Prediction and prevention of tuberculosis in contacts - Authors' reply

Tovar, Marco A.; Wingfield, Tom; Saunders, Matthew J.; Evans, Carlton A.; Datta, Sumona; Baldwin, Matthew R.

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	Evans, Carlton A.
dc.date.accessioned	2019-01-25T17:00:27Z
dc.date.available	2019-01-25T17:00:27Z
dc.date.issued	2017
dc.identifier.uri	https://hdl.handle.net/20.500.12866/4938
dc.description.abstract	We thank Sandra Arend and Jonathan Uzorka for their interest in our study. They argue that because our risk score predicts tuberculosis independently of the contact tuberculin skin test (TST) results and index case smear grade, it is likely that subsequent re-exposure to tuberculosis was an important risk factor. Therefore, they debate the justification for our calculation of numbers needed to treat (NNT) with preventive therapy at the time of known exposure to prevent each tuberculosis case. Although we agree that re-exposure might have been an important, unmeasured risk factor in our population, the highest rate of tuberculosis among contacts was in the first year after known exposure, and nearly all the cases occurred during the first 3 years. Furthermore, prolonged exposure to the index case was an important risk factor. Taken together, these findings suggest that the known exposure was by far the most important factor in determining tuberculosis risk. However, we appreciate the potential importance of subsequent re-exposure and therefore calculated the NNT to prevent each tuberculosis case within 5 as well as 10 years. Importantly, we calculated NNT principally to illustrate practical differences between risk groups. Because the cutoffs used to define risk groups were arbitrary and our risk score is a continuous variable, these NNTs inherently change depending on how a high-risk contact is defined...	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	Humans	en_US
dc.subject	Tuberculosis/prevention & control	en_US
dc.title	Prediction and prevention of tuberculosis in contacts - Authors' reply	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1016/S1473-3099(17)30642-4
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn	1474-4457