PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of pubhealthrepLink to Publisher's site
 
Public Health Rep. 2005 May-Jun; 120(3): 271–277.
PMCID: PMC1497729

Expanding tuberculosis case detection by screening household contacts.

Abstract

OBJECTIVES: Tuberculosis (TB) case detection remains low in many countries, compromising the efficacy of TB control efforts. Current global TB control policy emphasizes case finding through sputum smear microscopy for patients who self-report to primary health centers. Our objective was to assess the feasibility and yield of a simple active case finding strategy in a high incidence population in northern Lima, Peru. METHODS: We implemented this pilot strategy in one health center's catchment area. Health workers visited household contacts of new TB case subjects to identify symptomatic individuals and collect sputum for screening. Neighboring households were screened in the same manner. Secondary analyses measured risk of TB by (1) sputum smear status of the index case subject, (2) compliance with testing, and (3) risk factors for disease detected through active contact tracing in contrast to self-report. RESULTS: The TB prevalence detected through combined active and passive case finding among 1,094 household contacts was 0.91% (914 per 100,000), much higher than with passive case finding alone (0.18%; 183 per 100,000; p=0.02). Among 2,258 neighbors, the combined strategy detected a TB prevalence of 0.22% (221 per 100,000) in contrast to 0.08% (80 per 100,000) detected through passive case finding alone (p=0.25). Risk factors for being diagnosed through active case finding in contrast with self-report included age >55 years (odds ratio [OR]=5.5; 95% confidence interval [CI] 1.2, 22.8) and female gender (OR=3.9; 95% CI 0.99, 22.3). CONCLUSIONS: Risk of active TB among symptomatic household contacts of active case subjects in this community is very high. Results suggest that contact tracing in such settings may be a powerful means of improving case detection rates for active TB disease.

Full Text

The Full Text of this article is available as a PDF (82K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Dye Christopher, Watt Catherine J, Bleed Daniel. Low access to a highly effective therapy: a challenge for international tuberculosis control. Bull World Health Organ. 2002;80(6):437–444. [PubMed]
  • Xianyi Chen, Fengzeng Zhao, Hongjin Duanmu, Liya Wan, Lixia Wang, Xin Du, Chin Daniel P. The DOTS strategy in China: results and lessons after 10 years. Bull World Health Organ. 2002;80(6):430–436. [PubMed]
  • Blower SM, Daley CL. Problems and solutions for the Stop TB partnership. Lancet Infect Dis. 2002 Jun;2(6):374–376. [PubMed]
  • Raviglione MC, Pio A. Evolution of WHO policies for tuberculosis control, 1948-2001. Lancet. 2002 Mar 2;359(9308):775–780. [PubMed]
  • Murray CJ, Salomon JA. Expanding the WHO tuberculosis control strategy: rethinking the role of active case-finding. Int J Tuberc Lung Dis. 1998 Sep;2(9 Suppl 1):S9–15. [PubMed]
  • Reichler Mary R, Reves Randall, Bur Sarah, Thompson Virginia, Mangura Bonita T, Ford Josie, Valway Sarah E, Onorato Ida M. Evaluation of investigations conducted to detect and prevent transmission of tuberculosis. JAMA. 2002 Feb 27;287(8):991–995. [PubMed]
  • Kuaban C, Koulla-Shiro S, Lekama Assiene T, Hagbe P. Dépistage de la tuberculose chez les sujets-contacts en 1993 et 1994 à Yaoundé, Cameroun. Med Trop (Mars) 1996;56(2):156–158. [PubMed]
  • Harries AD, Kamenya A, Subramanyam VR, Maher D, Squire SB, Wirima JJ, Nyangulu DS, Nunn P. Screening pulmonary tuberculosis suspects in Malawi: testing different strategies. Trans R Soc Trop Med Hyg. 1997 Jul-Aug;91(4):416–419. [PubMed]
  • Zachariah R, Spielmann MP, Harries AD, Gomani P, Graham SM, Bakali E, Humblet P. Passive versus active tuberculosis case finding and isoniazid preventive therapy among household contacts in a rural district of Malawi. Int J Tuberc Lung Dis. 2003 Nov;7(11):1033–1039. [PubMed]
  • Gilpin TP, Hammond M. Active case-finding--for the whole community or for tuberculosis contacts only? S Afr Med J. 1987 Aug 15;72(4):260–262. [PubMed]
  • Sanghavi DM, Gilman RH, Lescano-Guevara AG, Checkley W, Cabrera LZ, Cardenas V. Hyperendemic pulmonary tuberculosis in a Peruvian shantytown. Am J Epidemiol. 1998 Aug 15;148(4):384–389. [PubMed]
  • Capewell S, Leitch AG. The value of contact procedures for tuberculosis in Edinburgh. Br J Dis Chest. 1984 Oct;78(4):317–329. [PubMed]
  • Wang PD, Lin RS. Tuberculosis transmission in the family. J Infect. 2000 Nov;41(3):249–251. [PubMed]
  • Noertjojo K, Tam CM, Chan SL, Tan J, Chan-Yeung M. Contact examination for tuberculosis in Hong Kong is useful. Int J Tuberc Lung Dis. 2002 Jan;6(1):19–24. [PubMed]
  • Nsanzumuhire H, Aluoch JA, Karuga WK, Edwards EA, Stott H, Fox W, Sutherland I. A third study of case-finding methods for pulmonary tuberculosis in Kenya, including the use of community leaders. Tubercle. 1981 Jun;62(2):79–94. [PubMed]
  • Wares DF, Akhtar M, Singh S, Luitel H. Is TB contact screening relevant in a developing country setting? Experiences from eastern Nepal, 1996-1998. Int J Tuberc Lung Dis. 2000 Oct;4(10):920–924. [PubMed]
  • Liippo KK, Kulmala K, Tala EO. Focusing tuberculosis contact tracing by smear grading of index cases. Am Rev Respir Dis. 1993 Jul;148(1):235–236. [PubMed]
  • El-Sony A, Enarson D, Khamis A, Baraka O, Bjune G. Relation of grading of sputum smears with clinical features of tuberculosis patients in routine practice in Sudan. Int J Tuberc Lung Dis. 2002 Feb;6(2):91–97. [PubMed]
  • Sepkowitz KA. How contagious is tuberculosis? Clin Infect Dis. 1996 Nov;23(5):954–962. [PubMed]
  • Borgdorff MW, Nagelkerke NJ, Dye C, Nunn P. Gender and tuberculosis: a comparison of prevalence surveys with notification data to explore sex differences in case detection. Int J Tuberc Lung Dis. 2000 Feb;4(2):123–132. [PubMed]
  • Holmes CB, Hausler H, Nunn P. A review of sex differences in the epidemiology of tuberculosis. Int J Tuberc Lung Dis. 1998 Feb;2(2):96–104. [PubMed]
  • Nsubuga Peter, Johnson John L, Okwera Alphonse, Mugerwa Roy D, Ellner Jerrold J, Whalen Christopher C. Gender and HIV-associated pulmonary tuberculosis: presentation and outcome at one year after beginning antituberculosis treatment in Uganda. BMC Pulm Med. 2002 Sep 11;2:4–4. [PMC free article] [PubMed]
  • Muula AS. Gender differences in delays to TB diagnosis. Int J Tuberc Lung Dis. 2001 Nov;5(11):1072–1074. [PubMed]
  • Begum V, de Colombani P, Das Gupta S, Salim AH, Hussain H, Pietroni M, Rahman S, Pahan D, Borgdorff MW. Tuberculosis and patient gender in Bangladesh: sex differences in diagnosis and treatment outcome. Int J Tuberc Lung Dis. 2001 Jul;5(7):604–610. [PubMed]
  • Thorson A, Diwan VK. Gender inequalities in tuberculosis: aspects of infection, notification rates, and compliance. Curr Opin Pulm Med. 2001 May;7(3):165–169. [PubMed]
  • Needham DM, Foster SD, Tomlinson G, Godfrey-Faussett P. Socio-economic, gender and health services factors affecting diagnostic delay for tuberculosis patients in urban Zambia. Trop Med Int Health. 2001 Apr;6(4):256–259. [PubMed]
  • Boeree MJ, Harries AD, Godschalk P, Demast Q, Upindi B, Mwale A, Nyirenda TE, Banerjee A, Salaniponi FM. Gender differences in relation to sputum submission and smear-positive pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis. 2000 Sep;4(9):882–884. [PubMed]
  • Diwan VK, Thorson A. Sex, gender, and tuberculosis. Lancet. 1999 Mar 20;353(9157):1000–1001. [PubMed]
  • Long NH, Johansson E, Lönnroth K, Eriksson B, Winkvist A, Diwan VK. Longer delays in tuberculosis diagnosis among women in Vietnam. Int J Tuberc Lung Dis. 1999 May;3(5):388–393. [PubMed]
  • Maartens Gary, Beyers Nulda. Tuberculosis in the tropics. Clin Chest Med. 2002 Jun;23(2):341–350. [PubMed]
  • Salazar GE, Schmitz TL, Cama R, Sheen P, Franchi LM, Centeno G, Valera C, Leyva M, Montenegro-James S, Oberhelman R, et al. Pulmonary tuberculosis in children in a developing country. Pediatrics. 2001 Aug;108(2):448–453. [PubMed]
  • Eamranond P, Jaramillo E. Tuberculosis in children: reassessing the need for improved diagnosis in global control strategies. Int J Tuberc Lung Dis. 2001 Jul;5(7):594–603. [PubMed]
  • Beyers N, Gie RP, Schaaf HS, Van Zyl S, Talent JM, Nel ED, Donald PR. A prospective evaluation of children under the age of 5 years living in the same household as adults with recently diagnosed pulmonary tuberculosis. Int J Tuberc Lung Dis. 1997 Feb;1(1):38–43. [PubMed]
  • Topley JM, Maher D, Mbewe LN. Transmission of tuberculosis to contacts of sputum positive adults in Malawi. Arch Dis Child. 1996 Feb;74(2):140–143. [PMC free article] [PubMed]
  • Beyers Nulda. Case finding in children in contact with adults in the house with TB. Int J Tuberc Lung Dis. 2003 Nov;7(11):1013–1014. [PubMed]

Articles from Public Health Reports are provided here courtesy of Association of Schools of Public Health