title: Can social interventions prevent tuberculosis?: the Papworth experiment (1918-1943) revisited.
abstract: BACKGROUND
  There is consensus on the need to address social determinants of tuberculosis (TB) to achieve TB control, but evidence based on interventions is lacking.
  
  
  OBJECTIVE
  We reanalyzed data from the sociomedical experiment performed at the Papworth Village Settlement in England, where the impact of stable employment and adequate housing and nutrition on the incidence of TB infection and disease in children living with parents with active TB was documented during 1918-1943.
  
  
  METHODS
  Information on 315 children of patients, who lived at Papworth, was abstracted from a published monograph. Overall and age-specific occurrence of TB infection, disease, and deaths among children born in the settlement (village-born cohort) were compared with those of children born outside and admitted later (admitted cohort) to Papworth.
  
  
  RESULTS
  The annual risks of infection in the village-born and admitted cohorts were 20 and 24%, respectively. Of 24 children who developed TB disease, only one was village-born. Among children 5 years of age or less, there was zero incidence of TB in the village-born, compared with five cases (1,217/100,000 person-years) among children born outside Papworth. In the admitted cohort, among children 13 years of age and older, the incidence of TB before admission to Papworth was 5,263/100,000 person-years, whereas it was 341/100,000 person-years while living in Papworth.
  
  
  CONCLUSIONS
  At Papworth social interventions including adequate nutrition did not reduce TB transmission but did reduce the incidence of TB disease in children living with parents with active TB. These results are relevant today for prevention of TB in children of patients with active TB, particularly with multidrug-resistant TB in high-burden settings.
authors: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.
authors: Anurag
authors: A
authors: Bhargava
authors: Madhukar
authors: M
authors: Pai
authors: Madhavi
authors: M
authors: Bhargava
authors: Ben J
authors: BJ
authors: Marais
authors: Dick
authors: D
authors: Menzies
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004651:Employment; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005522:Food Services; D006306:Health Surveys; D006798:Housing; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D011314:Preventive Health Services / Q000379:methods* / Q000458:organization & administration; D012946:Social Welfare; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D055815:Young Adult