title: Source Case Investigation for Children with TB Disease in Pune, India.
abstract: Setting. Contact tracing is broadly encouraged for tuberculosis (TB) control. In many high-burden countries, however, little effort is made to identify contacts of newly diagnosed TB patients. This failure puts children, many of whom live in poor crowded communities, at special risk. Objectives. To perform source-case investigations for 50 pediatric TB cases in Pune, India. Design. A descriptive cross-sectional observational study of pediatric TB cases < 5 years of age. Information was collected about the index case and household contacts. Results. In 15 (30%) of the 50 pediatric index cases, the household contained known TB contacts, 14 (86%) of whom were adults. Prior to their own diagnosis of TB, only one of the 15 pediatric index cases who met criteria for isoniazid preventive therapy received it. The index cases with known household TB contacts had a longer delay in initiating TB treatment than those without TB contacts (17.5 versus 2 days; P = 0.03). Use of contact tracing identified 14 additional household TB suspects, 8 (57%) of whom were children. Conclusions. This study identified missed opportunities for TB prevention, as contact tracing is poorly implemented in resource-limited countries, like India. Further strategies to improve the implementation of TB prevention, especially in young children, are urgently needed.
authors.affiliation: University of Michigan Medical School, 1301 Catherine Road, Ann Arbor, MI 48109, USA.
authors.forename: Debalina
authors.initials: D
authors.lastname: De
authors.affiliation: Byramjee Jeejeebhoy Medical College/Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India.
authors.forename: Aarti
authors.initials: A
authors.lastname: Kinikar
authors.affiliation: Byramjee Jeejeebhoy Medical College/Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India.
authors.forename: P S
authors.initials: PS
authors.lastname: Adhav
authors.affiliation: Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India.
authors.forename: Sunanda
authors.initials: S
authors.lastname: Kamble
authors.affiliation: Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India.
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sahoo
authors.affiliation: Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India.
authors.forename: Hari
authors.initials: H
authors.lastname: Koli
authors.affiliation: Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India.
authors.forename: Savita
authors.initials: S
authors.lastname: Kanade
authors.affiliation: Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India ; Division of Infectious Diseases, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Vidya
authors.initials: V
authors.lastname: Mave
authors.affiliation: Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India.
authors.forename: Nishi
authors.initials: N
authors.lastname: Suryavanshi
authors.affiliation: Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India ; Division of Infectious Diseases, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Gupte
authors.affiliation: Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India ; Division of Infectious Diseases, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Division of Infectious Diseases, Weill Cornell Medical College, 525 E 68th Street, New York, NY 10021, USA.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Mathad