title: A prospective evaluation of the symptom-based screening approach to the management of children who are contacts of tuberculosis cases.
abstract: BACKGROUND
  Child tuberculosis contact screening and management can enhance case finding and prevent tuberculosis disease. It is universally recommended but rarely implemented in tuberculosis-endemic settings. The World Health Organization (WHO)-recommended symptom-based screening approach could improve implementation but has not been prospectively evaluated.
  
  
  METHODS
  We conducted a cohort study of children who were close contacts of pulmonary tuberculosis patients in Indonesia from August 2010 to December 2012. We performed clinical assessment, tuberculin skin test, and chest radiography in all eligible children irrespective of symptoms at baseline. Mycobacterial culture and Xpert MTB/RIF assay were performed on sputum from children with persistent symptoms of suspected tuberculosis. Children were managed according to WHO guidelines and were prospectively followed for 12 months.
  
  
  RESULTS
  A total of 269 child contacts of 140 index cases were evaluated. At baseline, 21 (8%) children had tuberculosis diagnosed clinically; an additional 102 (38%) had evidence of infection without disease. Of children with any tuberculosis-related symptoms at baseline, 21% had tuberculosis diagnosed compared with none of the asymptomatic children (P < .001). After 12 months of follow-up, none of the 99 eligible young child contacts (<5 years) who received isoniazid preventive therapy (IPT) had developed disease compared with 4 of 149 (2.6%) asymptomatic older children who did not receive IPT.
  
  
  CONCLUSIONS
  Symptom-based screening is an effective and simple approach to child tuberculosis contact management that can be implemented at the primary healthcare level.
authors.affiliation: Department of Pediatrics, Dr Sardjito Hospital and Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia Centre for International Child Health, University of Melbourne Department of Paediatrics.
authors.forename: Rina
authors.initials: R
authors.lastname: Triasih
authors.affiliation: Department of Respiratory Medicine Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Colin F
authors.initials: CF
authors.lastname: Robertson
authors.affiliation: Centre for International Child Health, University of Melbourne Department of Paediatrics Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Trevor
authors.initials: T
authors.lastname: Duke
authors.affiliation: Centre for International Child Health, University of Melbourne Department of Paediatrics Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques; D002648:Child; D002675:Child, Preschool; D015510:Clinical Medicine / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007214:Indonesia; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D009161:Mycobacterium / Q000302:isolation & purification; D011446:Prospective Studies; D013902:Radiography, Thoracic; D013183:Sputum / Q000382:microbiology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*
chemical_list: D000995:Antitubercular Agents
keywords: child; contact screening; preventive therapy; tuberculosis