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A score to predict and stratify risk of tuberculosis in adult contacts of tuberculosis index cases: a prospective derivation and external validation cohort study

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dc.contributor.author Saunders, Matthew J.
dc.contributor.author Wingfield, Tom
dc.contributor.author Tovar, Marco A.
dc.contributor.author Baldwin, Matthew R.
dc.contributor.author Datta, Sumona
dc.contributor.author Zevallos, Karine
dc.contributor.author Montoya, Rosario
dc.contributor.author Valencia, Teresa R.
dc.contributor.author Friedland, Jon S.
dc.contributor.author Moulton, Larry H.
dc.contributor.author Gilman, Robert Hugh
dc.contributor.author Evans, Carlton Anthony William
dc.date.accessioned 2019-01-25T15:02:14Z
dc.date.available 2019-01-25T15:02:14Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4591
dc.description.abstract BACKGROUND: Contacts of tuberculosis index cases are at increased risk of developing tuberculosis. Screening, preventive therapy, and surveillance for tuberculosis are underused interventions in contacts, particularly adults. We developed a score to predict risk of tuberculosis in adult contacts of tuberculosis index cases. METHODS: In 2002-06, we recruited contacts aged 15 years or older of index cases with pulmonary tuberculosis who lived in desert shanty towns in Ventanilla, Peru. We followed up contacts for tuberculosis until February, 2016. We used a Cox proportional hazards model to identify index case, contact, and household risk factors for tuberculosis from which to derive a score and classify contacts as low, medium, or high risk. We validated the score in an urban community recruited in Callao, Peru, in 2014-15. FINDINGS: In the derivation cohort, we identified 2017 contacts of 715 index cases, and median follow-up was 10·7 years (IQR 9·5-11·8). 178 (9%) of 2017 contacts developed tuberculosis during 19 147 person-years of follow-up (incidence 0·93 per 100 person-years, 95% CI 0·80-1·08). Risk factors for tuberculosis were body-mass index, previous tuberculosis, age, sustained exposure to the index case, the index case being in a male patient, lower community household socioeconomic position, indoor air pollution, previous tuberculosis among household members, and living in a household with a low number of windows per room. The 10-year risks of tuberculosis in the low-risk, medium-risk, and high-risk groups were, respectively, 2·8% (95% CI 1·7-4·4), 6·2% (4·8-8·1), and 20·6% (17·3-24·4). The 535 (27%) contacts classified as high risk accounted for 60% of the tuberculosis identified during follow-up. The score predicted tuberculosis independently of tuberculin skin test and index-case drug sensitivity results. In the external validation cohort, 65 (3%) of 1910 contacts developed tuberculosis during 3771 person-years of follow-up (incidence 1·7 per 100 person-years, 95% CI 1·4-2·2). The 2·5-year risks of tuberculosis in the low-risk, medium-risk, and high-risk groups were, respectively, 1·4% (95% CI 0·7-2·8), 3·9% (2·5-5·9), and 8·6%· (5·9-12·6). INTERPRETATION: Our externally validated risk score could predict and stratify 10-year risk of developing tuberculosis in adult contacts, and could be used to prioritise tuberculosis control interventions for people most likely to benefit. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Lancet. Infectious Diseases
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Disease Transmission, Infectious en_US
dc.subject Epidemiologic Methods en_US
dc.subject Adult en_US
dc.subject Cohort Studies en_US
dc.subject Female en_US
dc.subject Follow-Up Studies en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Middle Aged en_US
dc.subject Peru en_US
dc.subject Prospective Studies en_US
dc.subject Risk Assessment en_US
dc.subject Rural Population en_US
dc.subject Tuberculosis/epidemiology/transmission en_US
dc.subject Urban Population en_US
dc.subject Young Adult en_US
dc.title A score to predict and stratify risk of tuberculosis in adult contacts of tuberculosis index cases: a prospective derivation and external validation cohort study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/S1473-3099(17)30447-4
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn 1474-4457


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