virus infection, skin test induration ≥10 mm, shared bedroom with an index patient, exposure to more than 1 index patient, and index patient weight loss (P < .05 for each). Of 1406 skin test-positive contacts, TB developed in 49 (9.8%) of 446 who did not initiate treatment, 8 (1.8%) of 443 who received partial treatment, and 1 (0.2%) of 517 who completed treatment (1951, 290, and 31 cases/100 000 person-years, respectively; P < .001). TB was diagnosed in 4.2% of US/Canadian-born compared with 2.3% of foreign-born contacts (P = .002), and TB rates for US/Canadian-born and foreign-born contacts who did not initiate treatment were 3592 and 811 per 100 000 person-years, respectively (P < .001). CONCLUSIONS: Treatment for LTBI was highly effective in preventing TB among close contacts of infectious TB patients. Several index patient, contact, and exposure characteristics associated with increased risk of contact TB were identified. These findings help inform contact investigation, LTBI treatment, and other public health prevention efforts. Published by Oxford University Press for the Infectious Diseases Society of America 2019.
BACKGROUND: Close contacts of persons with pulmonary tuberculosis (TB) have high rates of TB disease. METHODS: We prospectively enrolled TB patients and their close contacts at 9 US/Canadian sites. TB patients and contacts were interviewed to identify index patient, contact, and exposure risk factors for TB. Contacts were evaluated for latent TB infection (LTBI) and TB, and the effectiveness of LTBI treatment for preventing contact TB was examined. RESULTS: Among 4490 close contacts, multivariable risk factors for TB were age ≤5 years, US/Canadian birth, human immunodeficiency virus infection, skin test induration ≥10 mm, shared bedroom with an index patient, exposure to more than 1 index patient, and index patientweight loss (P < .05 for each). Of 1406 skin test-positive contacts, TB developed in 49 (9.8%) of 446 who did not initiate treatment, 8 (1.8%) of 443 who received partial treatment, and 1 (0.2%) of 517 who completed treatment (1951, 290, and 31 cases/100 000 person-years, respectively; P < .001). TB was diagnosed in 4.2% of US/Canadian-born compared with 2.3% of foreign-born contacts (P = .002), and TB rates for US/Canadian-born and foreign-born contacts who did not initiate treatment were 3592 and 811 per 100 000 person-years, respectively (P < .001). CONCLUSIONS: Treatment for LTBI was highly effective in preventing TB among close contacts of infectious TB patients. Several index patient, contact, and exposure characteristics associated with increased risk of contact TB were identified. These findings help inform contact investigation, LTBI treatment, and other public health prevention efforts. Published by Oxford University Press for the Infectious Diseases Society of America 2019.
Authors: Rosa Sloot; Maarten F Schim van der Loeff; Peter M Kouw; Martien W Borgdorff Journal: Am J Respir Crit Care Med Date: 2014-11-01 Impact factor: 21.405
Authors: Jason R Andrews; Farzad Noubary; Rochelle P Walensky; Rodrigo Cerda; Elena Losina; C Robert Horsburgh Journal: Clin Infect Dis Date: 2012-01-19 Impact factor: 9.079
Authors: B J Marais; R P Gie; H S Schaaf; A C Hesseling; C C Obihara; J J Starke; D A Enarson; P R Donald; N Beyers Journal: Int J Tuberc Lung Dis Date: 2004-04 Impact factor: 2.373
Authors: Greg J Fox; Nguyen V Nhung; Dinh N Sy; Nghiem L P Hoa; Le T N Anh; Nguyen T Anh; Nguyen B Hoa; Nguyen H Dung; Tran N Buu; Nguyen T Loi; Le T Nhung; Nguyen V Hung; Phan T Lieu; Nguyen K Cuong; Pham D Cuong; Jessica Bestrashniy; Warwick J Britton; Guy B Marks Journal: N Engl J Med Date: 2018-01-18 Impact factor: 91.245
Authors: Amyn A Malik; Neel R Gandhi; Timothy L Lash; Lisa M Cranmer; Saad B Omer; Junaid F Ahmed; Sara Siddiqui; Farhana Amanullah; Aamir J Khan; Salmaan Keshavjee; Hamidah Hussain; Mercedes C Becerra Journal: Emerg Infect Dis Date: 2021-03 Impact factor: 6.883
Authors: Mary R Reichler; Awal Khan; Yan Yuan; Bin Chen; James McAuley; Bonita Mangura; Timothy R Sterling Journal: Clin Infect Dis Date: 2020-10-23 Impact factor: 9.079
Authors: Jay M Brenner; Erik Blutinger; Brandon Ricke; Laura Vearrier; Nicholas H Kluesner; John C Moskop Journal: J Am Coll Emerg Physicians Open Date: 2021-05-29
Authors: Mary R Reichler; Christina Hirsch; Yan Yuan; Awal Khan; Susan E Dorman; Neil Schluger; Timothy R Sterling Journal: BMC Infect Dis Date: 2020-07-31 Impact factor: 3.090