Decreasing household contribution to TB transmission with age: a retrospective geographic analysis of young people in a South African township

BMC Infectious Diseases

Robin Wood¹  Namee Lee²  Carl Morrow¹  Linda-Gail Bekker¹  Keren Middelkoop¹ 

[1] Department of Medicine, University of Cape Town, Cape Town, South Africa;Human Biology Department and Cell & Systems Biology Department, University of Toronto, Toronto, Canada

关键词: Adolescents;    Transmission;    Infection;    Tuberculosis;   

Others  :  1134035
DOI  :  10.1186/1471-2334-14-221

 received in 2013-10-22, accepted in 2014-04-10,  发布年份 2014

【 摘 要 】

Background

Tuberculosis (TB) transmission rates are exceptionally high in endemic TB settings. Adolescence represents a period of increasing TB infection and disease but little is known as to where adolescents acquire TB infection. We explored the relationship between residential exposure to adult TB cases and infection in children and adolescents in a South African community with high burdens of TB and HIV.

Methods

TB infection data were obtained from community, school-based tuberculin skin test (TST) surveys performed in 2006, 2007 and 2009. A subset of 2007 participants received a repeat TST in 2009, among which incident TB infections were identified. Using residential address, all adult TB cases notified by the community clinic between 1996 and 2009 were cross-referenced with childhood and adolescent TST results. Demographic and clinic data including HIV status were abstracted for TB cases. Multivariate logistic regression models examined the association of adult TB exposure with childhood and adolescent prevalent and incident TB infection.

Results

Of 1,100 children and adolescents included in the prevalent TB infection analysis, 480 (44%) were TST positive and 651 (59%) were exposed to an adult TB case on their residential plot. Prevalent TB infection in children aged 5–9 and 10–14 years was positively associated with residential exposure to an adult TB case (odds ratio [OR]:2.0; 95% confidence interval [CI]: 1.1-3.6 and OR:1.5; 95% CI: 1.0-2.3 respectively), but no association was found in adolescents ≥15 years (OR:1.4; 95% CI: 0.9-2.0). HIV status of adult TB cases was not associated with TB infection (p = 0.62). Of 67 previously TST negative children, 16 (24%) converted to a positive TST in 2009. These incident infections were not associated with residential exposure to an adult TB case (OR: 1.9; 95% CI: 0.5-7.3).

Conclusions

TB infection among young children was strongly associated with residential exposure to an adult TB case, but prevalent and incident TB infection in adolescents was not associated with residential exposure. The HIV-status of adult TB cases was not a risk factor for transmission. The high rates of TB infection and disease among adolescents underscore the importance of identifying where infection occurs in this age group.

【 授权许可】

   
2014 Middelkoop et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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