Identifying children with tuberculosis among household contacts in The Gambia
OBJECTIVES: To identify co-prevalent tuberculosis (TB) among child contacts of adults with smear-positive TB.
DESIGN: Child contacts aged <15 years in the immediate household and compound were prospectively enrolled and evaluated for TB disease using screening questionnaires and the tuberculin skin test (TST). Symptomatic and/or TST-positive (10 mm) contacts were further investigated.
RESULTS: Of 4042 child contacts who underwent symptom screening and TST, 3339 (82.6%) were diagnosed as TB-exposed but not infected, 639 (15.8%) were latently infected and 64 (1.6%) had co-prevalent TB. Of the 64 TB cases, 50 (78.1%) were from within the immediate household of the index case, and 14 (21.9%) from within the same compound. Of the 27 asymptomatic but TST-positive children diagnosed with TB, 7 were microbiologically confirmed. The median age of the TB cases was 4.4 years (interquartile range 1.9–6.9); 53.1% were aged <5 years. Of the 4042 child contacts, 206 (5%) slept in the same bed as the index case; 28.1% of all TB cases occurred in this group. Symptom screening alone would have detected only 57.8% of the co-prevalent cases.
CONCLUSION: In our community setting, if contact tracing is restricted to symptom screening and immediate households only, nearly half of all co-prevalent TB disease in child contacts would be missed.
Keywords: contact tracing; prevalence; tuberculin skin test
Document Type: Research Article
Affiliations: 1: Vaccines and Immunity Theme, Medical Research Council (MRC) Unit–The Gambia, Banjul, The Gambia; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada 2: Vaccines and Immunity Theme, Medical Research Council (MRC) Unit–The Gambia, Banjul, The Gambia 3: Center for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, German Center for Infection Research, Munich Partner Site, Munich, Germany 4: Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand 5: Vaccines and Immunity Theme, Medical Research Council (MRC) Unit–The Gambia, Banjul, The Gambia; Centre for International Child Health, Academic Department of Paediatrics, St Mary's Campus, Imperial College London, London, UK
Publication date: 01 January 2017
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