Breaking News
March 27, 2019 - Managing MS
March 27, 2019 - Researchers reveal how receptor TLR-9 protects against lupus
March 27, 2019 - Doctors share story of daughter’s treatment for leukemia
March 27, 2019 - Medical Center Hosts Networking Session for Women’s History Month
March 27, 2019 - Positive link found between anxiety during childhood, adolescence with later alcohol use disorders
March 27, 2019 - Coronary artery calcium indicates patients’ imminent risk of a heart attack
March 27, 2019 - Luxia Scientific partners with Life Genomics to commercialize microbiome-based tests in the Nordic countries
March 26, 2019 - New mathematical algorithm objectively classifies shapes of neurons in the brain
March 26, 2019 - Research suggests oxytocin as potential new obesity treatment
March 26, 2019 - Education may not protect against dementia as previously thought
March 26, 2019 - Stanford acquires archive of palliative care pioneer Elisabeth Kübler-Ross | News Center
March 26, 2019 - New research aims to turn worms against parasite-associated cancer
March 26, 2019 - Psychological evolution may help explain differences between male and female serial killers
March 26, 2019 - New molecular mechanism involved in pancreas repair identified
March 26, 2019 - Obesity linked to reproductive problems in women with type 1 diabetes
March 26, 2019 - New short-pulse ultrasound technique enhances drug delivery to brains of mice
March 26, 2019 - Researchers uncover mechanism that initiates sexual organs maturation
March 26, 2019 - DermBiont Begins Phase 2 Clinical Trial for Athlete’s Foot with a Live Bacterial Topical Probiotic
March 26, 2019 - Persons with Alzheimer’s disease have a higher risk of head injuries
March 26, 2019 - Mental health issues associated with income inequalities in Indigenous people
March 26, 2019 - Participation in sports linked with fewer depressive symptoms in children
March 26, 2019 - Brain process common to sleep and aging discovered
March 26, 2019 - People under age 50 with hearing loss more likely to misuse alcohol and drugs
March 26, 2019 - People with and without cancer use different dosages of cannabis formulations, study shows
March 26, 2019 - Young people at risk of addiction show differences in key brain region
March 26, 2019 - In virtual exchange, students in California and Lebanon unite to improve refugee health
March 26, 2019 - Trump Administration Changes Course, Asks Court To Strike Down ACA
March 26, 2019 - People with untreated diabetes develop signs of Alzheimer’s disease at a faster rate
March 26, 2019 - Study explains how bright colors evolved and diversified in male guppies
March 26, 2019 - Savings from lower insurance costs of growth hormone drugs not passed on to patients
March 26, 2019 - Study highlights the need to pay more attention on specific nutritional needs of female athletes
March 26, 2019 - Sleep quality varies throughout menstrual cycle in young women
March 26, 2019 - A1c diabetes blood test found to be unreliable
March 26, 2019 - Younger Female Blood Donors Vulnerable to Iron Deficiency
March 26, 2019 - Prostate cancer cells ‘spit out’ a protein that promotes tumor growth
March 26, 2019 - Finding the elusive drinking ‘brake’
March 26, 2019 - Using the Mastermind strategy in brain research
March 26, 2019 - Symptomatic pharmacotherapy of elderly people should be regularly monitored
March 26, 2019 - Synthetic biological logic gate could one day be used to modify cellular function
March 26, 2019 - Damage to anxiety-associated brain region heightens monkeys’ defensive response
March 26, 2019 - Researchers uncover large-scale brain patterns and networks which control sleep
March 26, 2019 - Scientific Symposium at LABVOLUTION focuses on key issues in life sciences
March 26, 2019 - Screen time plus snacking could increase risk for metabolic syndrome in teens
March 26, 2019 - Attention, Seniors: Drink More Water and Head Off Disease
March 26, 2019 - Peptide shows promise for protecting kidneys from nephritis
March 26, 2019 - Causes of diabetes decline or disappear when ‘zombie cells’ are removed, shows study
March 26, 2019 - Scientists identify common genetic variants associated with post-stroke recovery
March 26, 2019 - Study finds link between menopause and changes in body composition
March 26, 2019 - Higher levels of sex hormones in older men related to lower biological age
March 26, 2019 - Research links participation in team sports to larger hippocampal volumes in children
March 26, 2019 - Cerveau announces research collaboration agreement with Eisai for novel tau imaging agent
March 26, 2019 - New technique measures frequency of sounds emitted from biological structures
March 26, 2019 - Removal of ‘zombie cells’ alleviates causes of diabetes in obese mice
March 26, 2019 - Women exposed to deepwater horizon oil spill continue to experience PTSD symptoms
March 26, 2019 - Shaping new treatments for tuberculosis
March 26, 2019 - Understanding genetic interactions holds key to new personalized therapies
March 26, 2019 - Nervous system relies on guidance cues for neuronal axons to reach destinations
March 26, 2019 - Altering gut microbiome may be potential treatment option for PCOS
March 26, 2019 - Moleculin Files with FDA for Expedited Approval Pathway for Annamycin
March 26, 2019 - GPs play pivotal role in ensuring success of new Faster Diagnosis Standard for Cancer
March 26, 2019 - New clues discovered to lung transplant rejection
March 26, 2019 - New study offers insight into development of delusions
March 26, 2019 - Children’s ball pits full of pathogenic microbes
March 26, 2019 - Exploring pathophysiological factors that link sleep problems and Alzheimer’s disease
March 26, 2019 - Walking downhill after meals can reduce bone resorption in postmenopausal women with diabetes
March 26, 2019 - USA LESS Issues Voluntary Nationwide Recall of LEOPARD Miracle Honey Due to Presence of Undeclared Sildenafil
March 26, 2019 - CT scan prior to spine fusion finds almost half of patients had undiagnosed osteoporosis
March 26, 2019 - After 2 Apparent Student Suicides, Parkland Grieves Again
March 25, 2019 - Inherited form of rickets improves more with new injectable medicine than conventional therapy
March 25, 2019 - Trastuzumab Tied to Higher Long-Term Risk for Heart Failure
March 25, 2019 - Personal context directly affects CPAP use
March 25, 2019 - Mosquito tracking key to preventing disease outbreaks
March 25, 2019 - Scientists Detect Hidden Signals from Beneficial Bacteria
March 25, 2019 - Treating women with thyroid antibodies with Levothyroxine do not increase live birth rate
March 25, 2019 - Brain area that only processes spoken, not written words identified
March 25, 2019 - Race and ethnicity influence fracture risk in diabetic patients
March 25, 2019 - Researchers report new regenerative medicine approach for treating osteoarthritis of the knee
March 25, 2019 - Exposure to dim light at night may contribute to spread of breast cancer to bones
March 25, 2019 - Benefits of osteoporosis treatment in postmenopausal women outweigh the perceived risks
March 25, 2019 - Researchers find evidence of Cryptosporidium parasite in Minnesota’s public water systems
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

1969-12-31T19:00:00-0500

last updated

Tagged with:

About author

Related Articles