TY - JOUR
T1 - Contact investigation for active tuberculosis among child contacts in Uganda
AU - Jaganath, Devan
AU - Zalwango, Sarah
AU - Okware, Brenda
AU - Nsereko, Mary
AU - Kisingo, Hussein
AU - Malone, La Shaunda
AU - Lancioni, Christina
AU - Okwera, Alphonse
AU - Joloba, Moses
AU - Mayanja-Kizza, Harriet
AU - Boom, W. Henry
AU - Stein, Catherine
AU - Mupere, Ezekiel
N1 - Funding Information:
Financial support. This work was supported by the National Institutes of Health (NIH) Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Eye Institute, National Heart, Blood, and Lung Institute, National Institute of Dental and Craniofacial Research, National Institute on Drug Abuse, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases (NIAID), and NIH Office of Women’s Health and Research through the Fogarty International Clinical Research Scholars and Fellows Program at Vanderbilt University (R24 TW007988), and the American Relief and Recovery Act. The Kawempe Community Health Study is funded by the Tuberculosis Research Unit, established with federal funds from the NIAID and the NIH (contract numbers N01-AI95383, HHSN266200700022C/ N01-AI70022, and AI32414). Potential conflicts of interest. All authors: No reported conflicts.
PY - 2013/12
Y1 - 2013/12
N2 - Background. Tuberculosis is a large source of morbidity and mortality among children. However, limited studies characterize childhood tuberculosis disease, and contact investigation is rarely implemented in high-burden settings. In one of the largest pediatric tuberculosis contact investigation studies in a resource-limited setting, we assessed the yield of contact tracing on childhood tuberculosis and indicators for disease progression in Uganda.Methods. Child contacts aged <15 years in Kampala, Uganda, were enrolled from July 2002 to June 2009 and evaluated for tuberculosis disease via clinical, radiographic, and laboratory methods for up to 24 months.Results. Seven hundred sixty-one child contacts were included in the analysis. Prevalence of tuberculosis in our child population was 10%, of which 71% were culture-confirmed positive. There were no cases of disseminated tuberculosis, and 483 of 490 children (99%) started on isoniazid preventative therapy did not develop disease. Multivariable testing suggested risk factors including human immunodeficiency virus (HIV) status (odds ratio [OR], 7.90; P <. 001), and baseline positive tuberculin skin test (OR, 2.21; P =. 03); BCG vaccination was particularly protective, especially among children aged ≤5 years (OR, 0.23; P <. 001). Adult index characteristics such as sex, HIV status, and extent or severity of disease were not associated with childhood disease.Conclusions. Contact tracing for children in high-burden settings is able to identify a large percentage of culture-confirmed positive tuberculosis cases before dissemination of disease, while suggesting factors for disease progression to identify who may benefit from targeted screening.
AB - Background. Tuberculosis is a large source of morbidity and mortality among children. However, limited studies characterize childhood tuberculosis disease, and contact investigation is rarely implemented in high-burden settings. In one of the largest pediatric tuberculosis contact investigation studies in a resource-limited setting, we assessed the yield of contact tracing on childhood tuberculosis and indicators for disease progression in Uganda.Methods. Child contacts aged <15 years in Kampala, Uganda, were enrolled from July 2002 to June 2009 and evaluated for tuberculosis disease via clinical, radiographic, and laboratory methods for up to 24 months.Results. Seven hundred sixty-one child contacts were included in the analysis. Prevalence of tuberculosis in our child population was 10%, of which 71% were culture-confirmed positive. There were no cases of disseminated tuberculosis, and 483 of 490 children (99%) started on isoniazid preventative therapy did not develop disease. Multivariable testing suggested risk factors including human immunodeficiency virus (HIV) status (odds ratio [OR], 7.90; P <. 001), and baseline positive tuberculin skin test (OR, 2.21; P =. 03); BCG vaccination was particularly protective, especially among children aged ≤5 years (OR, 0.23; P <. 001). Adult index characteristics such as sex, HIV status, and extent or severity of disease were not associated with childhood disease.Conclusions. Contact tracing for children in high-burden settings is able to identify a large percentage of culture-confirmed positive tuberculosis cases before dissemination of disease, while suggesting factors for disease progression to identify who may benefit from targeted screening.
KW - child
KW - contact tracing
KW - pediatric
KW - risk factors
KW - tuberculosis
UR - http://www.scopus.com/inward/record.url?scp=84890066349&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84890066349&partnerID=8YFLogxK
U2 - 10.1093/cid/cit645
DO - 10.1093/cid/cit645
M3 - Article
C2 - 24077055
AN - SCOPUS:84890066349
SN - 1058-4838
VL - 57
SP - 1685
EP - 1692
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 12
ER -