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@article{Saunders:2017:10.1016/S1473-3099(17)30447-4,
author = {Saunders, MJ and Wingfield, T and Tovar, MA and Baldwin, MR and Datta, S and Zevallos, K and Montoya, R and Valencia, TR and Friedland, JS and Moulton, LH and Gilman, RH and Evans, CA},
doi = {10.1016/S1473-3099(17)30447-4},
journal = {Lancet Infectious Diseases},
pages = {1190--1199},
title = {A score to predict and stratify risk of tuberculosis in adult contacts of tuberculosis index cases: a prospective derivation and external validation cohort study},
url = {http://dx.doi.org/10.1016/S1473-3099(17)30447-4},
volume = {17},
year = {2017}
}

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TY  - JOUR
AB  - BACKGROUND: Contacts of tuberculosis index cases are at increased risk of developing tuberculosis. Screening, preventive therapy, and surveillance for tuberculosis are underused interventions in contacts, particularly adults. We developed a score to predict risk of tuberculosis in adult contacts of tuberculosis index cases. METHODS: In 2002-06, we recruited contacts aged 15 years or older of index cases with pulmonary tuberculosis who lived in desert shanty towns in Ventanilla, Peru. We followed up contacts for tuberculosis until February, 2016. We used a Cox proportional hazards model to identify index case, contact, and household risk factors for tuberculosis from which to derive a score and classify contacts as low, medium, or high risk. We validated the score in an urban community recruited in Callao, Peru, in 2014-15. FINDINGS: In the derivation cohort, we identified 2017 contacts of 715 index cases, and median follow-up was 10·7 years (IQR 9·5-11·8). 178 (9%) of 2017 contacts developed tuberculosis during 19147 person-years of follow-up (incidence 0·93 per 100 person-years, 95% CI 0·80-1·08). Risk factors for tuberculosis were body-mass index, previous tuberculosis, age, sustained exposure to the index case, the index case being in a male patient, lower community household socioeconomic position, indoor air pollution, previous tuberculosis among household members, and living in a household with a low number of windows per room. The 10-year risks of tuberculosis in the low-risk, medium-risk, and high-risk groups were, respectively, 2·8% (95% CI 1·7-4·4), 6·2% (4·8-8·1), and 20·6% (17·3-24·4). The 535 (27%) contacts classified as high risk accounted for 60% of the tuberculosis identified during follow-up. The score predicted tuberculosis independently of tuberculin skin test and index-case drug sensitivity results. In the external validation cohort, 65 (3%)
AU  - Saunders,MJ
AU  - Wingfield,T
AU  - Tovar,MA
AU  - Baldwin,MR
AU  - Datta,S
AU  - Zevallos,K
AU  - Montoya,R
AU  - Valencia,TR
AU  - Friedland,JS
AU  - Moulton,LH
AU  - Gilman,RH
AU  - Evans,CA
DO  - 10.1016/S1473-3099(17)30447-4
EP  - 1199
PY  - 2017///
SN  - 1473-3099
SP  - 1190
TI  - A score to predict and stratify risk of tuberculosis in adult contacts of tuberculosis index cases: a prospective derivation and external validation cohort study
T2  - Lancet Infectious Diseases
UR  - http://dx.doi.org/10.1016/S1473-3099(17)30447-4
UR  - http://hdl.handle.net/10044/1/51285
VL  - 17
ER  -

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