Outcomes of Contact Investigations of Infectious Tuberculosis Patients

Abstract

The objective of this study was to describe outcomes of tuberculosis (TB) contact investigations, factors correlated with those outcomes, and current successes and ways to improve TB contact investigations. We abstracted clinic records of a representative U.S. urban sample of 1,080 pulmonary, sputum-smear(+) TB patients reported to CDC July 1996 through June 1997 and the cohort of their 6,225 close contacts. We found a median of four close contacts per patient. Fewer contacts were identified for homeless patients. A visit to the patient's residence resulted in two additional (especially child) contacts identified. Eighty-eight percent of eligible contacts received tuberculin skin tests (TSTs). Recording the last exposure date to the infectious patient facilitated follow-up TST provision. Thirty-six percent of contacts were TST(+). Household contacts and contacts to highly smear(+) or cavitary TB patients were most likely to be TST(+). Seventy-four percent of TST(+) contacts started treatment for latent TB infection (LTBI), of whom 56% completed. Sites using public health nurses (PHNs) started more high-risk TST(-) contacts on presumptive treatment for LTBI. Using directly observed treatment (DOT) increased the likelihood of treatment completion. We documented outcomes of contact investigation efforts by urban TB programs. We identified several successful practices, as well as suggestions for improvements, that will help TB programs target policies and procedures to enhance contact investigation effectiveness.

O controle de comunicantes de tuberculose no programa de controle da tuberculose em um município de médio porte da Região Sudeste do Brasil, em 2002

“…(10) The result of an investigation of contacts of patients with tuberculosis in public health clinics in the USA demonstrated, on average, four close contacts per patient, of whom 2% had active tuberculosis, and the contact was more frequent among individuals in the same household and children under six years of age. (11) In the present study, we found that the contacts were predominantly adults, which agrees with the literature showing that tuberculosis principally affects people between 15 and 59 years of age. (1) The combination of the age of the cases with the production of infection in the group is due both to the greater number of contacts and to the greater risk of infection of the latter, together with the age of the source.…”

Risk for Tuberculosis Disease Among Contacts with Prior Positive Tuberculin Skin Test: A retrospective Cohort Study, New York City

“…4,5 However, contacts identified during a contact investigation may also have a history of a prior positive tuberculin skin test (TST) result; one study found that 10 % of contacts had a prior positive TST. 6 Until recently, the risk for such individuals to develop active TB disease was unknown, 7 and guidelines do not make specific treatment recommendations for contacts with a prior positive TST, except to state that decisions to treat must be individualized. 1 The challenge of evaluating contacts with a prior positive TST result is of particular concern to health departments that serve communities with substantial foreign-born populations, such New York City (NYC).…”

Risk of tuberculosis among contacts in a low-incidence setting: Table 1–

“…This low proportion (9.5%) is in stark contrast to the USA where, mainly as a result of policy directives in line with the goal of TB elimination in the USA [6], 74-79% of patients diagnosed with LTBI commence treatment [7,8]. In our cohort of contacts, low treatment rates for LTBI appeared to be mainly a consequence of physicians' reluctance to offer LTBI treatment rather than low patient uptake of treatment.…”

“…Diverse chemical and biological substances, including autologous blood [2], talc [3,4], fibrin [5] and antibiotics [6], have demonstrated various efficiencies to treat PAL. Recently, an endobronchial valve (EBV) was successfully utilised to treat PAL [7][8][9]. Targeting the lung lobe or segment with an air leak is a prerequisite for stopping PAL using EBV.…”