Tuberculosis incidence among infected contacts detected through contact tracing of smear-positive patients
Por:
Martin-Sanchez, M, Brugueras, S, de Andres, A, Simon, P, Gorrindo, P, Ros, M, Masdeu, E, Millet, JP, Cayla, JA, Orcau, A, Ospina, J, Rafi, T, Abdelkarim, S, Lin, XM, Burcea, I, Diatta, O, Clos, R, Santoma, MJ, Badosa, I, Rovira, G, Martinez, JA, Ligero, C, Vilella, A, Pomar, V, Fontanet, A, Molina, I, Salvador, F, Sanchez-Montalva, A, Saborit, N, Rodrigo, JA, Martinez, X, Jimenez, MA, Mila, C, Solsona, J, de Souza, ML, Cantos, A, Knobel, H, Jove, N, Sanchez, F, Gracia, XC, Ruiz, MC, Rius, C
Publicada:
15 abr 2019
Resumen:
Background
The contacts of people with pulmonary tuberculosis (PTB) have a high risk of becoming infected and developing tuberculosis (TB). Our aim was to determine the incidence of TB and its risk factors in a cohort of contacts with latent TB infection (LTBI) detected through contact tracing of smear-positive PTB cases.
Methods and findings
We performed a population-based retrospective cohort study including contacts that had LTBI, and were contacts of people with PTB who started treatment between 2008 and 2014. We followed up contacts until they developed TB or until the end date for follow-up (31st December 2016). We used Kaplan-Meier curves to compute incidence at 2 and 5 years, and Cox regression to compute hazard ratios (HR) and their 95% confidence intervals (CI). We analyzed 3097 close contacts of 565 PTB cases. After exclusion of 81 coprevalent TB cases, 953 contacts had LTBI, of which 14 developed TB. Their risk of developing TB after two and five years was 0.7% (CI: 0.3-1.6) and 1.8% (CI: 1.1-3.1) respectively. Contacts who had not been referred for LTBI treatment had a 1.0% (CI: 0.24.0) risk at 5 years. Risk of developing TB at 5 years was 1.2% (CI: 0.5-3.0) among people who completed treatment, and 11.1% (CI: 5.1-23.3) for those who did not. Risk factors for TB were not completing LTBI treatment (HR 9.4, CI: 2.9-30.8) and being female (HR 3.5, CI: 1.1-11-3).
Conclusions
LTBI treatment plays a fundamental role in decreasing the risk of developing TB. It is necessary to achieve a maximum contact tracing coverage and the highest possible compliance with LTBI treatment.
Filiaciones:
Martin-Sanchez, M:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Pompeu Fabra Univ, Agencia Salut Publ Barcelona PSMar UPF ASPB, Prevent Med & Publ Hlth Training Unit, Parc Salut Mar, Barcelona, Spain
Brugueras, S:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Biomed Res Ctr Network Epidemiol & Publ Hlth CIBE, Madrid, Spain
Univ Autonoma Barcelona, Dept Paediat Obstet & Gynaecol, Barcelona, Spain
Univ Autonoma Barcelona, Prevent Med, Barcelona, Spain
de Andres, A:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Simon, P:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Gorrindo, P:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Ros, M:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Masdeu, E:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Millet, JP:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Biomed Res Ctr Network Epidemiol & Publ Hlth CIBE, Madrid, Spain
Fdn TB Res Unit Barcelona fuiTB, Barcelona, Spain
Cayla, JA:
Fdn TB Res Unit Barcelona fuiTB, Barcelona, Spain
Orcau, A:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Biomed Res Ctr Network Epidemiol & Publ Hlth CIBE, Madrid, Spain
Fdn TB Res Unit Barcelona fuiTB, Barcelona, Spain
Ospina, J:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Rafi, T:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Abdelkarim, S:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Lin, XM:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Burcea, I:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Diatta, O:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Clos, R:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Santoma, MJ:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Badosa, I:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Rovira, G:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Martinez, JA:
Hosp Clin Barcelona, Infect Dis Unit, Barcelona, Spain
Ligero, C:
Hosp Clin Barcelona, Infect Dis Unit, Barcelona, Spain
Vilella, A:
Hosp Clin Barcelona, Dept Epidemiol & Prevent Med, Barcelona, Spain
Pomar, V:
Hosp Santa Creu & Sant Pau, Infect Dis Unit, Dept Internal Med, Barcelona, Spain
Fontanet, A:
Hosp Santa Creu & Sant Pau, Infect Dis Unit, Dept Internal Med, Barcelona, Spain
Molina, I:
Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain
Salvador, F:
Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain
Sanchez-Montalva, A:
Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain
Saborit, N:
Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain
Rodrigo, JA:
Hosp Univ Vall dHebron, Dept Epidemiol & Prevent Med, Barcelona, Spain
Martinez, X:
Hosp Univ Vall dHebron, Dept Epidemiol & Prevent Med, Barcelona, Spain
Jimenez, MA:
Hosp Univ Vall dHebron, TB Unit Vall dHebron Drassanes, Barcelona, Spain
Mila, C:
Hosp Univ Vall dHebron, TB Unit Vall dHebron Drassanes, Barcelona, Spain
Solsona, J:
Hosp Univ Vall dHebron, TB Unit Vall dHebron Drassanes, Barcelona, Spain
de Souza, ML:
Hosp Univ Vall dHebron, TB Unit Vall dHebron Drassanes, Barcelona, Spain
Cantos, A:
Hosp Univ Vall dHebron, TB Unit Vall dHebron Drassanes, Barcelona, Spain
Knobel, H:
Hosp del Mar, Infect Dis Unit, Barcelona, Spain
Jove, N:
Hosp del Mar, Infect Dis Unit, Barcelona, Spain
Sanchez, F:
Hosp del Mar, Infect Dis Unit, Barcelona, Spain
Gracia, XC:
Unitat Clin Tractament Directament Observat TB, Serv Clin, Barcelona, Spain
Ruiz, MC:
Unitat Clin Tractament Directament Observat TB, Serv Clin, Barcelona, Spain
Rius, C:
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Gold, Green Published
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