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Targeting tuberculosis testing: the yield of source case investigations for young children with reactive tuberculin
Cynthia R Driver1, Isabel M Cordova, Sonal S Munsiff
1Tuberculosis Control Program, New York City Department of Health, New York, NY 10007, USA. cdriver@health.nyc.gov
Insights
Investigating tuberculosis (TB) infection in young children identified few source cases but revealed significant infection rates among close contacts. These investigations may target high-risk individuals, warranting consideration based on available resources.
Area of Science:
- Pediatric infectious diseases
- Public health surveillance
- Tuberculosis control
Background:
- Identifying the source of tuberculosis (TB) infection in young children is crucial for preventing further transmission.
- Tuberculin skin test reactors in children under 3 years old necessitate thorough contact investigations.
Purpose of the Study:
- To determine the yield of investigations aimed at identifying TB source cases in young children (≤3 years) who are tuberculin reactors.
- To assess the effectiveness of associate investigations in finding infectious TB cases within a community.
Main Methods:
- Conducted associate investigations for child tuberculin reactors reported between January 1996 and June 1998.
- Defined associates as individuals living with or spending significant time with a child reactor.
- Identified source cases as culture-positive, pulmonary TB cases in associates over 10 years old, present during the child's potential exposure period.
Main Results:
- 207 children underwent investigation with a median of 4 associates evaluated per child.
- Of 980 evaluated associates, 668 were household contacts, with 30% infected and 6 active TB cases (2 meeting source case criteria).
- The yield was 0.9 source cases per 100 children investigated; 18% of non-household contacts were infected, with no active disease.
Conclusions:
- Few source cases were identified in young tuberculin reactors in New York City.
- Investigations identified a notable proportion of TB cases and infection among associates, similar to contacts of adult TB cases.
- These investigations may identify high-risk populations and should be considered based on public health program resources.
Objective:
This study was designed to determine the yield of investigations whose aim is to identify a source case for tuberculosis infection among tuberculin reactors 3 years of age or younger.
Methods:
The authors describe the results of associate investigations conducted for child tuberculin reactors reported from January 1, 1996, through June 30, 1998. Associates were defined as individuals who live with or spend significant time with a child reactor. An associate investigation was defined as evaluation of at least one associate. A source case was an associate older than 10 years of age who had culture-positive, pulmonary tuberculosis during a period when the child could have been exposed.
Results:
Two hundred seven children had an associate investigation performed with a median of four associates investigated per child (range 1-21). Birthplace was known for 187 (90%); 128 were U.S.-born. Of 1,222 associates identified, 980 (80%) were evaluated. Among 452 (46%) associates for whom birthplace was known, 250 (55%) were non-U.S.-born. Of 980 associates, 668 were household contacts; 198 (30%) were infected, three had prior tuberculosis disease, and three had active tuberculosis. Two active cases met source case criteria; the yield was 0.9 (2 of 207) source cases per 100 children investigated. Of 312 non-household contacts, 57 (18%) were infected and none had the disease.
Conclusions:
Although few source cases were identified for young tuberculin skin test reactors in New York City, investigations identified a proportion of cases and infection in associates similar to that identified among contacts to pulmonary tuberculosis cases. Such investigations may be identifying a high-risk group and should be considered, depending on program resources.