Chest
Original Research: Chest InfectionsRisk of Active Tuberculosis in the Five Years Following Infection . . . 15%?
Section snippets
Materials and Methods
The full methods are described in e-Appendix 1 and are summarized as follows.
Results
Of the 15,094 contacts identified over the study period, 613 met the study criteria for infection at the time of exposure, and the characteristics of these cases are presented in Table 2. Results differed markedly according to age, with 29 of 81 (35.8%) aged < 5 years, 27 of 136 (17.4%) aged 5 to 14 years, and 11 of 396 (2.8%) aged ≥ 15 years developing TB. Of the 67 cases of active TB, 64 met the full case definition,18 and three were classified as presumptive cases; all cases were treated
Discussion
We estimated the 4½-year risk of active TB following an index infection at 14.5% by using a realistic reconstruction of a true survival analysis of contacts who could confidently determine that they had been infected at the time of their exposure. Moreover, even with less specific definitions for infection at time of exposure, our point estimates of risk remained > 11%. These values are considerably higher than the widely accepted estimates of 5% to 10% lifetime risk, with one-half occurring
Conclusions
The 5-year risk of active TB after infection was estimated at 11% to 18%, and this value is more likely to be an underestimate than an overestimate. Although this value is approximately twofold to sevenfold the traditionally accepted rate, our estimates are consistent with much of the previous research. Because the risk of developing active TB is likely to be higher in developing countries,3 as well as in populations with a high prevalence of comorbidities, even higher levels of risk may be
Acknowledgments
Author contributions: J. M. T. affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. J. M. T. conceived the study, developed the analysis approach, performed the analysis, and drafted the manuscript. N. M. and E.-L. T. compiled the broader database from which the subjects were
References (44)
- et al.
The development of clinical tuberculosis following infection with tubercle bacilli. 1. A theoretical model for the development of clinical tuberculosis following infection, linking from data on the risk of tuberculous infection and the incidence of clinical tuberculosis in the Netherlands
Tubercle
(1982) - et al.
Latent Mycobacterium tuberculosis infection
N Engl J Med
(2015) - et al.
The growing burden of tuberculosis: global trends and interactions with the HIV epidemic
Arch Intern Med
(2003) - et al.
Contact investigation for tuberculosis: a systematic review and meta-analysis
Eur Respir J
(2013) Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement
Am J Respir Crit Care Med
(2000)- et al.
Data needs for evidence-based decisions: a tuberculosis modeler's ‘wish list.'
Int J Tuberc Lung Dis
(2013) - et al.
Short-course rifampin and pyrazinamide compared with isoniazid for latent tuberculosis infection: a cost-effectiveness analysis based on a multicenter clinical trial
Clin Infect Dis
(2004) - et al.
Monitored isoniazid prophylaxis for low-risk tuberculin reactors older than 35 years of age: a risk-benefit and cost-effectiveness analysis
Ann Intern Med
(1997) - Centers for Disease Control and Prevention. Tuberculosis (TB) fact sheets: the difference between latent TB infection...
- World Health Organization. Latent tuberculosis infection (LTBI). http://www.who.int/tb/challenges/ltbi/en/. Accessed...
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
BMJ
Isoniazid for preventing tuberculosis in non-HIV infected persons
Cochrane Database Syst Rev
Isoniazid prophylaxis among Alaskan Eskimos: a final report of the Bethel isoniazid studies
Am Rev Respir Dis
Evaluation of tuberculin skin testing in tuberculosis contacts in Victoria, Australia 2005-2013
Public Health Action
Evaluation of investigations conducted to detect and prevent transmission of tuberculosis
JAMA
Interpretation of repeated tuberculin tests. Boosting, conversion, and reversion
Am J Respir Crit Care Med
Efficacy of various durations of isoniazid preventive therapy for tuberculosis: five years of follow-up in the IUAT trial. International Union Against Tuberculosis Committee on Prophylaxis
Bull World Health Organization
How much isoniazid is needed for prevention of tuberculosis among immunocompetent adults?
Int J Tuberc Lung Dis
Adverse effects of isoniazid preventative therapy for latent tuberculosis infection: a prospective cohort study
Drug Healthc Patient Saf
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2022, Lancet Regional Health - AmericasCitation Excerpt :These findings are of great concern because the greatest focus of screening and tracing of TB contacts should be placed on children during their first 5 years of life, as this is a period of high risk of progression from TBI to active disease. Indeed, the risk of TB incidence among exposed infants and children is very high, reaching 20% within 2 years of exposure.7,8 Many previous studies have described the investigation of contacts in children and adults for TBI and TPT,8,19,22,23 however we have previously demonstrated that the use of the TBI cascade of care can provide a greater depth of understanding of the dynamics of TBI care and follow-up of contacts of TB index cases.12,13,17
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FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.