Early and late tuberculosis risks among close contacts in Hong Kong

Abstract

Setting: Tuberculosis (TB) notification is a statutory requirement in Hong Kong, where contact investigations are performed by the Tuberculosis and Chest Service.

Objectives: 1) To evaluate the risk of active TB in close contacts within 5 years, and 2) to identify risk factors associated with early and late development of active TB disease.

Design: The characteristics of consecutive TB cases notified from 18 January to 17 April 2000 were collected together with those of their contacts. Contacts were prospectively followed up through the territory-wide TB notification registry for 5 years for the development of disease.

Results: A total of 1537 index cases and 4661 close contacts were analysed. Screening found 31 (0.67%) active TB cases within a 3-month period, and another 58 (1.24%) cases presented subsequently. Index cases with cough or pulmonary cavities and diabetic contacts were independent risk factors of early cases (all P<0.05). Adjusted at risk index characteristics for late TB development included positive sputum smear (2.79, 95%CI 1.31-5.95) and family history of TB (4.26, 95%CI 2.01-9.03). Contact risk factors included diabetes mellitus (3.44, 95%CI 1.04-11.33) and institutionalisation (3.61, 95%CI 1.70-7.65).

Conclusion: Considerable TB risk remains after initial contact screening. A number of possible risk factors were identified.