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. 2020 Apr 10;70(8):1562-1572.
doi: 10.1093/cid/ciz438.

Risk Factors for Tuberculosis and Effect of Preventive Therapy Among Close Contacts of Persons With Infectious Tuberculosis

Mary R Reichler  1 , Awal Khan  1 , Timothy R Sterling  2 , Hui Zhao  1 , Bin Chen  1 , Yan Yuan  1 , Joyce Moran  3 , James McAuley  4 , Bonita Mangura  5 ; Tuberculosis Epidemiologic Studies Consortium Task Order 2 Team
Collaborators, Affiliations

Risk Factors for Tuberculosis and Effect of Preventive Therapy Among Close Contacts of Persons With Infectious Tuberculosis

Mary R Reichler et al. Clin Infect Dis. .

Abstract

Background: Close contacts of persons with pulmonary tuberculosis (TB) have high rates of TB disease.

Methods: We prospectively enrolled TB patients and their close contacts at 9 US/Canadian sites. TB patients and contacts were interviewed to identify index patient, contact, and exposure risk factors for TB. Contacts were evaluated for latent TB infection (LTBI) and TB, and the effectiveness of LTBI treatment for preventing contact TB was examined.

Results: Among 4490 close contacts, multivariable risk factors for TB were age ≤5 years, US/Canadian birth, human immunodeficiency virus infection, skin test induration ≥10 mm, shared bedroom with an index patient, exposure to more than 1 index patient, and index patient weight loss (P < .05 for each). Of 1406 skin test-positive contacts, TB developed in 49 (9.8%) of 446 who did not initiate treatment, 8 (1.8%) of 443 who received partial treatment, and 1 (0.2%) of 517 who completed treatment (1951, 290, and 31 cases/100 000 person-years, respectively; P < .001). TB was diagnosed in 4.2% of US/Canadian-born compared with 2.3% of foreign-born contacts (P = .002), and TB rates for US/Canadian-born and foreign-born contacts who did not initiate treatment were 3592 and 811 per 100 000 person-years, respectively (P < .001).

Conclusions: Treatment for LTBI was highly effective in preventing TB among close contacts of infectious TB patients. Several index patient, contact, and exposure characteristics associated with increased risk of contact TB were identified. These findings help inform contact investigation, LTBI treatment, and other public health prevention efforts.

Keywords: contact investigation; contacts; preventive therapy; risk factors; tuberculosis.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Disease-free survival for 4490 contacts (158 with and 4332 without tuberculosis), by birthplace (United States/Canada shown in red, other countries shown in blue).
See this image and copyright information in PMC

References

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