Contact investigation for tuberculosis: a systematic review and meta-analysis.
Gregory J. Fox,Simone E. Barry,Warwick J. Britton,Warwick J. Britton,Guy B. Marks,Guy B. Marks +5 more
TLDR
A systematic review and meta-analysis of all studies reporting the prevalence of TB and latent TB infection, and the annual incidence of TB among contacts of patients with TB found that contact patients are a high-risk group for developing TB, particularly within the first year.Abstract:
Investigation of contacts of patients with tuberculosis (TB) is a priority for TB control in high-income countries, and is increasingly being considered in resource-limited settings. This review was commissioned for a World Health Organization Expert Panel to develop global contact investigation guidelines.
We performed a systematic review and meta-analysis of all studies reporting the prevalence of TB and latent TB infection, and the annual incidence of TB among contacts of patients with TB.
After screening 9,555 titles, we included 203 published studies. In 95 studies from low- and middle-income settings, the prevalence of active TB in all contacts was 3.1% (95% CI 2.2–4.4%, I2=99.4%), microbiologically proven TB was 1.2% (95% CI 0.9–1.8%, I2=95.9%), and latent TB infection was 51.5% (95% CI 47.1–55.8%, I2=98.9%). The prevalence of TB among household contacts was 3.1% (95% CI 2.1–4.5%, I2=98.8%) and among contacts of patients with multidrug-resistant or extensively drug-resistant TB was 3.4% (95% CI 0.8–12.6%, I2=95.7%). Incidence was greatest in the first year after exposure. In 108 studies from high-income settings, the prevalence of TB among contacts was 1.4% (95% CI 1.1–1.8%, I2=98.7%), and the prevalence of latent infection was 28.1% (95% CI 24.2–32.4%, I2=99.5%). There was substantial heterogeneity among published studies.
Contacts of TB patients are a high-risk group for developing TB, particularly within the first year. Children <5 yrs of age and people living with HIV are particularly at risk. Policy recommendations must consider evidence of the cost-effectiveness of various contact tracing strategies, and also incorporate complementary strategies to enhance case finding.read more
Citations
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The cascade of care in diagnosis and treatment of latent tuberculosis infection: a systematic review and meta-analysis
TL;DR: Major losses at several steps in the cascade of care for latent tuberculosis infection are identified, indicating improvements in management of latent tuberculosis will need programmatic approaches to address the losses at each step.
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Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study
TL;DR: The model has shown that the incidence of paediatric tuberculosis is higher than the number of notifications, particularly in young children, and estimates of current household exposure and cumulative infection suggest an enormous opportunity for preventive treatment.
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The ongoing challenge of latent tuberculosis
Hanif Esmail,Hanif Esmail,Clifton E. Barry,Douglas B. Young,Douglas B. Young,Robert J. Wilkinson,Robert J. Wilkinson,Robert J. Wilkinson +7 more
TL;DR: It is argued that the pool of individuals at high risk of progression may be significantly smaller than the 2.33 billion thought to be immune sensitized by Mycobacterium tuberculosis and that identifying and targeting this group will be an important strategy in the road to elimination.
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Antimicrobial resistance in Mycobacterium tuberculosis: mechanistic and evolutionary perspectives
Sebastian M. Gygli,Sebastian M. Gygli,Sonia Borrell,Sonia Borrell,Andrej Trauner,Andrej Trauner,Sebastien Gagneux,Sebastien Gagneux +7 more
TL;DR: Although the genetic diversity of M. tuberculosis is low compared to other pathogenic bacteria, the strain genetic background has been demonstrated to influence multiple aspects in the evolution of drug resistance.
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Four Months of Rifampin or Nine Months of Isoniazid for Latent Tuberculosis in Adults
Dick Menzies,Menonli Adjobimey,Rovina Ruslami,Anete Trajman,Oumou Sow,Hee Jin Kim,Joseph Obeng Baah,Guy B. Marks,Richard Long,Vernon Hoeppner,Kevin Elwood,Hamdan Al-Jahdali,M. Gninafon,Lika Apriani,Raspati C Koesoemadinata,Afranio Lineu Kritski,Valeria Cavalcanti Rolla,Boubacar Bah,Alioune Camara,Isaac Boakye,Victoria J. Cook,Hazel Goldberg,Chantal Valiquette,Karen Hornby,Marie-Josée Dion,Pei-Zhi Li,Philip C. Hill,Kevin Schwartzman,Andrea Benedetti +28 more
TL;DR: The 4‐ month regimen of rifampin was not inferior to the 9‐month regimen of isoniazid for the prevention of active tuberculosis and was associated with a higher rate of treatment completion and better safety.
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