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Meta-Analysis
. 2014 Feb;58(3):381-91.
doi: 10.1093/cid/cit643. Epub 2013 Sep 24.

Yield of contact investigations in households of patients with drug-resistant tuberculosis: systematic review and meta-analysis

N Sarita Shah  1 , Courtney M Yuen, Moonseong Heo, Arielle W Tolman, Mercedes C Becerra
Affiliations
Meta-Analysis

Yield of contact investigations in households of patients with drug-resistant tuberculosis: systematic review and meta-analysis

N Sarita Shah et al. Clin Infect Dis. 2014 Feb.

Abstract

Contact investigations among individuals living with drug-susceptible tuberculosis patients (source cases) have shown a high yield of tuberculosis disease and latent tuberculosis, but the yield of such investigations in households of drug-resistant tuberculosis source cases is unknown. In this systematic review and meta-analysis, we found 25 studies that evaluated a median of 111 (interquartile range, 21-302) household contacts of drug-resistant tuberculosis source cases. The pooled yield was 7.8% (95% CI, 5.6%-10.0%) for active tuberculosis and 47.2% (95% CI, 30.0%-61.4%) for latent tuberculosis, although there was significant statistical heterogeneity (P < .0001). More than 50% of secondary cases with drug susceptibility test results were concordant with those of the source case. Among studies that followed household members, the majority of secondary cases were detected within 1 year of the source case's diagnosis. Household contact investigation around drug-resistant tuberculosis patients is a high-yield intervention for detection of drug-resistant tuberculosis and prevention of ongoing transmission.

Keywords: contact; drug resistance; transmission; tuberculosis.

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Figures

Figure 1.
Figure 1.
Flow diagram for study selection. Abbreviations: DR, drug-resistant; WHO, World Health Organization.
Figure 2.
Figure 2.
Forest plot for secondary cases of active tuberculosis among household contacts of drug-resistant tuberculosis source cases. Abbreviations: CDC, Centers for Disease Control and Prevention; CI, confidence interval; TB, tuberculosis; Wt, weight.
Figure 3.
Figure 3.
Forest plot for secondary cases of latent tuberculosis infection among household contacts of drug-resistant tuberculosis source cases. Abbreviations: CDC, Centers for Disease Control and Prevention; CI, confidence interval; LTBI, latent tuberculosis; Wt, weight.
Figure 4.
Figure 4.
Yield for active tuberculosis disease over time among household contacts of drug-resistant tuberculosis source cases.
See this image and copyright information in PMC

Comment in

  • Reply to Hong-min et al.
    Shah NS, Yuen CM, Heo M, Tolman AW, Becerra MC. Shah NS, et al. Clin Infect Dis. 2016 Jan 15;62(2):267-8. doi: 10.1093/cid/civ834. Epub 2015 Sep 23. Clin Infect Dis. 2016. PMID: 26400992 Free PMC article. No abstract available.
  • Drug-resistant Tuberculosis and the Prevention of Ongoing Transmission.
    Hong-Min W, Xiao-Hong Z, Jing W. Hong-Min W, et al. Clin Infect Dis. 2016 Jan 15;62(2):266-7. doi: 10.1093/cid/civ832. Epub 2015 Sep 23. Clin Infect Dis. 2016. PMID: 26400994 No abstract available.

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