title: Risk of infection and disease with Mycobacterium tuberculosis among children identified through prospective community-based contact screening in Indonesia.
abstract: OBJECTIVE
  To identify characteristics of the child contact, index case or environment that are associated with infection or tuberculosis in child contacts in an urban community in Indonesia.
  
  
  METHODS
  Children who were close contacts of an index case with pulmonary tuberculosis were screened for infection and disease in Yogyakarta, Indonesia from August 2010 to December 2012. Data of the index case and child were collected prospectively, and all child contacts had clinical assessment, tuberculin skin test (TST) and chest X-ray performed. Those with clinically suspected tuberculosis also had sputum examined by Xpert MTB/RIF and culture. Child contacts were managed according to national guidelines, followed for 12 months and had a final classification of either tuberculosis 'disease', latent tuberculous infection (LTBI) or 'exposed only'.
  
  
  RESULTS
  About 269 children of 141 index cases were investigated. Final classification was tuberculosis in 25 (9%) and LTBI in 121 (45%). The risk of infection was significantly greater if the source case was female (AOR 1.7; 95% CI: 1.0-2.8), had sputum smear-positive tuberculosis (AOR 3.0; 95% CI 1.5-6.0) or slept in the same room (AOR 1.7, 95% CI 1.0-2.9). A positive TST was independently associated with a diagnosis of tuberculosis (AOR 7.3; 95% CI 2.4-22).
  
  
  CONCLUSIONS
  This study highlights the high risk and the risk factors associated with tuberculosis and LTBI among child contacts in Indonesia.
authors.affiliation: Department of Pediatrics, Dr. Sardjito Hospital/Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia; Centre for International Child Health, Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia.
authors.forename: Rina
authors.initials: R
authors.lastname: Triasih
authors.forename: Colin
authors.initials: C
authors.lastname: Robertson
authors.forename: Trevor
authors.initials: T
authors.lastname: Duke
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D016358:Contact Tracing; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission*
keywords: child; contact; contacto; disease; enfant; enfermedad; infección; infection; maladie; niño; riesgo; risk; risque; tuberculose; tuberculosis