Egere U, Togun T, Sillah A, Mendy F, Otu J, Hoelscher M, Heinrich N, Hill P C, Kampmann B
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia.
Int J Tuberc Lung Dis. 2017 Jan 1;21(1):46-52. doi: 10.5588/ijtld.16.0289.
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.
冈比亚的大斑珠尔地区。
确定涂片阳性肺结核成人患者的儿童接触者中同时存在的结核病（TB）情况。
对直系家庭和大院中年龄小于15岁的儿童接触者进行前瞻性登记，并使用筛查问卷和结核菌素皮肤试验（TST）对其进行结核病评估。对有症状和/或TST阳性（≥10mm）的接触者进行进一步调查。
在4042名接受症状筛查和TST的儿童接触者中，3339名（82.6%）被诊断为接触过结核但未感染，639名（15.8%）为潜伏感染，64名（1.6%）同时存在结核病。在这64例结核病例中，50例（78.1%）来自索引病例的直系家庭，14例（21.9%）来自同一大院。在27例无症状但TST阳性且被诊断为结核病的儿童中，7例经微生物学确诊。结核病例的中位年龄为4.4岁（四分位间距1.9 - 6.9）；53.1%的患者年龄小于5岁。在4042名儿童接触者中，206名（5%）与索引病例同床睡觉；所有结核病例中有28.1%发生在该组。仅靠症状筛查只能检测到57.8%的同时存在的病例。
在我们的社区环境中，如果接触者追踪仅限于症状筛查且仅涉及直系家庭，那么儿童接触者中几乎一半的同时存在的结核病将会漏诊。
