Yield of contact tracing from pediatric tuberculosis index cases in Gaborone, Botswana
OBJECTIVE: To determine the yield of contact tracing in household contacts of pediatric TB index cases in Botswana.
DESIGN: Index cases included all pediatric (age ≤13 years) TB admissions from January 2009 to December 2011 to Botswana's largest referral hospital. A contact tracing team identified cases, conducted home visits, symptom-screened contacts and referred those with ≥1 TB symptoms. The primary outcome was newly diagnosed TB in a contact.
RESULTS: From 163 pediatric index cases, 548 contacts were screened (median 3 contacts/case, interquartile range [IQR] 2–4). Of these, 49 (9%) were referred for positive symptoms on screening and 27/49 (55%) were evaluated for active TB. Twelve new TB cases were diagnosed (12/548, 2.2%); the median age was 31 years (IQR 23–38); 11 (92%) were smear-positive. Ten (83%) had known HIV status: 7 (70%) were HIV-positive. To find one new TB case, the number needed to contact trace (index cases/new cases) was 13.6, and the number needed to screen (contacts/new cases) was 46.
CONCLUSION: This yield of contact tracing using pediatric index cases is similar to the traditional adult index case approach. Improving the proportion of symptomatic contacts evaluated may increase yield.
Keywords: TB case detection; TB screening
Document Type: Research Article
Affiliations: 1: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Doris Duke Clinical Research Fellowship Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA 2: Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA 3: Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA 4: Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA 5: Faculty of Health Sciences, University of Botswana, Gaborone, Botswana 6: Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Faculty of Health Sciences, University of Botswana, Gaborone, Botswana 7: Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA; and McMaster University, Hamilton, Ontario, Canada 8: National TB Program, Botswana Ministry of Health, Gaborone, Botswana 9: Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics & Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Publication date: 01 August 2013
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