Tuberculosis preventive treatment should be considered for all household contacts of pulmonary tuberculosis patients in India

Paradkar, Mandar; Padmapriyadarsini, Chandrasekaran; Jain, Deepali; Shivakumar, Shri Vijay Bala Yogendra; Thiruvengadam, Kannan; Gupte, Akshay; Thomas, Beena; Kinikar, Aarti; Sekar, Krithika; Bharadwaj, Renu; Dolla, Chandrakumar; Gaikwad, Sanjay; Selladurai, Elilarasi; Lokhande, Rahul; Reddy, Devarajulu; Murali, Lakshmi; Kulkarni, Vandana; Pradhan, Neeta; Hanna, Luke Elizabeth; Sathyamurthi, Pattabiraman; Kohli, Rewa; Rani, Sudha; Suryavanshi, Nishi; Shrinivasa, BM; Cox, Samyra R.; Selvaraju, Sriram; Gupte, Nikhil; Mave, Vidya; Gupta, Amita; Bollinger, Robert C.

doi:10.1371/journal.pone.0236743

Cited by 23 publications

(26 citation statements)

References 38 publications

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“…Independent of reported TB exposure, children with Mtb-sir-nodis were nearly four times more likely to develop incident TB than peers without Mtb-sir-nodis. In contrast, recent evidence from a primarily adult cohort found no association between Mtb-sir-nodis and incident TB [ 34 ], likely reflecting the increased risk of recent infection in children. Although not required for initiation of TPT, the WHO guidelines support the use of the TST and IGRA in children living in low- and middle-income countries [ 35 ].…”

Section: Discussionmentioning

confidence: 86%

Tuberculosis prevention in children: a prospective community-based study in South Africa

et al. 2020

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Tuberculosis preventive therapy reduces tuberculosis risk in children. However, the effectiveness of tuberculosis preventive therapy in children living in high burden settings is unclear.In a prospective observational community-based cohort study in Cape Town, South Africa, we assessed the effectiveness of routine tuberculosis preventive therapy in children ≤15 years of age in a tuberculosis and HIV high-prevalence setting.Among 966 children (median age 5.07 years; inter-quartile range [IQR] 2.52,8.72), 676 (70%) reported exposure to an adult with tuberculosis in the past 3 months and 240/326 (74%) of eligible children initiated isoniazid preventive therapy (IPT) under programmatic guidelines. Prevalent (n=73) and incident (n=27) tuberculosis were diagnosed among 100/966 (10%) of children. Children who initiated IPT were 82% less likely to develop incident tuberculosis than children who did not (aOR=0.18; 95% confidence-interval [CI] 0.06,0.52; p=0.0014). Children's risk of incident tuberculosis increased if they were younger than 5 years, living with HIV, had a positive M.tuberculosis specific immune response, or recent tuberculosis exposure. The risk of incident tuberculosis was not associated with gender or M. bovis-BCG vaccination status. Number needed to treat (NNT) was lowest in children living with HIV (NNT=15) and children less than 5 years of age (NNT=19) compared to children of all ages (NNT=82).In communities with high tuberculosis prevalence, tuberculosis preventive therapy substantially reduces the risk of tuberculosis among children who are younger than 5 years or living with HIV, especially those with recent tuberculosis exposure or a positive M.tuberculosis specific immune response in the absence of disease (Mtb-sir-nodis).

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Section: Discussionmentioning

confidence: 86%

Tuberculosis prevention in children: a prospective community-based study in South Africa

et al. 2020

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“…As estimated for child household contacts globally or in the WHO Southeast Asia region, future modeling studies could build on this work by estimating the impact of reaching household contacts of all ages in averting TB disease and death and the associated cost [ 22 , 33 ]. Household contact investigation studies continue to show the benefit of TPT among household contacts of all ages, including the recent study by Paradkar et al reporting that 2% of household contacts at study sites in India developed TB in the first 24 months of follow-up [34] . The feasibility of scaling up household contact investigation to reach this larger population remains a concern, particularly in light of the negative impact of the COVID-19 pandemic on essential TB services globally [35] .…”

Section: Discussionmentioning

confidence: 99%

Estimating the population at high risk for tuberculosis through household exposure in high-incidence countries: a model-based analysis

Ross¹,

Xie²,

Wang³

et al. 2021

eClinicalMedicine

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Background Household contacts of people with pulmonary tuberculosis (TB) have greater risk of developing TB. Recent guidelines conditionally recommended TB preventive treatment (TPT) for household contacts of any age living in TB high-incidence countries, expanding earlier guidance to provide TPT to household contacts under five. The all-age population of household contacts has not been estimated. Methods Our model-based estimation included 20 countries with >80% of incident TB globally in 2019. We developed country-specific distributions of household composition by age and sex using bootstrap resampling from health surveys and census data. We incorporated age-, sex-, year-, and location-specific estimates of pulmonary TB incidence from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 to estimate the population in each country sharing a household with someone with incident pulmonary TB, and quantified uncertainty using a Monte Carlo approach. Findings We estimate that 38 million [95% uncertainty interval (UI) 33- 43 million] individuals lived in a household with someone with incident pulmonary TB in 2019 in these 20 countries. Children under five made up 12% of the population with household exposure, while adults were 65%. Zimbabwe, Mozambique, Zambia, and Pakistan had the highest proportion of the population with household exposure, while India had the highest number of contacts (11·4 million, 95% UI 9·7-13·4 million). Interpretation Expanding TPT evaluation to household contacts of all ages in high-incidence countries could include a population more than 7-times larger than the under-5 contacts previously prioritized. This would substantially increase the impact of household contact investigation on reducing TB morbidity and mortality. Funding JMR is supported by the National Institute of Allergy and Infectious Diseases (K01 AI138620). This research was funded in part by a 2020 developmental grant from the University of Washington / Fred Hutch Center for AIDS Research, an NIH funded program under award number AI027757 which is supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, NIDDK. This work was funded in part by the National Science Foundation (DMS-1839116).

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“…The copyright holder for this this version posted December 11, 2021. ; https://doi.org/10.1101/2021.12.09.21267540 doi: medRxiv preprint with the risk of incident TB [20]. The adjusted incidence rate ratio (aIRR) of undernutrition was 6.16 (95% CI: 1.89, 20.03) measured as a composite index of low BMI (< 18.5 kg/m 2 ) in adults, and less than two z-scores of weight or BMI for age in children [20].…”

Section: Physiological Condition Undernutritionmentioning

confidence: 99%

Attributable is Preventable: Corrected and revised estimates of population attributable fraction of TB related to undernutrition in 30 high TB burden countries

Bhargava

Beneditti

et al. 2021

Preprint

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IntroductionThe Global TB Report 2020 estimated the population attributable fractions (PAF) for the major risk factors of TB. Undernourishment emerged as the leading risk factor accounting for 19% of the cases. The WHO however used the terms undernourishment and undernutrition interchangeably in its computation of PAF. Undernourishment is an indirect model derived estimate of decreased per capita energy availability, while undernutrition is defined by direct anthropometric measurements of nutritional status.MethodsWe re-estimated the PAF of undernutrition (instead of undernourishment) in 30 high TB burden countries, using the prevalence of undernutrition (age standardized estimate of BMI < 18.5 kg/m2 in adults for both sexes), and the relative risk (RR) of 3.2. Further, we revised PAF estimates of undernutrition with an RR of 4.49, in light of recent evidence.FindingsTwenty four percent of TB in high burden countries is attributable to undernutrition. The PAF of undernutrition was highest in Asian countries, unlike the PAF of undernourishment that was highest in Africa. The corrected estimate led up to 65% increase in number of cases attributable to undernutrition in Asian countries. More than one-third to nearly half of TB cases in India could be attributable to undernutrition.InterpretationEstimation of the PAF of TB related to undernutrition is methodologically valid and operationally relevant, rather than PAF related to undernourishment. Addressing undernutrition, the leading driver of TB in high TB burden countries (especially Asia) could enable achievement of END TB milestones of TB incidence for 2025.

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Tuberculosis preventive treatment should be considered for all household contacts of pulmonary tuberculosis patients in India

Cited by 23 publications

References 38 publications

Tuberculosis prevention in children: a prospective community-based study in South Africa

Tuberculosis prevention in children: a prospective community-based study in South Africa

Estimating the population at high risk for tuberculosis through household exposure in high-incidence countries: a model-based analysis

Attributable is Preventable: Corrected and revised estimates of population attributable fraction of TB related to undernutrition in 30 high TB burden countries

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