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Yield of source-case and contact investigations in identifying previously undiagnosed childhood tuberculosis
M N Lobato1, S E Royce, J C Mohle-Boetani
1Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. mnl0@cdc.gov
Insights
Tuberculosis (TB) investigations, initiated by either a child or adult case, effectively identify new TB cases and individuals needing treatment for latent tuberculosis infection (LTBI). These methods are crucial for preventing further TB transmission and reducing childhood TB.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Pediatric Tuberculosis
Background:
- Childhood tuberculosis (TB) remains a significant global health concern.
- Effective strategies are needed to detect undiagnosed TB and latent tuberculosis infection (LTBI), especially in children.
- Source-case and contact investigations are established public health interventions for communicable diseases.
Purpose of the Study:
- To evaluate the effectiveness of source-case investigations (child index cases) and contact investigations (adult pulmonary cases) in identifying undiagnosed TB and LTBI.
- To assess the yield of these investigations in pediatric and adult populations.
Main Methods:
- Retrospective review of 111 source-case and 38 contact investigations in California health jurisdictions.
- Focus on investigations involving children under 5 years old with a TB rate above the state average.
- Evaluation of TB disease and LTBI status in evaluated children and adults.
Main Results:
- Source-case investigations identified 14 new TB cases (7 in children <5 years) and identified individuals for LTBI treatment (45% positive tuberculin reaction).
- Contact investigations of adult cases identified 46 children with TB (<5 years), plus 4 children (5-14 years) and 10 adults with TB.
- A high proportion of contacts (41%) had a positive tuberculin reaction, particularly household contacts, indicating significant LTBI prevalence.
Conclusions:
- Source-case and contact investigations are highly effective in detecting previously undiagnosed TB cases.
- These investigations are valuable for identifying individuals, including children and adults, who could benefit from LTBI treatment.
- Early detection and treatment of adult TB cases can interrupt transmission, contributing to the elimination of childhood TB.
Objective:
To determine the extent to which source-case investigations, in which a child was the index tuberculosis (TB) case, and contact investigations of adult pulmonary cases, identified children and adults with previously undiagnosed TB or latent tuberculosis infection (LTBI).
Methods:
We reviewed records of 111 source-case investigations and 38 contact investigations involving 164 TB cases among children <5 years of age from eight California health jurisdictions with a case rate greater than the state average for this age group (9.6/100000).
Results:
In source-case investigations, 141 children <5 years and 113 children 5-14 years of age were evaluated for TB disease and LTBI. Fourteen previously undiagnosed TB cases were found, including seven children <5 years of age. Source-case investigations also identified persons who might benefit from treatment for LTBI (45% had a positive tuberculin reaction). In contact investigations of adult TB cases, 202 children <5 years and 122 children 5-14 years of age were evaluated. In addition to 46 children with TB <5 years of age, the basis on which these contact investigations were selected for study, four children 5-14 years of age and 10 adults were found to have TB disease. A high percentage (41%) of contacts with a positive tuberculin reaction was found, especially among household contacts.
Conclusions:
Source-case investigations and contact investigations are effective for finding previously undiagnosed cases of TB. They are also useful for identifying children and adults who would possibly benefit from treatment for LTBI. Earlier detection and treatment of adults with TB could interrupt transmission and be a step toward eliminating childhood TB.
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