Tuberculosis among families of children with suspected tuberculosis and employees at a children's hospital.
ABSTRACT Children with tuberculosis are rarely contagious, but their caregivers may be. Only 7 (12%) of 59 children were potentially contagious, and 10 (17%) were accompanied by contagious adults. Screening caregivers was more cost-effective than performing employee contact investigations, with one-sixteenth the cost ($5,470 vs $88,323) and requiring screening of 35 times fewer persons.
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ABSTRACT: Investigation of contacts for patients with tuberculosis is a priority for tuberculosis 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 tuberculosis and latent tuberculosis infection, and the annual incidence of tuberculosis among contacts of patients with tuberculosis.After screening 9555 titles, we included 203 published studies. In 95 studies from low and middle-income settings, the prevalence of active tuberculosis in all contacts was 3.1% (95% CI 2.2%-4.4%, I(2)=99.4%), microbiologically proven tuberculosis 1.2% (95% CI 0.9-1.8%, I(2)=95.9%), and latent tuberculosis infection 51.5% (95% CI 47.1-55.8%, I(2)=98.9%). The prevalence of tuberculosis among household contacts was 3.1% (95% CI 2.1-4.5%, I(2)=98.8%) and among contacts of patients with multi-drug resistant or extensively drug resistant tuberculosis was 3.4% (95% CI 0.8-12.6%, I(2)=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%, I(2)=98.7%), and the prevalence of latent infection was 28.1% (95% CI 24.2-32.4%, I(2)=99.5%). There was substantial heterogeneity among published studies.Contacts of tuberculosis patients are a high-risk group for developing tuberculosis, particularly within the first year. Children under 5 years 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.European Respiratory Journal 08/2012; · 6.36 Impact Factor
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ABSTRACT: Contact investigation and management form the key for tuberculosis (TB) control in countries with a low tuberculosis incidence. Oman, with a low TB incidence, has implemented contact investigation and management as one important strategy to control TB. However there is a lack of clear guidelines for the investigation and treatment of contacts, especially with regard to children who are contacts of TB cases. The failure to manage children in contact with infectious TB cases indicates a missed opportunity to prevent TB disease in a population which is prone to progress rapidly to severe and complicated illness. This article attempts to provide a concise and practical approach for managing infants and children who are in contact with TB patients. Essential steps in a variety of possible scenarios are briefly discussed.Sultan Qaboos University medical journal 11/2013; 13(4):477-485.
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ABSTRACT: Childhood multidrug-resistant (MDR) tuberculosis is an emerging disease with increasing numbers being recognized. This review presents recent developments in childhood MDR tuberculosis. New molecular-based diagnostic tests, although not optimal, have reduced the difficulty in confirming the diagnosis of MDR tuberculosis in children. However, the importance of making a diagnosis of probable MDR tuberculosis has been reaffirmed by contact tracing studies showing 80-90% of child contacts of MDR tuberculosis cases who develop disease have MDR tuberculosis themselves. Prevention of MDR tuberculosis in child contacts with appropriate preventive treatment regimens is supported by new observational data and deserves further study. When diagnosed and treated appropriately, outcomes for MDR tuberculosis and even extensively drug-resistant tuberculosis in children are good, despite limited pharmacokinetic data on second-line drugs. Novel anti-tuberculosis drugs and regimens are becoming available and should be studied in children for dose-finding and safety. Recording and reporting of MDR tuberculosis in children are frequently poor, leading to inaccurate estimates of disease burden and suboptimal resource planning. Rapid diagnosis and appropriate treatment results in good outcomes in the majority of children with MDR tuberculosis. Additional research on optimal diagnosis, prevention and treatment of MDR tuberculosis in children remains a high priority.Current Opinion in Infectious Diseases 04/2014; · 4.87 Impact Factor