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. 2011 Jun 1:11:156.
doi: 10.1186/1471-2334-11-156.

Force of tuberculosis infection among adolescents in a high HIV and TB prevalence community: a cross-sectional observation study

Keren Middelkoop  1 , Linda-Gail Bekker, Hua Liang, Lisa D H Aquino, Elaine Sebastian, Landon Myer, Robin Wood
Affiliations

Force of tuberculosis infection among adolescents in a high HIV and TB prevalence community: a cross-sectional observation study

Keren Middelkoop et al. BMC Infect Dis. .

Abstract

Background: Understanding of the transmission dynamics of tuberculosis (TB) in high TB and HIV prevalent settings is required in order to develop effective intervention strategies for TB control. However, there are little data assessing incidence of TB infection in adolescents in these settings.

Methods: We performed a tuberculin skin test (TST) and HIV survey among secondary school learners in a high HIV and TB prevalence community. TST responses to purified protein derivative RT23 were read after 3 days. HIV-infection was assessed using Orasure® collection device and ELISA testing. The results of the HIV-uninfected participants were combined with those from previous surveys among primary school learners in the same community, and force of TB infection was calculated by age.

Results: The age of 820 secondary school participants ranged from 13 to 22 years. 159 participants had participated in the primary school surveys. At a 10 mm cut-off, prevalence of TB infection among HIV-uninfected and first time participants, was 54% (n = 334/620). HIV prevalence was 5% (n = 40/816). HIV infection was not significantly associated with TST positivity (p = 0.07). In the combined survey dataset, TB prevalence was 45% (n = 645/1451), and was associated with increasing age and male gender. Force of infection increased with age, from 3% to 7.3% in adolescents ≥ 20 years of age.

Conclusions: We show a high force of infection among adolescents, positively associated with increasing age. We postulate this is due to increased social contact with infectious TB cases. Control of the TB epidemic in this setting will require reducing the force of infection.

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Figures

Figure 1
Figure 1
Consort Diagram for Secondary School Cohort. * including the 3 participants who declined HIV testing
Figure 2
Figure 2
Frequency distribution of TST reactions (>0 mm) in HIV-uninfected participants in secondary school survey.
Figure 3
Figure 3
TB prevalence in combined dataset, by age (in years). Note: This figure is based on the unadjusted data presented in Table 3.
See this image and copyright information in PMC

References

    1. World Health Organization. Global tuberculosis control: surveillance, planning, financing. 2009. http://www.who.int/tb/publications/global_report/2009/en/index.html Accessed 02 October 2010.
    1. Middelkoop K, Bekker LG, Myer L, Dawson R, Wood R. Rates of tuberculosis transmission to children and adolescents in a community with a high prevalence of HIV infection among adults. Clin Infect Dis. 2008;47:349–355. doi: 10.1086/589750. - DOI - PMC - PubMed
    1. Shanaube K, Sismanidis C, Ayles H, Beyers N, Schaap A, Lawrence KA, Barker A, Godfrey-Faussett P. Annual risk of tuberculous infection using different methods in communities with a high prevalence of TB and HIV in Zambia and South Africa. PLoS One. 2009;4:e7749. doi: 10.1371/journal.pone.0007749. - DOI - PMC - PubMed
    1. Odhiambo JA, Borgdorff MW, Kiambih FM, Kibuga DK, Kwamanga DO, Ng'ang'a L, Agwanda R, Kalisvaart NA, Misljenovic O, Nagelkerke NJ, Bosman M. Tuberculosis and the HIV epidemic: increasing annual risk of tuberculous infection in Kenya, 1986-1996. Am J Public Health. 1999;89:1078–1082. doi: 10.2105/AJPH.89.7.1078. - DOI - PMC - PubMed
    1. Egwaga SM, Cobelens FG, Muwinge H, Verhage C, Kalisvaart N, Borgdorff MW. The impact of the HIV epidemic on tuberculosis transmission in Tanzania. AIDS. 2006;20:915–921. doi: 10.1097/01.aids.0000218557.44284.83. - DOI - PubMed

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