학술논문
1-Year Incidence of Tuberculosis Infection and Disease Among Household Contacts of Rifampin- and Multidrug-Resistant Tuberculosis.
Document Type
Article
Author
Krishnan, Sonya; Wu, Xingye; Kim, Soyeon; McIntire, Katie; Naini, Linda; Hughes, Michael D; Dawson, Rodney; Mave, Vidya; Gaikwad, Sanjay; Sanchez, Jorge; Mendoza-Ticona, Alberto; Gonzales, Pedro; Comins, Kyla; Shenje, Justin; Fontain, Sandy Nerette; Omozoarhe, Ayotunde; Mohapi, Lerato; Lalloo, Umesh G; Ferreira, Ana Cristina Garcia; Mugah, Christopher
Source
Subject
*TUBERCULOSIS epidemiology
*TUBERCULOSIS prevention
*HOME environment
*INTERFERON gamma release tests
*HIV infections
*CONFIDENCE intervals
*CROSS-sectional method
*AGE distribution
*TIME
*DISEASE incidence
*REGRESSION analysis
*TREATMENT effectiveness
*DESCRIPTIVE statistics
*RIFAMPIN
TUBERCULOSIS transmission
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Language
ISSN
1058-4838
Abstract
Background Tuberculosis infection (TBI) and TB disease (TBD) incidence remains poorly described following household contact (HHC) rifampin-/multidrug-resistant TB exposure. We sought to characterize TBI and TBD incidence at 1 year in HHCs and to evaluate TB preventive treatment (TPT) use in high-risk groups. Methods We previously conducted a cross-sectional study of HHCs with rifampin-/multidrug-resistant TB in 8 high-burden countries and reassessed TBI (interferon-gamma release assay, HHCs aged ≥5 years) and TBD (HHCs all ages) at 1 year. Incidence was estimated across age and risk groups (<5 years; ≥5 years, diagnosed with human immunodeficiency virus [HIV]; ≥5 years, not diagnosed with HIV/unknown, baseline TBI-positive) by logistic or log-binomial regression fitted using generalized estimating equations. Results Of 1016 HHCs, 850 (83.7%) from 247 households were assessed (median, 51.4 weeks). Among 242 HHCs, 52 tested interferon-gamma release assay–positive, yielding a 1-year 21.6% (95% confidence interval [CI], 16.7–27.4) TBI cumulative incidence. Sixteen of 742 HHCs developed confirmed (n = 5), probable (n = 3), or possible (n = 8) TBD, yielding a 2.3% (95% CI, 1.4–3.8) 1-year cumulative incidence (1.1%; 95% CI,.5–2.2 for confirmed/probable TBD). TBD relative risk was 11.5-fold (95% CI, 1.7–78.7), 10.4-fold (95% CI, 2.4–45.6), and 2.9-fold (95% CI,.5–17.8) higher in age <5 years, diagnosed with HIV, and baseline TBI high-risk groups, respectively, vs the not high-risk group (P =.0015). By 1 year, 4% (21 of 553) of high-risk HHCs had received TPT. Conclusions TBI and TBD incidence continued through 1 year in rifampin-/multidrug-resistant TB HHCs. Low TPT coverage emphasizes the need for evidence-based prevention and scale-up, particularly among high-risk groups. [ABSTRACT FROM AUTHOR]