title: Preventing the spread of multidrug-resistant tuberculosis and protecting contacts of infectious cases.
abstract: Prevention of multidrug-resistant and extensively drug-resistant tuberculosis (MDR/XDR-TB) is a top priority for global TB control, given the need to limit epidemic spread and considering the high cost, toxicity and poor treatment outcomes with available therapies. We performed a systematic literature review to evaluate the evidence for strategies to reduce MDR/XDR-TB transmission and disease progression. Rapid detection and timely initiation of effective treatment is critical to rendering MDR/XDR-TB cases non-infectious. The scale-up of rapid molecular testing has transformed the capacity of high-incidence settings to identify and treat patients with MDR/XDR-TB. Optimized infection control measures in hospitals and clinics are critical to protect other patients and healthcare workers, whereas creative measures to reduce transmission within community hotspots require consideration. Targeted screening of high-risk communities may enhance early case-detection and limit the spread of MDR/XDR-TB. Among infected contacts, preventive therapy promises to reduce the risk of disease progression. This is supported by observational cohort studies, but randomized trials are urgently needed to confirm these observations and guide policy formulation. Substantial investment in MDR/XDR-TB prevention and care will be critical if the ambitious global goal of TB elimination is to be realized.
authors: Sydney Medical School, University of Sydney, Sydney, Australia. Electronic address: greg.fox@sydney.edu.au.
authors: G J
authors: GJ
authors: Fox
authors: Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors: H S
authors: HS
authors: Schaaf
authors: Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
authors: A
authors: A
authors: Mandalakas
authors: Paediatric Infectious Disease Unit, Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy.
authors: E
authors: E
authors: Chiappini
authors: University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
authors: A
authors: A
authors: Zumla
authors: The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia.
authors: B J
authors: BJ
authors: Marais
mesh_terms: D003140:Communicable Disease Control / Q000379:methods* / Q000458:organization & administration*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D042241:Early Diagnosis; D014943:Global Health; D006801:Humans; D008403:Mass Screening / Q000379:methods; D055502:Secondary Prevention; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission*
keywords: Elimination;; Household contacts;; Latent tuberculosis;; Mycobacterium tuberculosis;; Transmission; Tuberculosis, multidrug-resistant;