Transmission of tuberculosis to contacts of sputum positive adults in Malawi

Over a period of one year from June 1993 to May 1994, 282 children under 6 years old who were household contacts of sputum positive adults with tuberculosis were evaluated in a screening clinic. Of these, 180 (63.8%) had evidence of tuberculosis, a much higher transmission rate than reported elsewhere. HIV seropositivity was 77.4% in the adult index cases and 18% in the contact children. No increased infectivity to household contacts was detected in HIV seropositive index adults compared with those who were seronegative. Child tuberculosis contact tracing is essential in these families, where transmission of disease is higher than reported elsewhere, and attention to the health needs of the children may be diminished by the high morbidity and mortality among adult family members.