Breaking News
December 16, 2018 - Social stigma contributes to poor mental health in the autistic community
December 16, 2018 - Multidisciplinary team successfully performs complex surgery on patient suffering from enlarged skull
December 16, 2018 - Experts analyze data that can guide antidepressant discontinuation
December 16, 2018 - Menlo Therapeutics’ Successful Phase 2 Clinical Trial of Serlopitant Demonstrates Reduction of Pruritus Associated with Psoriasis
December 16, 2018 - Siblings of children with autism or ADHD are at elevated risk for both disorders
December 16, 2018 - New project aims to understand why and how metabolic disorders develop in patients
December 16, 2018 - Diets containing GM maize have no harmful effects on health or metabolism of rats
December 16, 2018 - Are doctors and teachers confusing immaturity and attention deficit?
December 16, 2018 - Hearing loss linked with increased risk for premature death
December 16, 2018 - Chromatrap buffer reagents for lysing cells offer many benefits
December 16, 2018 - Young Breast Cancer Patients Face Higher Risk for Osteoporosis
December 16, 2018 - 3-D printing offers helping hand to people with arthritis
December 16, 2018 - Community Health Choice helps manage complex and chronic care conditions
December 16, 2018 - Regular trips out could dramatically reduce depression in older age
December 16, 2018 - CWRU to use VivaLNK’s Vital Scout device for stress study in student athletes
December 16, 2018 - ‘Easy Way Out’? Stigma May Keep Many From Weight Loss Surgery
December 16, 2018 - Gout drug may protect against chronic kidney disease
December 16, 2018 - Talking about memories enhances the wellbeing of older and younger people
December 16, 2018 - Occupational exposure to pesticides increases risk for cardiovascular disease among Latinos
December 16, 2018 - A biomarker in the brain’s circulation system may be Alzheimer’s earliest warning
December 16, 2018 - Magnesium may play important role in optimizing vitamin D levels, study shows
December 16, 2018 - The effect of probiotics on intestinal flora of premature babies
December 16, 2018 - Parents spend more time talking with kids about mechanics of using mobile devices
December 16, 2018 - Biohaven Announces Positive Results from Ongoing Rimegepant Long-Term Safety Study
December 16, 2018 - Arterial stiffness may predict dementia risk
December 16, 2018 - Study explores link between work stress and increased cancer risk
December 16, 2018 - Sex work criminalization linked to incidences of violence finds study
December 16, 2018 - Johns Hopkins researchers discover swarming behavior in fish-dwelling parasite
December 16, 2018 - Schistosomiasis prevention and treatment could help control HIV
December 16, 2018 - Early postpartum opioids linked with persistent usage
December 16, 2018 - Johns Hopkins researchers identify molecular causes of necrotizing enterocolitis in preemies
December 16, 2018 - Advanced illumination expands capabilities of light-sheet microscopy
December 16, 2018 - Alzheimer’s could possibly be spread via contaminated neurosurgery
December 16, 2018 - Unraveling the complexity of cancer biology can prompt new avenues for drug development
December 16, 2018 - Inflammatory Bowel Disease, Prostate Cancer Linked
December 16, 2018 - Cannabis youth prevention strategy should target mental wellbeing
December 15, 2018 - Recent developments and challenges in hMAT inhibitors
December 15, 2018 - Sewage bacteria found lurking in Hudson River sediments
December 15, 2018 - CDC selects UMass Amherst biostatistician model that helps predict influenza outbreaks
December 15, 2018 - Researchers reveal brain mechanism that drives itch-evoked scratching behavior
December 15, 2018 - New computer model helps predict course of the disease in prostate cancer patients
December 15, 2018 - Obesity to Blame for Almost 1 in 25 Cancers Worldwide
December 15, 2018 - How the brain tells you to scratch that itch
December 15, 2018 - New findings could help develop new immunotherapies against cancer
December 15, 2018 - World’s largest AI-powered medical research network launched by OWKIN
December 15, 2018 - Young people suffering chronic pain battle isolation and stigma as they struggle to forge their identities
December 15, 2018 - Lifespan extension at low temperatures depends on individual’s genes, study shows
December 15, 2018 - New ingestible capsule can be controlled using Bluetooth wireless technology
December 15, 2018 - Researchers uncover microRNAs involved in the control of social behavior
December 15, 2018 - Research offers hope for patients with serious bone marrow cancer
December 15, 2018 - Link between poverty and obesity is only about 30 years old, study shows
December 15, 2018 - Mass spectrometry throws light on old case of intentional heavy metal poisoning
December 15, 2018 - BeyondSpring Announces Phase 3 Study 105 of its Lead Asset Plinabulin for Chemotherapy-Induced Neutropenia Meets Primary Endpoint at Interim Analysis
December 15, 2018 - Study finds that in treating obesity, one size does not fit all
December 15, 2018 - Tenacity and flexibility help maintain psychological well-being, mobility in older people
December 15, 2018 - Study reveals role of brain mechanism in memory recall
December 15, 2018 - High levels of oxygen encourage the brain to remain in deep, restorative sleep
December 15, 2018 - Experimental HIV vaccine strategy works in non-human primates, research shows
December 15, 2018 - Genetically modified pigs could limit replication of classical swine fever virus, study shows
December 15, 2018 - FDA Approves Herzuma (trastuzumab-pkrb), a Biosimilar to Herceptin
December 15, 2018 - Cost and weight-loss potential matter most to bariatric surgery patients
December 15, 2018 - Cancer Research UK and AstraZeneca open new Functional Genomics Centre
December 15, 2018 - New research lays out potential path for treatment of Huntington’s disease
December 15, 2018 - Prestigious R&D 100 Award presented to Leica Microsystems
December 15, 2018 - Study shows septin proteins detect and kill gut pathogen, Shigella
December 15, 2018 - Study sheds new light on disease-spreading mosquitoes
December 15, 2018 - 2017 Saw Slowing in National Health Care Spending
December 15, 2018 - Monitoring movement reflects efficacy of mandibular splint
December 15, 2018 - Study supports BMI as useful tool for assessing obesity and health
December 15, 2018 - Self-guided, internet-based therapy platforms effectively reduce depression
December 15, 2018 - Organically farmed food has bigger climate impact than conventional food production
December 15, 2018 - Faster, cheaper test has potential to enhance prostate cancer evaluation
December 15, 2018 - Researchers study abnormal blood glucose levels of patients after hospital discharge
December 15, 2018 - Swedish scientists explore direct association of dementia and ischemic stroke deaths
December 15, 2018 - Study finds 117% increase in number of dementia sufferers in 26 years
December 15, 2018 - Eczema Can Drive People to Thoughts of Suicide: Study
December 15, 2018 - Link between neonatal vitamin D deficiency and schizophrenia confirmed
December 15, 2018 - Nurse denied life insurance because she carries naloxone
December 15, 2018 - Ritalin drug affects organization of pathways that build brain networks used in attention, learning
December 15, 2018 - Research pinpoints two proteins involved in creation of stem cells
Closer Look at Household Contacts Finds More TB Cases

Closer Look at Household Contacts Finds More TB Cases

image_pdfDownload PDFimage_print

Action Points

  • Investigating household contacts of patients who contracted tuberculosis (TB) combined with passive measurement was able to detect more cases of TB than passive measurement alone.
  • Note that the study provides formal proof in a high-burden setting that active case finding can detect early and asymptomatic cases of tuberculosis more effectively than the current strategy, according to an editorial.

Investigating household contacts of patients who contracted tuberculosis (TB) combined with passive measurement was able to detect more cases of TB than passive measurement alone, a randomized trial in Vietnam found.

This active screening intervention, which included inviting household contacts for clinical exam and imaging, was able to uncover significantly more TB cases among household contacts than passive methods of screening, reported Greg J. Fox, MB BS, PhD, of the University of Sydney, and colleagues.

They described the passive method of investigating cases of TB as a person presenting with symptoms of cough and sputum production to a health facility. This assumes most people who have the infection will seek care because of their symptoms, but prevalence surveys indicate “this long-standing assumption is not justified,” they wrote in the New England Journal of Medicine.

The reason is that some people who test positive for TB on sputum smear microscopy, and are infectious, do not have “typical symptoms of the disease,” the authors noted.

Investigating household contacts has had success in high-income, low-prevalence countries, but Fox’s group pointed out “limited” implementation in high-prevalence areas because there is little evidence that shows it is effective. In fact, one trial in southern Africa found that investigating household contacts did not significantly reduce prevalence of TB within the population.

“Data from randomized trials are lacking with respect to the effectiveness of adding active screening to traditional passive case finding for contacts of infected persons,” they wrote.

The authors conducted a cluster-randomized trial at clinics in 70 districts in eight provinces of Vietnam. Districts randomized to receive the intervention had health workers testing patients for TB, then inviting household contacts of patients who tested positive for a clinical assessment and chest radiography, with follow-up at 6, 12, and 24 months. Passive assessment or the control group tested patients for TB only and were asked to return after 24 months for an interview.

Index case patients were eligible if they were ages ≥15 years, tested positive for TB, and visited the TB clinic in their home district. Household contacts were eligible if they lived in the house with the index patient during the 2 months prior to the TB diagnosis.

Patients were about three-quarters men, though household contacts in both districts were around 60% female. Average household size was 3.3 people in intervention districts and 3.9 in control districts.

Overall, there were 25,707 contacts of 10,964 patients with smear-positive TB. Two-thirds of the 10,069 contacts in the intervention districts came for the 6-month screening visit, while 56% attended the 12 month and a little under three-quarters attended the 24 month.

In the intervention districts, 180 contacts (1,788 per 100,000 population) were registered as having TB, while 110 contacts (703 per 100,000) were registered in control districts (RR 2.6, 95% CI 2.0-3.3, P<0.001). The number of people needing to be screened for one additional registered case of tuberculosis was 74.6 (95% CI 64.2-89.2).

Secondary analyses also found more registered cases of smear-positive TB in the intervention group versus controls (160 versus 39, RR 6.4, 95% CI 4.5-9.0, P<0.001).

Study limitations included a larger household size in the control districts versus the intervention districts, and a lower proportion of contacts that reported a prior history of TB. The authors also said they were unable to confirm diagnosis of TB for cases not listed by the National Tuberculosis Program.

An accompanying editorial by Barry R. Bloom, PhD, of the Harvard T.H. Chan School of Public Health in Boston, characterized these as important new findings, arguing that this “provides formal proof in a high-burden setting that active case finding can detect early and asymptomatic cases of tuberculosis more effectively than the current strategy.”

Bloom added that interventions such as this, which can help strengthen the health system in diagnosing and treating TB are critical to help “bend the incidence curve” of the disease.

“When patients need to see three providers before being diagnosed and only a quarter of physicians can recognize the cardinal symptoms of tuberculosis or know the standard treatment, there is a major health system problem,” he wrote.

The study was supported by grants from the Australian government.

Fox disclosed support from the National Health and Medical Research Council. Co-authors disclosed support from the Australian government, AstraZeneca Australia, and GlaxoSmithKline Australia.

Bloom disclosed support from the Indian Council of Medical Research, Aeras, and the Gates Foundation.

  • Reviewed by
    Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner


last updated

Tagged with:

About author

Related Articles