title: An evaluation of tuberculosis contact investigations against national standards.
abstract: Contact tracing is a key element in England's 2015 collaborative TB strategy, although proposed indicators of successful contact tracing remain undescribed.
  
  
  
  We conducted descriptive and multivariable analyses of contact tracing of TB cases in London between 1 July 2012 and 31 December 2015 using cohort review data from London's TB Register, identifying characteristics associated with improved indicators and yield.
  
  
  
  Of the pulmonary TB cases notified, 60% (2716/4561) had sufficient information for inclusion. Of these, 91% (2481/2716) had at least 1 contact (median: 4/case (IQR: 2-6)) identified, with 86% (10 251/11 981) of these contacts evaluated. 4.1% (177/4328), 1.3% (45/3421) and 0.70% (51/7264) of evaluated contacts of pulmonary smear-positive, pulmonary smear-negative and non-pulmonary cases, respectively, had active disease. Cases who were former prisoners or male were less likely to have at least one contact identified than those never imprisoned or female, respectively. Cases diagnosed at clinics with more directly observed therapy or social workers were more likely to have one or more contacts identified. Contacts screened at a different clinic to their index case or of male index cases were less likely to be evaluated than those screened at the same clinic or of women, respectively; yield of active disease was similar by sex. 10% (490/4850) of evaluated child contacts had latent TB infection.
  
  
  
  These are the first London-wide estimates of TB contact tracing indicators which are important for monitoring the strategy's success and informing risk assessment of index cases. Understanding why differences in indicators occur between groups could improve contact tracing outcomes.
authors.affiliation: TB Modelling Group, TB Centre and CMMID, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.|Statistics, Modelling and Economics Department, Public Health England, London, UK.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Cavany
authors.affiliation: TB Modelling Group, TB Centre and CMMID, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Sumner
authors.affiliation: TB Modelling Group, TB Centre and CMMID, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.|Statistics, Modelling and Economics Department, Public Health England, London, UK.
authors.forename: Emilia
authors.initials: E
authors.lastname: Vynnycky
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London , UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Flach
authors.affiliation: TB Modelling Group, TB Centre and CMMID, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: White
authors.affiliation: Respiratory Diseases Department, Public Health England, London, UK.
authors.forename: H Lucy
authors.initials: HL
authors.lastname: Thomas
authors.affiliation: Field Epidemiology Services, Public Health England, London, UK.|Department of Infection and Population Health, University College London, London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Maguire
authors.affiliation: Field Epidemiology Services, Public Health England, London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D016358:Contact Tracing / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008131:London / Q000453:epidemiology; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission; D055815:Young Adult
keywords: Tuberculosis