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

作者：M. R. Reichler, Awal Khan, Timothy R. Sterling, Hui Zhao, Bin Chen, Yan Yuan, Joyce Moran, James McAuley, Bonita T. Mangura, I Bakhtawar, Catherine Ledoux, James McAuley, J Beison, M Fitzgerald, Monika Naus, Motohiro Nakajima, Neil W. Schluger, Yael Hirsch‐Moverman, Jennifer L. Moran, Henry M. Blumberg, J Tapia, L Singha, E Hershfeld, B. Roche, Bonita T. Mangura, A Sevilla, Timothy R. Sterling, T Chavez-Lindell, Fernanda Maruri, Susan E. Dorman, Wendy Cronin, Elizabeth Munk, Abdul Qadir Khan, Ye Yuan, B Chen, F Yan, Y Shen, Hui Zhao, Rose Punnoose, Haoran Zhang, Patricia A. Bessler, M Fagley, M. R. Reichler, M. R. Reichler, Timothy R. Sterling, J Tapia, Christina S. Hirsch, Cheng Luo · 发表于：Clinical Infectious Diseases · 年份：2019 · DOI：10.1093/cid/ciz438 · 被引用次数：52 · 研究领域：Tuberculosis Research and Epidemiology、HIV/AIDS Research and Interventions、Infectious Diseases and Tuberculosis

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 con...