Identifying children with tuberculosis among household contacts in The Gambia.
Greater Banjul Area of the Gambia.



To identify co-prevalent tuberculosis (TB) among child contacts of adults with smear-positive TB.



Child contacts aged <15 years in the immediate household and compound were prospectively enrolled and evaluated for TB disease using screening questionnaires and the tuberculin skin test (TST). Symptomatic and/or TST-positive (10 mm) contacts were further investigated.



Of 4042 child contacts who underwent symptom screening and TST, 3339 (82.6%) were diagnosed as TB-exposed but not infected, 639 (15.8%) were latently infected and 64 (1.6%) had co-prevalent TB. Of the 64 TB cases, 50 (78.1%) were from within the immediate household of the index case, and 14 (21.9%) from within the same compound. Of the 27 asymptomatic but TST-positive children diagnosed with TB, 7 were microbiologically confirmed. The median age of the TB cases was 4.4 years (interquartile range 1.9-6.9); 53.1% were aged <5 years. Of the 4042 child contacts, 206 (5%) slept in the same bed as the index case; 28.1% of all TB cases occurred in this group. Symptom screening alone would have detected only 57.8% of the co-prevalent cases.



In our community setting, if contact tracing is restricted to symptom screening and immediate households only, nearly half of all co-prevalent TB disease in child contacts would be missed.
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
U
U
Egere
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
T
T
Togun
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia.
A
A
Sillah
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia.
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F
Mendy
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia.
J
J
Otu
Center for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, German Center for Infection Research, Munich Partner Site, Munich, Germany.
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M
Hoelscher
Center for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, German Center for Infection Research, Munich Partner Site, Munich, Germany.
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N
Heinrich
Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
P C
PC
Hill
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia; Centre for International Child Health, Academic Department of Paediatrics, St Mary's Campus, Imperial College London, London, UK.
B
B
Kampmann
D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D024881:Drug Resistance, Bacterial; D005191:Family Characteristics; D005260:Female; D005500:Follow-Up Studies; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D011795:Surveys and Questionnaires; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000635:transmission*
D000995:Antitubercular Agents; D007538:Isoniazid