The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64577

Patrick K. Moonan, MPH¹, Marco Marruffo, MD, MS¹, Manuel Bayona, MD, PhD¹, Behzad Sahbazian, DO², and Stephen E. Weis, DO². (1) Department of Epidemiology, University of North Texas Health Science Center - Fort Worth, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, (2) Department of Internal Medicine, Texas College of Osteopathic Medicine, 3500 Camp Bowie Blvd., Fort Worth, TX 76107

BACKGROUND: Childhood tuberculosis (TB) is an indictor of current community transmission and provides a unique opportunity to observe and evaluate the effectiveness of prevention strategies. Associate or source case investigations are standard practice in low-prevalent communities in the United States and are recommended by the Center for Disease Control and Prevention and American Academy of Pediatrics. However, the efficacy of associate investigations has recently been questioned. OBJECTIVE: This study was designed to determine the relative yield of childhood associate and adult contact investigations. METHODS: The authors compared the yeild of tuberculosis from associate investigations conducted for non-BCG immunized preschool tuberculin skin test reactors to adult contact investigations reported from January 1, 1999, through December 31, 2001. Latent tuberculosis infection (LTBI) was defined as an asymptomatic contact with tuberculin skin test (TST) of at least 5 mm and normal chest xray. A secondary case was a contact with clinical evidence supporting active TB disease. Yield ratios were calculated to compare the ability of childhood associate investigations and adult contact investigations to find LTBI and secondary TB cases. RESULTS: Childhood investigations were nearly 18 times more likely (RR = 17.9; 95% CI: 10.3-31.3) to discover secondary TB cases, and 2.3 times more likely (RR = 2.3; 95% CI: 1.9-2.7) to find LTBI in contacts when compared to adult investigations. CONCLUSIONS: Associate investigations of non-BCG immunized preschool children are an effective method for discovering additional TB cases and LTBI in low-prevalence areas.

Learning Objectives:

• At the conclusion of the session, the participant will be able to:
• Articulate the rational for conducting associate investigations in children with positive skin tests
• Articulate the rational for limiting investigations to children under the age of 5 years and who are not BCG immunized

Keywords: TB, Pediatrics

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.