Eur Respir J. 2012 Aug 30. [Epub ahead of print]
Contact investigation for tuberculosis: a systematic review and meta-analysis.
Source
University of Sydney.
Abstract
Investigation of contacts for patients with tuberculosis is a priority for tuberculosis control in high-income countries, and is increasingly being considered in resource-limited settings. This review was commissioned for a World Health Organization Expert Panel to develop global contact investigation guidelines.We performed a systematic review and meta-analysis of all studies reporting the prevalence of tuberculosis and latent tuberculosis infection, and the annual incidence of tuberculosis among contacts of patients with tuberculosis.After screening 9555 titles, we included 203 published studies. In 95 studies from low and middle-income settings, the prevalence of active tuberculosis in all contacts was 3.1% (95% CI 2.2%-4.4%, I(2)=99.4%), microbiologically proven tuberculosis 1.2% (95% CI 0.9-1.8%, I(2)=95.9%), and latent tuberculosis infection 51.5% (95% CI 47.1-55.8%, I(2)=98.9%). The prevalence of tuberculosis among household contacts was 3.1% (95% CI 2.1-4.5%, I(2)=98.8%) and among contacts of patients with multi-drug resistant or extensively drug resistant tuberculosis was 3.4% (95% CI 0.8-12.6%, I(2)=95.7%). Incidence was greatest in the first year after exposure. In 108 studies from high-income settings, the prevalence of TB among contacts was 1.4% (95% CI 1.1-1.8%, I(2)=98.7%), and the prevalence of latent infection was 28.1% (95% CI 24.2-32.4%, I(2)=99.5%). There was substantial heterogeneity among published studies.Contacts of tuberculosis patients are a high-risk group for developing tuberculosis, particularly within the first year. Children under 5 years and people living with HIV are particularly at risk. Policy recommendations must consider evidence of the cost-effectiveness of various contact tracing strategies, and also incorporate complementary strategies to enhance case finding.
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