Well-quantified tuberculosis exposure is a reliable surrogate measure of tuberculosis infection
OBJECTIVE: To develop a standardized, reliable measure of household tuberculosis (TB) exposure that considers child-specific risk factors.
DESIGN: We assessed TB exposure in 536 children. Children were considered Mycobacterium tuberculosis infected if two of three tests of infection were positive. Principal component analysis identified a discrete set of components that collectively described exposure and contributed to a composite contact score. Logistic regression assessed the odds of having M. tuberculosis infection given increasing contact score while controlling for age and past TB treatment.
RESULTS: Four components described 68% of data variance: 1) maternal TB and sleep proximity, 2) index case infectivity, 3) duration of exposure, and 4) exposure to multiple index cases. Components were derived from 10 binary questions that contributed to a contact score (range 1–10, median 5, 25th–75th interquartile range [IQR] 4–7). Among children aged 3 months to 6 years with household exposure, the odds of being M. tuberculosis-infected increased by 74% (OR 1.74, 95%CI 1.42–2.12) with each 1-point increase in the contact score.
CONCLUSIONS: Well-quantified TB exposure is a good surrogate measure of M. tuberculosis infection in child household contacts in a high-burden setting, and could guide targeted preventive treatment in children at highest risk of M. tuberculosis infection.
Keywords: children; contact tracing; latent tuberculosis infection; pediatrics; preventive therapy
Document Type: Research Article
Affiliations: 1: Section on Retrovirology and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA; Center for Global Health, Texas Children's Hospital, Houston, Texas, USA; and Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa 2: Geisinger Clinic, Danville, Pennsylvania, USA 3: Medical Research Council, Cape Town, South Africa 4: Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa 5: Section of Microbiology and Immunology, The Gade Institute, University of Bergen, Bergen, Norway; and Department of Microbiology, Haukeland University Hospital, Bergen, Norway 6: Center for Global Health, Texas Children's Hospital, Houston, Texas, USA
Publication date: 01 August 2012
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