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Free Content Yield of contact tracing from pediatric tuberculosis index cases in Gaborone, Botswana

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SETTING: Contact tracing using pediatric index cases has not been adequately investigated in high tuberculosis (TB) and human immunodeficiency virus (HIV) prevalence settings.

OBJECTIVE: To determine the yield of contact tracing in household contacts of pediatric TB index cases in Botswana.

DESIGN: Index cases included all pediatric (age ≤13 years) TB admissions from January 2009 to December 2011 to Botswana's largest referral hospital. A contact tracing team identified cases, conducted home visits, symptom-screened contacts and referred those with ≥1 TB symptoms. The primary outcome was newly diagnosed TB in a contact.

RESULTS: From 163 pediatric index cases, 548 contacts were screened (median 3 contacts/case, interquartile range [IQR] 2–4). Of these, 49 (9%) were referred for positive symptoms on screening and 27/49 (55%) were evaluated for active TB. Twelve new TB cases were diagnosed (12/548, 2.2%); the median age was 31 years (IQR 23–38); 11 (92%) were smear-positive. Ten (83%) had known HIV status: 7 (70%) were HIV-positive. To find one new TB case, the number needed to contact trace (index cases/new cases) was 13.6, and the number needed to screen (contacts/new cases) was 46.

CONCLUSION: This yield of contact tracing using pediatric index cases is similar to the traditional adult index case approach. Improving the proportion of symptomatic contacts evaluated may increase yield.
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Keywords: TB case detection; TB screening

Document Type: Research Article

Affiliations: 1: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Doris Duke Clinical Research Fellowship Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA 2: Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA 3: Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA 4: Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA 5: Faculty of Health Sciences, University of Botswana, Gaborone, Botswana 6: Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Faculty of Health Sciences, University of Botswana, Gaborone, Botswana 7: Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA; and McMaster University, Hamilton, Ontario, Canada 8: National TB Program, Botswana Ministry of Health, Gaborone, Botswana 9: Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics & Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, USA

Publication date: August 1, 2013

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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