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. 2013 Dec;57(12):1685-92.
doi: 10.1093/cid/cit645. Epub 2013 Sep 27.

Contact investigation for active tuberculosis among child contacts in Uganda

Devan Jaganath  1 , Sarah Zalwango, Brenda Okware, Mary Nsereko, Hussein Kisingo, LaShaunda Malone, Christina Lancioni, Alphonse Okwera, Moses Joloba, Harriet Mayanja-Kizza, W Henry Boom, Catherine Stein, Ezekiel Mupere; Tuberculosis Research Unit
Affiliations

Contact investigation for active tuberculosis among child contacts in Uganda

Devan Jaganath et al. Clin Infect Dis. 2013 Dec.

Abstract

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.

Keywords: child; contact tracing; pediatric; risk factors; tuberculosis.

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Figures

Figure 1.
Figure 1.
Cumulative incidence of childhood tuberculosis (TB) in the 24 months after enrollment.
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