ArticlePloS one2017
School and household tuberculosis contact investigations in Swaziland: Active TB case finding in a high HIV/TB burden setting.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Screening tests for active pulmonary tuberculosis in children.The Cochrane database of systematic reviews · 2021Pooled it
- The role of Xpert MTB/RIF using bronchoalveolar lavage fluid in active screening: insights from a tuberculosis outbreak in a junior school in eastern China.Frontiers in public health · 2023Article
- Tuberculosis: First in Flight.American journal of respiratory and critical care medicine · 2022Article
- Whole-Genome Sequencing and Epidemiological Investigation of Tuberculosis Outbreaks in High Schools in Hunan, China.Infection and drug resistance · 2022Article
- Child Contact Case Management-A Major Policy-Practice Gap in High-Burden Countries.Pathogens (Basel, Switzerland) · 2021Review
- Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People.Tropical medicine and infectious disease · 2021Review
- Distinct Risk Factors for Clinical and Bacteriologically Confirmed Tuberculosis among Child Household Contacts in a High-Burden Setting.The American journal of tropical medicine and hygiene · 2020Article
- Quality matters: Redefining child TB care with an emphasis on quality.Journal of clinical tuberculosis and other mycobacterial diseases · 2019Article
- A tuberculosis school outbreak in China, 2018: reaching an often overlooked adolescent population.Epidemiology and infection · 2019Article
- Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort.BMC public health · 2019Article
- Tuberculosis Transmission in Households and Classrooms of Adolescent Cases Compared to the Community in China.International journal of environmental research and public health · 2018Article
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Authors and funding
10 authors at 2 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInvestigation of household contacts exposed to infectious tuberculosis (TB) is widely recommended by international guidelines to identify secondary cases of TB and limit spread. There is little data to guide the use of contact investigations outside of the household, despite strong evidence that most TB infections occur outside of the home in TB high burden settings. In older adolescents, the majority of infections are estimated to occur in school. Therefore, as part of a project to increase active case finding in Swaziland, we performed school contact investigations following the identification of a student with infectious TB.
methodsThe Butimba Project identified 7 adolescent TB index cases (age 10-20) with microbiologically confirmed disease attending 6 different schools between June 2014 and March 2015. In addition to household contact investigations, Butimba Project staff worked with the Swaziland School Health Programme (SHP) to perform school contact investigations. At 6 school TB screening events, between May and October 2015, selected students underwent voluntary TB screening and those with positive symptom screens provided sputum for TB testing.
resultsAmong 2015 student contacts tested, 177 (9%) screened positive for TB symptoms, 132 (75%) produced a sputum sample, of which zero tested positive for TB. Household contact investigations of the same index cases yielded 40 contacts; 24 (60%) screened positive for symptoms; 19 produced a sputum sample, of which one case was confirmed positive for TB. The odds ratio of developing TB following household vs. school contact exposure was significantly lower (OR 0.0, 95% CI 0.0 to 0.18, P = 0.02) after exposure in school.
conclusionSchool-based contact investigations require further research to establish best practices in TB high burden settings. In this case, a symptom-based screening approach did not identify additional cases of tuberculosis. In comparison, household contact investigations yielded a higher percentage of contacts with positive TB screens and an additional tuberculosis case.
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