Soyeon Kim1, Xingye Wu2, Michael D Hughes2, Caryn Upton3, Kim Narunsky4, Alberto Mendoza-Ticona5, Saltnat Khajenoori6, Pedro Gonzales7, Sharlaa Badal-Faesen8, Justin Shenje9, Ayotunde Omoz-Oarhe10, Vanessa Rouzier11, Anthony J Garcia-Prats12, Anne-Marie Demers12, Linda Naini13, Elizabeth Smith14, Gavin Churchyard15, Susan Swindells16, N Sarita Shah17, Amita Gupta18, Anneke C Hesseling12. 1. From the Department of Biostatistics, Frontier Science Foundation, Brookline, Massachusetts. 2. Center for Biostatistics in AIDS Research in the Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 3. TASK CRS, Cape Town, South Africa. 4. Centre for TB Research Innovation, University of Cape Town Lung Institute, Cape Town, South Africa. 5. Barranco CRS, Asociación Civil Impacta Salud y Educación, Lima, Peru. 6. Byramjee Jeejeebhoy Government Medical College CRS and Department of Medicine, Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India. 7. San Miguel CRS, Asociación Civil Impacta Salud y Educación, Lima, Peru. 8. University of the Witwatersrand CRS, University of the Witwatersrand, Johannesburg, South Africa. 9. South African Tuberculosis Vaccine Initiative, University of Cape Town, Cape Town, South Africa. 10. Gaborone CRS, Princess Marina Hospital, Gaborone, Botswana. 11. Les Centres GHESKIO, Institute of Infectious Diseases and Reproductive Health, Port-au-Prince, Haiti. 12. Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. 13. Department of Clinical Research and Bioscience, Social & Scientific Systems, Silver Spring, Maryland. 14. Division of AIDS, National Institutes of Health, Bethesda, Maryland. 15. Aurum Institute, Parktown, South Africa, School of Public Health, University of Witwatersrand, Johannesburg, South Africa. 16. Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska. 17. Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia. 18. Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Abstract
BACKGROUND: Household contact (HHC) investigation is an important strategy to identify individuals with tuberculosis (TB) exposure, infection and disease, including those who may benefit from tuberculosis preventive therapy (TPT). Data in children exposed to rifampin-resistant TB are limited. METHODS: In preparation for and to inform the feasibility of an interventional trial, HHC of adults with pulmonary rifampin-resistant TB from high TB-burden countries were evaluated in a cross-sectional study. Using interferon-gamma release assay and study-specific and 2015 international consensus definitions of intrathoracic TB in children, we evaluated the prevalence and predictors of TB infection and disease in child (<15 years) HHCs. RESULTS: Of 303 child HHCs, median age (range) 7 years (0-14), 57% [95% confidence interval (CI): 50%-64%] had a positive interferon-gamma release assay result (TB infected). TB infection was associated with the index case smoking (P = 0.034), being the parent or sleeping in the same room (P = 0.002) and the child HHC being age ≥5 years and having attended school (P = 0.013). Four had study-defined confirmed TB and 9 had probable TB, a prevalence of 4.3% (95% CI: 2.6%-7.1%). Using the international consensus definitions, 4 had confirmed TB and 49 had unconfirmed TB, a prevalence of 17.2% (95% CI: 12.9%-22.4%). Twenty (7%) children had received TPT. CONCLUSIONS: The prevalence of TB infection and disease was high in child HHC exposed to rifampin-resistant TB. Few children had routinely received TPT. High-quality evidence is needed to inform strong recommendations for and access to TPT in children exposed to TB resistant to rifampin.
BACKGROUND: Household contact (HHC) investigation is an important strategy to identify individuals with tuberculosis (TB) exposure, infection and disease, including those who may benefit from tuberculosis preventive therapy (TPT). Data in children exposed to rifampin-resistant TB are limited. METHODS: In preparation for and to inform the feasibility of an interventional trial, HHC of adults with pulmonary rifampin-resistant TB from high TB-burden countries were evaluated in a cross-sectional study. Using interferon-gamma release assay and study-specific and 2015 international consensus definitions of intrathoracic TB in children, we evaluated the prevalence and predictors of TB infection and disease in child (<15 years) HHCs. RESULTS: Of 303 child HHCs, median age (range) 7 years (0-14), 57% [95% confidence interval (CI): 50%-64%] had a positive interferon-gamma release assay result (TB infected). TB infection was associated with the index case smoking (P = 0.034), being the parent or sleeping in the same room (P = 0.002) and the child HHC being age ≥5 years and having attended school (P = 0.013). Four had study-defined confirmed TB and 9 had probable TB, a prevalence of 4.3% (95% CI: 2.6%-7.1%). Using the international consensus definitions, 4 had confirmed TB and 49 had unconfirmed TB, a prevalence of 17.2% (95% CI: 12.9%-22.4%). Twenty (7%) children had received TPT. CONCLUSIONS: The prevalence of TB infection and disease was high in child HHC exposed to rifampin-resistant TB. Few children had routinely received TPT. High-quality evidence is needed to inform strong recommendations for and access to TPT in children exposed to TB resistant to rifampin.
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