Abstract
BackgroundBeing a contact of a pulmonary tuberculosis (TB) case is a risk factor for active and latent TB. The objective of this study is to determine the contact tracing yield using two different programmatic definitions of close contact in the city of Rio de Janeiro, Brazil.MethodsThis is a retrospective quasi-experimental study. Data were obtained by reviewing the medical records from TB index cases and their close contacts admitted to the Outpatient TB Clinic of the Institute of Thoracic Diseases, University of Rio de Janeiro. From January 2001 to December 2004, a close contact was defined as an individual who shared an enclosed space with a TB index case for a total period of ≥ 100 hours, whereas from January 2005 to December 2008 the definition of close contact was changed to an individual who shared an enclosed space with a TB index case ≥ 4 hours a week. The primary outcome of this study was newly diagnosed pulmonary TB cases and the secondary outcome was the prevalence of latent TB infection (LTBI) among close contacts during both periods.ResultsFrom 2001–2004, 810 close contacts from 257 index cases were evaluated and the prevalence of active TB and LTBI were 2% (16/810) and 62% (496/794), respectively. From 2005–2008, 1,310 close contacts from 369 index cases were identified and the prevalence of active TB and LTBI were 2.7% (35/1,310) and 69% (877/1,275), respectively. There was not a statically significant difference in the detection of active TB (p = 0.3) between the 2 time periods, but the detection of LTBI was significant higher (p = 0.003). The number needed to screen (contacts/new cases) decreased from 50 to 37 and the number need to contact trace (index cases/new cases) decreased from 16 to 10 from 2001–2004 to 2005–2008.ConclusionIn conclusion, the findings of this study suggest that the less conservative definition of TB close contacts (sharing space ≥ 4 h/week) can be a helpful tool for increasing the rate of diagnosis for newly active pulmonary TB cases and for the detection of LTBI among contacts of active pulmonary TB cases.
Highlights
Being a contact of a pulmonary tuberculosis (TB) case is a risk factor for active and latent TB
It is internationally recognized that children under five years of age and persons living with human immunodeficiency virus (PLHIV) who were exposed to infectious cases of tuberculosis (TB) must be evaluated for active TB and considered for treatment of latent TB infection (LTBI) once active TB is excluded [1,2]
In the Outpatient TB Clinic of the Institute of Thoracic Diseases (IDT) of the Federal University of Rio de Janeiro (UFRJ), Brazil, all contacts of TB index cases who shared and enclosed space for ≥ 100 hours in total used to be defined as a close contact and eligible to be investigated for active TB and for LTBI
Summary
Being a contact of a pulmonary tuberculosis (TB) case is a risk factor for active and latent TB. In the Outpatient TB Clinic of the Institute of Thoracic Diseases (IDT) of the Federal University of Rio de Janeiro (UFRJ), Brazil, all contacts of TB index cases who shared and enclosed space for ≥ 100 hours in total used to be defined as a close contact and eligible to be investigated for active TB and for LTBI. In 2005, the TB Clinic of IDT/UFRJ reduced the exposure time for TB contacts from 100 total hours to ≥ 4 hours a week This new definition for “close contacts” was based on the definition utilized by the Tuberculosis Trial Consortium (TBTC) from Center for Diseases Control and Prevention for the Study 26 Protocol (www.clinicaltrials.gov; NCT00164450), a clinical trial of 9 months of daily Isoniazid (INH) versus 12 weeks of weekly Rifapentine/INH for the prevention of TB. The Federal University of Rio de Janeiro (UFRJ) in collaboration with Johns Hopkins University was one of TBTC sites for Study 26 [8]
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