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Home / The International Journal of Tuberculosis and Lung Disease, Volume 15, Number 9

Household contact investigation of multidrug-resistant and extensively drug-resistant tuberculosis in a high HIV prevalence setting

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SETTING: Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are now a nationwide epidemic in South Africa. Epidemiological data suggest nosocomial transmission as the primary route of spread; however, transmission among household contacts has not yet been investigated.

OBJECTIVE: To determine the incidence rates of MDR- and XDR-TB among household contacts of MDR- and XDR-TB index cases diagnosed between January 2005 and September 2008 in a high human immunodeficiency virus prevalence setting.

DESIGN: Prospective, observational study evaluating adult household contacts for active TB by culture and drug susceptibility testing at index case diagnosis and again 1 year later. Outcomes were incidence and time to diagnosis of MDR- and XDR-TB.

RESULTS: A total of 1766 contacts of 221 MDR-TB and 287 XDR-TB index cases were screened. Of 793 contacts of MDR-TB index cases, 14 (1.8%) were diagnosed with MDR-TB (incidence 1765/100 000); 19 (2.0%) of 973 XDR-TB contacts had XDR-TB (incidence 1952/100 000). Median time to diagnosis of household cases was 70 days (interquartile range 57–89).

CONCLUSION: Incidence rates of MDR- and XDR-TB among household contacts were extremely high, with most secondary cases occurring shortly after the diagnosis of the index case. Active case finding of drug-resistant TB is a high-yield public health activity and must be a priority, as early diagnosis may stem further disease spread and improve survival.

Keywords: South Africa; drug resistance; household contacts; transmission; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Italian Cooperation, Pietermaritzburg, KwaZulu-Natal, South Africa 2: Italian Cooperation, Rome, Italy 3: Instituto Superiore di Sanita, Rome, Italy 4: Italian Cooperation, Pietermaritzburg, KwaZulu-Natal, South Africa; Instituto Superiore di Sanita, Rome, Italy; Philanjalo, Tugela Ferry, KwaZulu-Natal, South Africa 5: Philanjalo, Tugela Ferry, KwaZulu-Natal, South Africa 6: Umzinyathi Department of Health, Dundee, KwaZulu-Natal, South Africa 7: KwaZulu-Natal Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa 8: Departments of Internal Medicine, and Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA 9: Divisions of General Internal Medicine, Infectious Diseases, and Epidemiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA

Publication date: 01 September 2011

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

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