title: Long term follow-up of drug resistant and drug susceptible tuberculosis contacts in a Low incidence setting.
abstract: BACKGROUND
  Studies examining the transmission of multidrug-resistant tuberculosis (MDR-TB) strains have yielded conflicting results.
  
  
  METHODS
  We examined transmission of MDR-TB strains using contact tracing data from a low incidence setting. Contacts of MDR-TB cases diagnosed in British Columbia, Canada, from 1990-2008 were identified through a provincial tuberculosis (TB) registry. Tuberculin skin test (TST) results and TB disease incident rates were determined for contacts. For comparison, TB disease incident rates and TST results were measured in close contacts of isoniazid mono-resistant (HMR-TB) and drug susceptible TB (DS-TB) cases.
  
  
  RESULTS
  Of 89 identified close contacts of MDR-TB patients, 5 patients (6%) developed TB disease and 42 (47%) were TST positive. The incidence rate of TB disease (3%, p = 0.31) and TST positivity (49%, p = 0.82) were similar in contacts of HMR-TB cases. Compared with MDR-TB contacts, DS-TB contacts had lower incidence rate of TB disease (2%, p = 0.04) and TST positivity (32%, p < 0.01). All MDR-TB contacts with culture positive TB diagnosed in follow-up were drug-susceptible; three of six HMR-TB contacts with culture positive TB were HMR-TB. Multivariate analysis demonstrated that contact with MDR-TB (adjusted OR 1.72; 95%CI 1.05-2.81) and HMR-TB (adjusted OR 1.99; 95%CI 1.48-2.67) was associated with TST positivity. In addition, adult age, male gender, BCG positivity, source case sputum smear positivity, foreign birth and fewer contacts per source case were significantly associated with TST positivity in the multivariate model.
  
  
  CONCLUSIONS
  Contacts of MDR-TB and HMR-TB patients in a low incidence setting show high rates of TST positivity and TB disease but low rates of drug resistance.
authors.affiliation: Division of Tuberculosis Control, British Columbia Centre for Disease Control, Vancouver, BC, Canada. james.johnston@bccdc.ca
authors.forename: James
authors.initials: J
authors.lastname: Johnston
authors.forename: Andrew
authors.initials: A
authors.lastname: Admon
authors.forename: Amir
authors.initials: A
authors.lastname: Ibrahim
authors.forename: Kevin
authors.initials: K
authors.lastname: Elwood
authors.forename: Patrick
authors.initials: P
authors.lastname: Tang
authors.forename: Victoria
authors.initials: V
authors.lastname: Cook
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification*; D014374:Tuberculin Test; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000635:transmission*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents