Yield of contact investigations in households of patients with drug-resistant tuberculosis: systematic review and meta-analysis.
Contact investigations among individuals living with drug-susceptible tuberculosis patients (source cases) have shown a high yield of tuberculosis disease and latent tuberculosis, but the yield of such investigations in households of drug-resistant tuberculosis source cases is unknown. In this systematic review and meta-analysis, we found 25 studies that evaluated a median of 111 (interquartile range, 21-302) household contacts of drug-resistant tuberculosis source cases. The pooled yield was 7.8% (95% CI, 5.6%-10.0%) for active tuberculosis and 47.2% (95% CI, 30.0%-61.4%) for latent tuberculosis, although there was significant statistical heterogeneity (P < .0001). More than 50% of secondary cases with drug susceptibility test results were concordant with those of the source case. Among studies that followed household members, the majority of secondary cases were detected within 1 year of the source case's diagnosis. Household contact investigation around drug-resistant tuberculosis patients is a high-yield intervention for detection of drug-resistant tuberculosis and prevention of ongoing transmission.
Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
N Sarita
NS
Shah
Courtney M
CM
Yuen
Moonseong
M
Heo
Arielle W
AW
Tolman
Mercedes C
MC
Becerra
D016358:Contact Tracing; D005191:Family Characteristics; D006801:Humans; D015995:Prevalence; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000382:microbiology* / Q000635:transmission
contact; drug resistance; transmission; tuberculosis