ArticleThe Lancet. Respiratory medicine2019
Paediatric tuberculosis transmission outside the household: challenging historical paradigms to inform future public health strategies.
Article in The Lancet. Respiratory medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 6 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
60 citing papers in PubMed, 6 syntheses or guidelines pooled it, 79 citations in OpenAlex.
- Low-complexity manual nucleic acid amplification tests for pulmonary tuberculosis in children.The Cochrane database of systematic reviews · 2025Pooled it
- Mycobacterium tuberculosis Infection in School Contacts of Tuberculosis Cases: A Systematic Review and Meta-Analysis.The American journal of tropical medicine and hygiene · 2024Pooled it
- Number Needed to Screen for Tuberculosis Disease Among Children: A Systematic Review.Pediatrics · 2023Pooled it
- Concordance of Drug-resistance Profiles Between Persons With Drug-resistant Tuberculosis and Their Household Contacts: A Systematic Review and Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Pooled it
- Screening tests for active pulmonary tuberculosis in children.The Cochrane database of systematic reviews · 2021Pooled it
- The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis.Lancet (London, England) · 2020Pooled it
- Trial
- A Randomized Controlled Trial of Isoniazid to Prevent Mycobacterium tuberculosis Infection in Kenyan Human Immunodeficiency Virus-Exposed Uninfected Infants.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Trial
- Trial
- Comparison of phylogenetic metrics of transmission between symptomatic and asymptomatic tuberculosis in individuals who were incarcerated in Brazil in 2008-24: a retrospective genomic epidemiology study.The Lancet. Microbe · 2026Article
- Within-household transmission risk of pulmonary tuberculosis in the era of universal antiretroviral therapy.medRxiv : the preprint server for health sciences · 2026Article
- Mycobacterium tuberculosis transmission from tuberculosis patients with and without recognized symptoms: a case-contact study in eastern China.Nature communications · 2026Article
- Article
- Mycobacterium tuberculosis-Specific CFP-10/ESAT-6 CD4 and CD8 T-Cell Non-IFN-γ+ Responses Are Common in Young Kenyan Children Despite Low Reported Tuberculosis Exposure.The Journal of infectious diseases · 2026Article
- Heterogeneity in Mycobacterium tuberculosis immunoreactivity in young children in Blantyre, Malawi: A community-based survey.PLOS global public health · 2026Article
- Detect early TB infection, evaluate contacts for TB (DETEC-TB) - a protocol for a prospective cohort study on active case finding for tuberculosis disease and tuberculosis infection source tracing.BMC infectious diseases · 2025Article
- Mycobacterium tuberculosis transmission in China during the COVID-19 pandemic period (2020-2021) compared with the pre-pandemic period (2017-2019).Nature communications · 2025Article
- Comparison of phylogenetic metrics of transmission in symptomatic and asymptomatic tuberculosis.medRxiv : the preprint server for health sciences · 2025Article
- Estimating childhood tuberculosis incidence and under-reporting in Gedeo Zone, Ethiopia: a Bayesian hidden Markov model.IJID regions · 2025Article
- Prediction models for Mtb infection among adolescent and adult household contacts in high tuberculosis incidence settings.PLOS global public health · 2025Article
Corrections and comments
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Authors and funding
12 authors at 8 institutions in 5 countries.
Funding
Abstract
Tuberculosis is a major cause of death and disability among children globally, yet children have been neglected in global tuberculosis control efforts. Historically, tuberculosis in children has been thought of as a family disease, and because of this, household contact tracing of children after identification of an adult tuberculosis case has been emphasised as the principal public health intervention. However, the population-level effect of household contact tracing is predicated on the assumption that most paediatric tuberculosis infections are acquired within the household. In this Personal View, we focus on accumulating scientific evidence indicating that the majority of Mycobacterium tuberculosis transmission to children in high-burden settings occurs in the community, outside of households in which a person has tuberculosis. We estimate the population-attributable fraction of M tuberculosis transmission to children due to household exposures to be between 10% and 30%. M tuberculosis transmission from the household was low (<30%) even in children younger than age 5 years. We propose that an effective public health response to childhood tuberculosis requires comprehensive, community-based interventions, such as active surveillance in select settings, rather than contact tracing alone. Importantly, the historical paradigm that most paediatric transmission occurs in households should be reconsidered on the basis of the scientific knowledge presented.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.