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Li, Wei, Bo Zhang, Jianhua Lu, Shihua Liu, Zhiqiang Chang, Cao Peng, Xinghua Liu, et al. "Characteristics of Household Transmission of COVID-19." Clinical Infectious Diseases 71, no. 8 (April 17, 2020): 1943–46. http://dx.doi.org/10.1093/cid/ciaa450.
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Abstract Background Since December 2019, SARS-CoV-2 has extended to most parts of China with >80 000 cases and to at least 100 countries with >60 000 international cases as of 15 March 2020. Here we used a household cohort study to determine the features of household transmission of COVID-19. Methods A total of 105 index patients and 392 household contacts were enrolled. Both index patients and household members were tested by SARS-CoV-2 RT-PCR. Information on all recruited individuals was extracted from medical records and confirmed or supplemented by telephone interviews. The baseline characteristics of index cases and contact patients were described. Secondary attack rates of SARS-CoV-2 to contact members were computed and the risk factors for transmission within the household were estimated. Results Secondary transmission of SARS-CoV-2 developed in 64 of 392 household contacts (16.3%). The secondary attack rate to children was 4% compared with 17.1% for adults. The secondary attack rate to the contacts within the households with index patients quarantined by themselves since onset of symptoms was 0% compared with 16.9% for contacts without quarantined index patients. The secondary attack rate to contacts who were spouses of index cases was 27.8% compared with 17.3% for other adult members in the households. Conclusions The secondary attack rate of SARS-CoV-2 in household is 16.3%. Age of household contacts and spousal relationship to the index case are risk factors for transmission of SARS-CoV-2 within a household. Quarantine of index patients at home since onset of symptoms is useful to prevent the transmission of SARS-Co-2 within a household.
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Hall, JA, RJ Harris, A. Zaidi, SC Woodhall, G. Dabrera, and JK Dunbar. "HOSTED—England’s Household Transmission Evaluation Dataset: preliminary findings from a novel passive surveillance system of COVID-19." International Journal of Epidemiology 50, no. 3 (April 9, 2021): 743–52. http://dx.doi.org/10.1093/ije/dyab057.
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Abstract Background Household transmission of SARS-CoV-2 is an important component of the community spread of the pandemic. Little is known about the factors associated with household transmission, at the level of the case, contact or household, or how these have varied over the course of the pandemic. Methods The Household Transmission Evaluation Dataset (HOSTED) is a passive surveillance system linking laboratory-confirmed COVID-19 cases to individuals living in the same household in England. We explored the risk of household transmission according to: age of case and contact, sex, region, deprivation, month and household composition between April and September 2020, building a multivariate model. Results In the period studied, on average, 5.5% of household contacts in England were diagnosed as cases. Household transmission was most common between adult cases and contacts of a similar age. There was some evidence of lower transmission rates to under-16s [adjusted odds ratios (aOR) 0.70, 95% confidence interval (CI) 0.66–0.74). There were clear regional differences, with higher rates of household transmission in the north of England and the Midlands. Less deprived areas had a lower risk of household transmission. After controlling for region, there was no effect of deprivation, but houses of multiple occupancy had lower rates of household transmission [aOR 0.74 (0.66–0.83)]. Conclusions Children are less likely to acquire SARS-CoV-2 via household transmission, and consequently there was no difference in the risk of transmission in households with children. Households in which cases could isolate effectively, such as houses of multiple occupancy, had lower rates of household transmission. Policies to support the effective isolation of cases from their household contacts could lower the level of household transmission.
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Leng, Trystan, Connor White, Joe Hilton, Adam Kucharski, Lorenzo Pellis, Helena Stage, Nicholas G. Davies, Matt J. Keeling, and Stefan Flasche. "The effectiveness of social bubbles as part of a Covid-19 lockdown exit strategy, a modelling study." Wellcome Open Research 5 (September 10, 2020): 213. http://dx.doi.org/10.12688/wellcomeopenres.16164.1.
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Background: During the coronavirus disease 2019 (COVID-19) lockdown, contact clustering in social bubbles may allow extending contacts beyond the household at minimal additional risk and hence has been considered as part of modified lockdown policy or a gradual lockdown exit strategy. We estimated the impact of such strategies on epidemic and mortality risk using the UK as a case study. Methods: We used an individual based model for a synthetic population similar to the UK, stratified into transmission risks from the community, within the household and from other households in the same social bubble. The base case considers a situation where non-essential shops and schools are closed, the secondary household attack rate is 20% and the initial reproduction number is 0.8. We simulate social bubble strategies (where two households form an exclusive pair) for households including children, for single occupancy households, and for all households. We test the sensitivity of results to a range of alternative model assumptions and parameters. Results: Clustering contacts outside the household into exclusive bubbles is an effective strategy of increasing contacts while limiting the associated increase in epidemic risk. In the base case, social bubbles reduced fatalities by 42% compared to an unclustered increase of contacts. We find that if all households were to form social bubbles the reproduction number would likely increase to above the epidemic threshold of R=1. Strategies allowing households with young children or single occupancy households to form social bubbles increased the reproduction number by less than 11%. The corresponding increase in mortality is proportional to the increase in the epidemic risk but is focussed in older adults irrespective of inclusion in social bubbles. Conclusions: If managed appropriately, social bubbles can be an effective way of extending contacts beyond the household while limiting the increase in epidemic risk.
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Leng, Trystan, Connor White, Joe Hilton, Adam Kucharski, Lorenzo Pellis, Helena Stage, Nicholas G. Davies, Matt J. Keeling, and Stefan Flasche. "The effectiveness of social bubbles as part of a Covid-19 lockdown exit strategy, a modelling study." Wellcome Open Research 5 (March 29, 2021): 213. http://dx.doi.org/10.12688/wellcomeopenres.16164.2.
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Background: During the coronavirus disease 2019 (COVID-19) lockdown, contact clustering in social bubbles may allow extending contacts beyond the household at minimal additional risk and hence has been considered as part of modified lockdown policy or a gradual lockdown exit strategy. We estimated the impact of such strategies on epidemic and mortality risk using the UK as a case study. Methods: We used an individual based model for a synthetic population similar to the UK, stratified into transmission risks from the community, within the household and from other households in the same social bubble. The base case considers a situation where non-essential shops and schools are closed, the secondary household attack rate is 20% and the initial reproduction number is 0.8. We simulate social bubble strategies (where two households form an exclusive pair) for households including children, for single occupancy households, and for all households. We test the sensitivity of results to a range of alternative model assumptions and parameters. Results: Clustering contacts outside the household into exclusive bubbles is an effective strategy of increasing contacts while limiting the associated increase in epidemic risk. In the base case, social bubbles reduced fatalities by 42% compared to an unclustered increase of contacts. We find that if all households were to form social bubbles the reproduction number would likely increase to above the epidemic threshold of R=1. Strategies allowing households with young children or single occupancy households to form social bubbles increased the reproduction number by less than 11%. The corresponding increase in mortality is proportional to the increase in the epidemic risk but is focussed in older adults irrespective of inclusion in social bubbles. Conclusions: If managed appropriately, social bubbles can be an effective way of extending contacts beyond the household while limiting the increase in epidemic risk.
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Loo, Vivian G., Paul Brassard, and Mark A. Miller. "Household Transmission ofClostridium difficileto Family Members and Domestic Pets." Infection Control & Hospital Epidemiology 37, no. 11 (August 8, 2016): 1342–48. http://dx.doi.org/10.1017/ice.2016.178.
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OBJECTIVETo determine the risk ofClostridium difficiletransmission from index cases withC. difficileinfection (CDI) to their household contacts and domestic pets.DESIGNA prospective study from April 2011 to June 2013.SETTINGPatients with CDI from Canadian tertiary care centers.PARTICIPANTSPatients with CDI, their household human contacts, and pets.METHODSEpidemiologic information and stool or rectal swabs were collected from participants at enrollment and monthly for up to 4 months. Pulsed-field gel electrophoresis (PFGE) was performed onC. difficileisolates. Probable transmission was defined as the conversion of aC. difficileculture–negative contact toC. difficileculture–positive contact with a PFGE pattern indistinguishable or closely related to the index case. Possible transmission was defined as a contact with a positiveC. difficileculture at baseline with a strain indistinguishable or closely related to the index case.RESULTSA total of 51 patients with CDI participated in this study; 67 human contacts and 15 pet contacts were included. Overall, 9 human contacts (13.4%) wereC. difficileculture positive; 1 contact (1.5%) developed CDI; and 8 contacts were asymptomatic. Of 67 human contacts, probable transmission occurred in 1 human contact (1.5%) and possible transmission occurred in 5 human contacts (7.5%). Of 15 pet contacts, probable transmission occurred in 3 (20%) and possible transmission occurred in 1 (6.7%).CONCLUSIONSThere was a high proportion ofC. difficileculture positivity at 13.4% among human contacts and asymptomatic carriage of domestic pets reached 26.7%. These results suggest that household transmission ofC. difficilemay be a source of community-associated cases.Infect Control Hosp Epidemiol2016;1–7
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SIMMONS, G., D. MARTIN, J. STEWART, and D. BREMNER. "Carriage of N. lactamica in a population at high risk of meningococcal disease." Epidemiology and Infection 125, no. 1 (August 2000): 99–104. http://dx.doi.org/10.1017/s095026889900415x.
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Carriage of Neisseria lactamica among household contacts of meningococcal disease (MCD) cases was investigated during an epidemic in Auckland, New Zealand. The overall carriage rate for N. lactamica was 10·5% (95% CI 7·4–13·5%) with a peak carriage rate in 2-year-olds of 61·5% (95% CI 26·6–88·1%). Factors associated with a significant (P < 0·05) increase in the likelihood of carriage included runny nose, the number of people per bedroom and youth. Genetic analysis of isolates revealed a striking correlation of strains within the same household but a high level of diversity between households, suggesting that household contact is an important factor in acquisition. For household contacts aged less than 5 years, there was a higher rate of carriage amongst those in contact with MCD cases under 8 years old than for contacts of cases aged 8 years and over. It is likely that development of MCD is a reflection of the nature and intensity of the exposure to a virulent strain of N. meningitidis, coupled with an absence of host resistance among those individuals not carrying N. lactamica.
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Davis, J. Lucian, Patricia Turimumahoro, Amanda J. Meyer, Irene Ayakaka, Emma Ochom, Joseph Ggita, David Mark, et al. "Home-based tuberculosis contact investigation in Uganda: a household randomised trial." ERJ Open Research 5, no. 3 (July 2019): 00112–2019. http://dx.doi.org/10.1183/23120541.00112-2019.
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IntroductionThe World Health Organization (WHO) recommends household tuberculosis (TB) contact investigation in low-income countries, but most contacts do not complete a full clinical and laboratory evaluation.MethodsWe performed a randomised trial of home-based, SMS-facilitated, household TB contact investigation in Kampala, Uganda. Community health workers (CHWs) visited homes of index patients with pulmonary TB to screen household contacts for TB. Entire households were randomly allocated to clinic (standard-of-care) or home (intervention) evaluation. In the intervention arm, CHWs offered HIV testing to adults; collected sputum from symptomatic contacts and persons living with HIV (PLWHs) if ≥5 years; and transported sputum for microbiologic testing. CHWs referred PLWHs, children <5 years, and anyone unable to complete sputum testing to clinic. Sputum testing results and/or follow-up instructions were returned by automated SMS texts. The primary outcome was completion of a full TB evaluation within 14 days; secondary outcomes were TB and HIV diagnoses and treatments among screened contacts.ResultsThere were 471 contacts of 190 index patients allocated to the intervention and 448 contacts of 182 index patients allocated to the standard-of-care. CHWs identified 190/471 (40%) intervention and 213/448 (48%) standard-of-care contacts requiring TB evaluation. In the intervention arm, CHWs obtained sputum from 35/91 (39%) of sputum-eligible contacts and SMSs were sent to 95/190 (50%). Completion of TB evaluation in the intervention and standard-of-care arms at 14 days (14% versus 15%; difference −1%, 95% CI −9% to 7%, p=0.81) and yields of confirmed TB (1.5% versus 1.1%, p=0.62) and new HIV (2.0% versus 1.8%, p=0.90) diagnoses were similar.ConclusionsHome-based, SMS-facilitated evaluation did not improve completion or yield of household TB contact investigation, likely due to challenges delivering the intervention components.
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KLICK, B., H. NISHIURA, G. M. LEUNG, and B. J. COWLING. "Optimal design of studies of influenza transmission in households. II: Comparison between cohort and case-ascertained studies." Epidemiology and Infection 142, no. 4 (July 5, 2013): 744–52. http://dx.doi.org/10.1017/s0950268813001623.
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SUMMARYBoth case-ascertained household studies, in which households are recruited after an ‘index case’ is identified, and household cohort studies, where a household is enrolled before the start of the epidemic, may be used to test and estimate the protective effect of interventions used to prevent influenza transmission. A simulation approach parameterized with empirical data from household studies was used to evaluate and compare the statistical power of four study designs: a cohort study with routine virological testing of household contacts of infected index case, a cohort study where only household contacts with acute respiratory illness (ARI) are sampled for virological testing, a case-ascertained study with routine virological testing of household contacts, and a case-ascertained study where only household contacts with ARI are sampled for virological testing. We found that a case-ascertained study with ARI-triggered testing would be the most powerful design while a cohort design only testing household contacts with ARI was the least powerful. Sensitivity analysis demonstrated that these conclusions varied by model parameters including the serial interval and the risk of influenza virus infection from outside the household.
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Goeyvaerts, Nele, Eva Santermans, Gail Potter, Andrea Torneri, Kim Van Kerckhove, Lander Willem, Marc Aerts, Philippe Beutels, and Niel Hens. "Household members do not contact each other at random: implications for infectious disease modelling." Proceedings of the Royal Society B: Biological Sciences 285, no. 1893 (December 12, 2018): 20182201. http://dx.doi.org/10.1098/rspb.2018.2201.
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Airborne infectious diseases such as influenza are primarily transmitted from human to human by means of social contacts, and thus easily spread within households. Epidemic models, used to gain insight into infectious disease spread and control, typically rely on the assumption of random mixing within households. Until now, there has been no direct empirical evidence to support this assumption. Here, we present the first social contact survey specifically designed to study contact networks within households. The survey was conducted in Belgium (Flanders and Brussels) from 2010 to 2011. We analysed data from 318 households totalling 1266 individuals with household sizes ranging from two to seven members. Exponential-family random graph models (ERGMs) were fitted to the within-household contact networks to reveal the processes driving contact between household members, both on weekdays and weekends. The ERGMs showed a high degree of clustering and, specifically on weekdays, decreasing connectedness with increasing household size. Furthermore, we found that the odds of a contact between older siblings and between father and child are smaller than for any other pair. The epidemic simulation results suggest that within-household contact density is the main driver of differences in epidemic spread between complete and empirical-based household contact networks. The homogeneous mixing assumption may therefore be an adequate characterization of the within-household contact structure for the purpose of epidemic simulations. However, ignoring the contact density when inferring based on an epidemic model will result in biased estimates of within-household transmission rates. Further research regarding the implementation of within-household contact networks in epidemic models is necessary.
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Shah, Komal. "Secondary Attack Rate of COVID-19 in Non-Household Contacts - A Systematic Review of Global Studies." Journal of Communicable Diseases 52, no. 04 (December 31, 2020): 97–107. http://dx.doi.org/10.24321/0019.5138.202047.
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Objective: Secondary Attack Rate (SAR) of COVID-19 varies across various populations. We aim to assess global articles reporting SAR in non-household contacts of COVID-19 patients through systematic review approach. Methods: Four databases - MEDLINE, SCOPUS, Google Scholar and EMBASE were systematically searched for retrieval of articles reporting SAR of COVID-19 in various contacts. Initial search provided 436 articles, which through series of evaluation finally yielded 14 articles. Result: Findings suggested that SAR in various contacts varies widely. Substantial number of studies (50%) were from China; however, the two largest studies were from India. Irrespective of type of contacts, overall SAR ranged from 0.55-6%. Highest risk was found from non-household close (family, friends) contacts (2.2-22.31%) followed by casual contact (travel, meal and health-care contacts). In spite of prolonged contact with the patients, SAR was lowest in health-care workers (0-7.3%). Review highlighted that the included studies were suffering from limitations of missing data and continuously evolving operational guidelines. Conclusion: The review showed that studies furnishing SAR data in non-household contacts are limited in number and exact mode of transmission is yet not clear. Six-percent of overall SAR indicates that though the disease is infectious in nature and proper precautions must be taken, not everybody that comes in contact with the index case is infected. However, with greater risk in non-household close contacts, it is important to identify vulnerable population and implement effective preventive strategies in them. Review also indicated serious data gaps in the published literature and stipulated need of more global studies.
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Baliashvili, Davit, Neel R. Gandhi, Soyeon Kim, Michael Hughes, Vidya Mave, Alberto Mendoza-Ticona, Pedro Gonzales, et al. "Resistance to Mycobacterium tuberculosis Infection Among Household Contacts: A Multinational Study." Clinical Infectious Diseases 73, no. 6 (March 27, 2021): 1037–45. http://dx.doi.org/10.1093/cid/ciab269.
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Abstract Background Some contacts of patients with tuberculosis remain negative on tests for tuberculosis infection, despite prolonged exposure, suggesting they might be resistant to Mycobacterium tuberculosis infection. The objective of this multinational study was to estimate the proportion of household contacts resistant to M. tuberculosis (resisters). Methods We conducted a longitudinal study enrolling index patients enrolled in treatment for pulmonary multidrug- or rifampin-resistant tuberculosis and their household contacts. Contacts were tested for tuberculosis infection with a tuberculin skin test (TST) and interferon-gamma release assay (IGRA) at baseline and after 1 year. Exposure was quantified based on index patients’ infectiousness, index patient and household contact interaction, and age. We explored multiple definitions of resistance to tuberculosis infection by varying TST negativity cutoffs (0 vs <5 mm), classification of missing test results, and exposure level. Results In total, 1016 contacts were evaluated from 284 households; 572 contacts aged ≥5 years had TST and longitudinal IGRA results available. And 77 (13%) or 71 (12%) contacts were classified as resisters with a <5 mm or 0 mm TST threshold, respectively. Among 263 highly exposed contacts, 29 (11%) or 26 (10%) were classified as resisters using TST cutoffs of <5 mm and 0 mm, respectively. The prevalence of resisters did not differ substantially by sex, age, human immunodeficiency virus (HIV) coinfection, or comorbid conditions. Conclusions At least 10% of household contacts can be classified as resistant to tuberculosis infection, depending on the definition used, including those with high exposure. Further studies to understand genetic or immunologic mechanisms underlying the resister phenotype may inform novel strategies for therapeutics and vaccines.
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Wagner, Moritz, Ivy K. Kombe, Moses Chapa Kiti, Rabia Aziza, Edwine Barasa, and D. James Nokes. "Using contact data to model the impact of contact tracing and physical distancing to control the SARS-CoV-2 outbreak in Kenya." Wellcome Open Research 5 (September 10, 2020): 212. http://dx.doi.org/10.12688/wellcomeopenres.16264.1.
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Background: Across the African continent, other than South Africa, COVID-19 cases have remained relatively low. Nevertheless, in Kenya, despite early implementation of containment measures and restrictions, cases have consistently been increasing. Contact tracing forms one of the key strategies in Kenya, but may become infeasible as the caseload grows. Here we explore different contact tracing strategies by distinguishing between household and non-household contacts and how these may be combined with other non-pharmaceutical interventions. Methods: We extend a previously developed branching process model for contact tracing to include realistic contact data from Kenya. Using the contact data, we generate a synthetic population of individuals and their contacts categorised by age and household membership. We simulate the initial spread of SARS-CoV-2 through this population and look at the effectiveness of a number of non-pharmaceutical interventions with a particular focus on different contact tracing strategies and the potential effort involved in these. Results: General physical distancing and avoiding large group gatherings combined with contact tracing, where all contacts are isolated immediately, can be effective in slowing down the outbreak, but were, under our base assumptions, not enough to control it without implementing extreme stay at home policies. Under optimistic assumptions with a highly overdispersed R0 and a short delay from symptom onset to isolation, control was possible with less stringent physical distancing and by isolating household contacts only. Conclusions: Without strong physical distancing measures, controlling the spread of SARS-CoV-2 is difficult. With limited resources, physical distancing combined with the isolation of households of detected cases can form a moderately effective strategy, and control is possible under optimistic assumptions. More data are needed to understand transmission in Kenya, in particular by studying the settings that lead to larger transmission events, which may allow for more targeted responses, and collection of representative age-related contact data.
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Kendall, Emily A., Fahima Chowdhury, Yasmin Begum, Ashraful I. Khan, Shan Li, James H. Thierer, Jason Bailey, et al. "Relatedness of Vibrio cholerae O1/O139 Isolates from Patients and Their Household Contacts, Determined by Multilocus Variable-Number Tandem-Repeat Analysis." Journal of Bacteriology 192, no. 17 (June 28, 2010): 4367–76. http://dx.doi.org/10.1128/jb.00698-10.
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ABSTRACT The genetic relatedness of Vibrio cholerae O1/O139 isolates obtained from 100 patients and 146 of their household contacts in Dhaka, Bangladesh, between 2002 and 2005 was assessed by multilocus variable-number tandem-repeat analysis. Isolate genotypes were analyzed at five loci containing tandem repeats. Across the population, as well as within households, isolates with identical genotypes were clustered in time. Isolates from individuals within the same household were more likely to have similar or identical genotypes than were isolates from different households, but even within a household, isolates from different individuals often had different genotypes. When household contacts were sampled regularly for 3 weeks after the illness of the household index patient, isolates with genotypes related to the index patient appeared in contacts, on average, ∼3 days after the index patient, while isolates with unrelated genotypes appeared in contacts ∼6 days after. Limited data revealed that multiple isolates from the same individual collected within days of each other or even from a single stool sample may have identical, similar, or unrelated genotypes as well. Our results demonstrate that genetically related V. cholerae strains cluster in local outbreaks but also suggest that multiple distinct strains of V. cholerae O1 may circulate simultaneously within a household.
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Raznatovska, O. M., A. S. Moskaliuk, T. A. Grekova, L. I. Chernyshova, O. O. Pushnova, and T. I. Shelestina. "The relevance of household contacts tracing among child contacts of patients with multidrug-resistant tuberculosis." Infusion & Chemotherapy, no. 1 (2020): 14–23. http://dx.doi.org/10.32902/2663-0338-2020-1-14-23.
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King, Sam, Martin Murchie, and Jenny Dalrymple. "A bird’s eye view: Sexual health adviser coordination of contact tracing for hepatitis B." International Journal of STD & AIDS 32, no. 5 (February 3, 2021): 476–78. http://dx.doi.org/10.1177/0956462420976217.
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An National Health Service sexual health adviser led service to facilitate management of new cases of hepatitis B from all settings across a large Scottish health board was initiated in 2012. Sexual health advisers contacted testing clinicians to support referral into appropriate services and facilitate identification, testing and vaccination of sexual partners, family and household contacts. A retrospective audit of contact tracing outcomes was conducted between September 2012 and December 2019. From a total of 1344 people diagnosed with hepatitis B, 2248 household and sexual contacts were identified. A documented outcome was established for 1741 (78%) of contacts, equalling 1.3 per index case. 257 (11%) of traced contacts were hepatitis B surface antigen positive, 162 (7%) had natural immunity and 1222 (54%) were vaccinated, either before or after contact tracing. This suggests a multi-agency approach to contact tracing for hepatitis B can achieve good outcomes. Further work is required to reduce the disproportionate burden of hepatitis B among ethnic minority subpopulations in Scotland.
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AKHTAR, S., T. E. CARPENTER, and S. K. RATHI. "A chain-binomial model for intra-household spread of Mycobacterium tuberculosis in a low socio-economic setting in Pakistan." Epidemiology and Infection 135, no. 1 (June 2, 2006): 27–33. http://dx.doi.org/10.1017/s0950268806006364.
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A simulation study using Greenwood's chain-binomial model was carried out to elucidate the spread and control of Mycobacterium tuberculosis among the household contacts of infectious pulmonary tuberculosis (TB) patients. Based on the observed data, the maximum-likelihood estimates (±S.E.) of chain-binomial probabilities of intra-household M. tuberculosis transmission from an index case in 3-person and 4-person households were 0·313±0·008 and 0·325±0·009 respectively. The χ2 goodness-of-fit test of observed and simulated mean expected frequencies of cases revealed good fit for 3-person (P=0·979) and 4-person (P=0·546) households. With the assumption of varying risk of M. tuberculosis transmission across the households under β-distribution, goodness-of-fit tests of observed and mean simulated expected frequencies revealed the inadequacy of Greenwood's chain-binomial model both for 3-person (P=0·0185) and 4-person (P<0·001) households. Simulated M. tuberculosis control strategy comprising efficient diagnosis, segregation and prompt antibiotic therapy of index pulmonary TB patients showed a substantial reduction of new cases among the household contacts in both household sizes. In conclusion, segregation coupled with prompt antibiotic therapy of the index case, chemoprophylaxis of M. tuberculosis-exposed household contacts, and the assessment of household environmental risks to devise and implement an educational programme may help reduce the TB burden in this and similar settings.
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Douglas, J. T., R. V. Cellona, T. T. Fajardo, R. M. Abalos, M. V. F. Balagon, and P. R. Klatser. "Prospective Study of Serological Conversion as a Risk Factor for Development of Leprosy among Household Contacts." Clinical Diagnostic Laboratory Immunology 11, no. 5 (September 2004): 897–900. http://dx.doi.org/10.1128/cdli.11.5.897-900.2004.
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ABSTRACT Although the prevalence of leprosy has declined over the years, there is no evidence that incidence rates are falling. A method of early detection of those people prone to develop the most infectious form of leprosy would contribute to breaking the chain of transmission. Prophylactic treatment of serologically identified high-risk contacts of incident patients should be an operationally feasible approach for routine control programs. In addition, classification of high-risk household contacts will allow control program resources to be more focused. In this prospective study, we examined the ability of serology used for the detection of antibodies to phenolic glycolipid I of Mycobacterium leprae to identify those household contacts of multibacillary leprosy patients who had the highest risk of developing leprosy. After the start of multidrug therapy for the index case, a new case of leprosy developed in one in seven of the 178 households studied. In households where new cases appeared, the seropositivity rates were significantly higher (P < 0.001) than those in households without new cases. Seropositive household contacts had a significantly higher risk of developing leprosy (relative hazard adjusted for age and sex [aRH], 7.2), notably multibacillary leprosy (aRH = 24), than seronegative contacts.
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Al Kubaisy, W., A. Al Dulayme, and H. D. Selman. "Active tuberculosis among Iraqi schoolchildren with positive skin tests and their household contacts." Eastern Mediterranean Health Journal 9, no. 4 (September 21, 2003): 675–88. http://dx.doi.org/10.26719/2003.9.4.675.
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In a prospective cohort study in Iraq, schoolchildren with a positive tuberculin skin test during the nationwide survey in 2000 were followed up in 2002 to determine prevalence of latent tuberculosis [TB] infection and risk factors among household contacts. Of 205 children, 191 remained skin-test positive in 2002. Based on X-ray and clinical examination, 9 children [4.4%] were active TB cases. Among 834 household contacts, there were 144 new TB cases, giving a cumulative incidence of 17.3%. Risk factors for TB among household contacts were: age > / = 15 years; technical/professional job; smoking; low body mass index; diabetes mellitus; steroid therapy; and closeness of contact with the index cases. Based on past history of TB in index children and their contacts, 77.2% of new TB cases were attributable to household contacts
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SAMUELSSON, S., E. T. HANSEN, M. OSLER, and B. JEUNE. "Prevention of secondary cases of meningococcal disease in Denmark." Epidemiology and Infection 124, no. 3 (June 2000): 433–40. http://dx.doi.org/10.1017/s0950268899003775.
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Close contacts of cases of meningococcal disease are at increased risk of disease themselves. We identified household-like contacts of index cases, to investigate whether relevant target groups are informed, receive and follow recommended chemoprophylaxis and vaccination, and to ascertain the time delay for implementation of these measures. A telephone interview of 172 households of index cases and a questionnaire survey among 634 parents of contacts of cases in institutions were carried out. Results were compared with reports from Medical Officers of Health. In 21% of the cases, Medical Officers reported fewer household-like contacts than were identified in this study. Written information was effective. However, 59% of households, and 36% of parents of contacts in institutions felt a lack of information about how the disease is acquired, the risk and signs of illness. For household-like contacts the coverage rate for chemoprophylaxis with an appropriate drug was 90% and for vaccination 59%. No secondary cases occurred among those treated with chemoprophylaxis, but among those not treated, there were two secondary cases. The study design provided a useful audit methodology to evaluate the completeness of implementation and the success of prophylactic measures for meningococcal disease.
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Ogata, Tsuyoshi, Fujiko Irie, Eiko Ogawa, Shifuko Ujiie, Aina Seki, Koji Wada, and Hideo Tanaka. "Secondary Attack Rate among Non-Spousal Household Contacts of Coronavirus Disease 2019 in Tsuchiura, Japan, August 2020–February 2021." International Journal of Environmental Research and Public Health 18, no. 17 (August 25, 2021): 8921. http://dx.doi.org/10.3390/ijerph18178921.
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Household secondary attack rate (HSAR) by risk factor might have a higher transmission rate between spouses. We investigated risk factors for the HSAR among non-spousal household contacts of patients with coronavirus disease 2019 (COVID-19). We studied household contacts of index cases of COVID-19 in Tsuchiura, Japan, from August 2020 through February 2021. The HSARs of the whole household contacts and non-spousal household contacts were calculated and compared across risk factors. We used a generalized linear mixed regression model for multivariate analysis. We enrolled 496 household contacts of 236 index COVID-19 cases. The HSAR was higher for spousal household contacts (37.8%) than for other contacts (21.2%). The HSAR was lower for non-spousal household contacts with a household size (number of household members) of two (18.2%), compared to the HSAR for contacts with a household size ≥4. The HSAR was higher for non-spousal household contacts of index patients with ≥3 days of diagnostic delay (period between onset and diagnosis) (26.0%) compared to those with ≤2 days’ delay (12.5%) (p = 0.033). Among non-spousal household contacts, the HSAR was low for those with a household size of two and was high for contacts of index patients with a long diagnostic delay.
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Krismawati, Hana, Antonius Oktavian, Yustinus Maladan, and Tri Wahyuni. "Risk factor for Mycobacterium leprae detection in household contacts with leprosy patients: a study in Papua, East Indonesia." Medical Journal of Indonesia 29, no. 1 (March 20, 2020): 64–70. http://dx.doi.org/10.13181/mji.oa.192962.
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BACKGROUND In the era of leprosy eradication, Jayapura is still one of the biggest leprosy pockets in Papua, Indonesia. The trend for leprosy case detection rate has remained relatively stable over recent years. This study was aimed to detect Mycobacterium leprae in household contacts and to evaluate the associated factors with the detection.
METHODS This cross-sectional study recruited household contacts of leprosy patients who were diagnosed consecutively from March to August 2015 in Hamadi Point of Care, Jayapura. The leprosy patients were diagnosed using polymerase chain reaction (PCR). For each leprosy patient, up to four household contacts that had no symptom were included. Every household contact received screening through DNA detection of M. leprae extracted from nasal swab specimens and examined using PCR. Factors for bacteria detection included intensity, time duration and number of contacts living together in the same house, and random blood glucose levels were evaluated. Bivariate analysis was used to associate them with M. leprae detection in household contacts.
RESULTS From 107 household contacts of 35 patients who had leprosy, M. leprae was detected in 19.6%. Household contacts with leprosy patients for >1 year was a risk factor for detection (OR = 12.45; 95% CI = 1.595–97.20; p = 0.002). Blood glucose (p = 0.444), ethnic (p = 0.456), sleeping proximity to leprosy case (p = 0.468) and relatives (p = 0.518) give no effect to M. leprae detection in household contacts.
CONCLUSIONS Among the various risk factors studied, duration of living together with the patient significantly increased the risk of M. leprae transmission.
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Becerra, Mercedes C., Iliana F. Pachao-Torreblanca, Jaime Bayona, Rosa Celi, Sonya S. Shin, Jim Yong Kim, Paul E. Farmer, and Megan Murray. "Expanding Tuberculosis Case Detection by Screening Household Contacts." Public Health Reports 120, no. 3 (May 2005): 271–77. http://dx.doi.org/10.1177/003335490512000309.
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Objectives. Tuberculosis (TB) case detection remains low in many countries, compromising the efficacy of TB control efforts. Current global TB control policy emphasizes case finding through sputum smear microscopy for patients who self-report to primary health centers. Our objective was to assess the feasibility and yield of a simple active case finding strategy in a high incidence population in northern Lima, Peru. Methods. We implemented this pilot strategy in one health center's catchment area. Health workers visited household contacts of new TB case subjects to identify symptomatic individuals and collect sputum for screening. Neighboring households were screened in the same manner. Secondary analyses measured risk of TB by ( 1) sputum smear status of the index case subject, ( 2) compliance with testing, and ( 3) risk factors for disease detected through active contact tracing in contrast to self-report. Results. The TB prevalence detected through combined active and passive case finding among 1,094 household contacts was 0.91% (914 per 100,000), much higher than with passive case finding alone (0.18%; 183 per 100,000; p=0.02). Among 2,258 neighbors, the combined strategy detected a TB prevalence of 0.22% (221 per 100,000) in contrast to 0.08% (80 per 100,000) detected through passive case finding alone ( p=0.25). Risk factors for being diagnosed through active case finding in contrast with self-report included age >55 years (odds ratio [OR]=5.5; 95% confidence interval [CI] 1.2, 22.8) and female gender (OR=3.9; 95% CI 0.99, 22.3). Conclusions. Risk of active TB among symptomatic household contacts of active case subjects in this community is very high. Results suggest that contact tracing in such settings may be a powerful means of improving case detection rates for active TB disease.
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Khaparde, Kshitij, Pawan Jethani, Puneet K. Dewan, Sreenivas A. Nair, Madhav Rao Deshpande, Srinath Satyanarayana, Shamim Mannan, and Patrick K. Moonan. "Evaluation of TB Case Finding through Systematic Contact Investigation, Chhattisgarh, India." Tuberculosis Research and Treatment 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/670167.
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Rationale. Contact investigation is an established tool for early case detection of tuberculosis (TB). In India, contact investigation is not often conducted, despite national policy, and the yield of contact investigation is not well described.Objective. To determine the yield of evaluating household contacts of sputum smear-positive TB cases in Rajnandgaon district, Chhattisgarh, India.Methods. Among 14 public health care facilities with sputum smear microscopy services, home visits were conducted to identify household contacts of all registered sputum smear-positive TB cases. We used a standardized protocol to screen for clinical symptoms suggestive of active TB with additional referral for chest radiograph and sputa collection.Results. From December 2010 to May 2011, 1,556 household contacts of 312 sputum smear-positive TB cases were identified, of which 148 (9.5%) were symptomatic. Among these, 109 (73.6%) were evaluated by sputum examination resulting in 11 cases (10.1%) of sputum smear-positive TB and 4 cases (3.6%) of smear-negative TB. Household visits contributed additional 63% TB cases compared to passive case detection alone.Conclusion. A standard procedure for conducting household contact investigation identified additional TB cases in the community and offered an opportunity to initiate isoniazid chemoprophylaxis among children.
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Parrón, Ignacio, Elsa Plasencia, Thais Cornejo-Sánchez, Mireia Jané, Cristina Pérez, Conchita Izquierdo, Susana Guix, and Àngela Domínguez. "Human Astrovirus Outbreak in a Daycare Center and Propagation among Household Contacts." Viruses 13, no. 6 (June 9, 2021): 1100. http://dx.doi.org/10.3390/v13061100.
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We investigated an outbreak of acute gastroenteritis due to human astrovirus in a daycare center, describing the transmission mechanism, the most affected age groups, conditioning factors and the extent of the outbreak among household contacts of the daycare center attenders. Data were collected from persons exposed at the daycare center and their home contacts. Fecal samples from affected and non-affected daycare center attenders were analyzed for viruses causing acute gastroenteritis by RT-PCR. The percentage of households affected and the attack rates (AR) were calculated. The attack rates were compared using the rate ratio (RR) with 95% confidence intervals. Information was obtained from 245 people (76 attenders and 169 contacts) of whom 49 were clinical cases. Five HAstV-4, two HAstV-8 and three non-typable HAstV cases were identified (six from clinical cases and four from asymptomatic infected people). The global AR was 20% (41.2% in children aged < 2 years). Data were obtained from 67 households: 20 households of affected attenders and 47 of non-affected attendees. Household contacts of affected attenders had a higher AR (74.3%) than that of non-affected attendees (2.4%). We found asymptomatic infections amongst daycare attendees. The transmission of HAstV during the outbreak was not limited to the daycare center but extended to household contacts of both affected and non-affected attenders.
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Triasih, Rina, Merrin Rutherford, Trisasi Lestari, Adi Utarini, Colin F. Robertson, and Stephen M. Graham. "Contact Investigation of Children Exposed to Tuberculosis in South East Asia: A Systematic Review." Journal of Tropical Medicine 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/301808.
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Background. Screening of children who are household contacts of tuberculosis (TB) cases is universally recommended but rarely implemented in TB endemic setting. This paper aims to summarise published data of the prevalence of TB infection and disease among child contacts in South East Asia.Methods. Search strategies were developed to identify all published studies from South East Asia of household contact investigation that included children (0–15 years).Results. Eleven studies were eligible for review. There was heterogeneity across the studies. TB infection was common among child contacts under 15 years of age (24.4–69.2%) and was higher than the prevalence of TB disease, which varied from 3.3% to 5.5%.Conclusion. TB infection is common among children that are household contacts of TB cases in South East Asia. Novel approaches to child contact screening and management that improve implementation in South East Asia need to be further evaluated.
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Cartwright, K. A. V., J. M. Stuart, and P. M. Robinson. "Meningococcal carriage in close contacts of cases." Epidemiology and Infection 106, no. 1 (February 1991): 133–41. http://dx.doi.org/10.1017/s0950268800056491.
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SUMMARYBetween 1 October 1986 and 31 March 1987, 55 cases of meningococcal disease were identified in the South-West of England, an attack rate of 1·54 per 100000 during the study period. Antibiotics used in the treatment of the disease successfully eliminated nasopharyngeal carriage of meningococci in 13 out of 14 cases without use of rifampicin. The overall meningococcal carriage rate in 384 close contacts was 18·2% and the carriage rate of strains indistinguishable from the associated case strain was 11·1%. The carriage rate of indistinguishable strains in household contacts (16·0%) was higher than the carriage rate in contacts living at other addresses (7·0%, P > 0·05). A 2·day course of rifampicin successfully eradicated meningococci from 46 (98%) of 47 colonized contacts.In one third of cases groupable meningococci were isolated from at least one household contact; 92% of these isolates were of the same serogroup as the associated case strain. When a meningococcus is not isolated from a deep site in a clinical case of meningococcal disease, culture of serogroup A or C strains from nasopharyngeal swabs of the case or of household contacts is an indication that the close contact group should be offered meningococcal A + C vaccine in addition to chemoprophylaxis. The failure in this and other studies to isolate meningococci from any household contact in the majority of cases may be due either to the relative insensitivity of nasopharyngeal swabbing in detecting meningococcal carriage or to the acquisition of meningococci by most index cases from sources outside the household.
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Handayani, Irda, Muhammad Nasrum Massi, Yanti Leman, Rosdiana Natzir, Ilhamjaya Patellongi, Subair Subair, Najdah Hidayah, Ayu Andini Wulandari, and Handayani Halik. "Composite Bacterial Infection Index and Serum Amyloid A Protein in Pulmonary Tuberculosis Patients and their Household Contacts in Makassar." Open Access Macedonian Journal of Medical Sciences 9, B (June 10, 2021): 557–62. http://dx.doi.org/10.3889/oamjms.2021.6114.
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BACKGROUND: Early diagnosis of tuberculosis (TB) cases in limited resource remains challenging. It is urgent to identify the new diagnostic tools which can control the spread of disease with accurate and rapid test. AIM: This study aimed to investigate the levels of infection markers: Composite bacterial infection index (CBII) and serum amyloid A (SAA) protein in pulmonary TB (PTB), and their healthy household contacts, as the alternative diagnostic markers for TB. METHODS: CBII and SAA were measured from 44 new PTB patients, and 31 household contact serum samples. The value of CBII was calculated from neutrophils, lymphocytes, monocytes, erythrocyte sedimentation rate, and high-sensitivity C-reactive protein (hs-CRP) level. hs-CRP and SAA levels were quantified from their serum samples using ELISA. QuantiFERON-TB Gold Plus (interferon gamma release assay [IGRA]) was used to screen latent TB infection among household contacts. RESULTS: Among 31 household contacts, there were 24 positive IGRA results and the rest (n = 7) had negative results. PTB patients exhibited significantly higher level CBII in the serum specimens, than those in household contact (p < 0.0001). There was no significant difference in the SAA level between TB cases and household contacts (p = 0.679). CONCLUSIONS: CBII can be used as one of the biomarkers for the identification of PTB from the serum specimens.
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Malosh, Ryan E., Richard Evans, Emily T. Martin, Joshua G. Petrie, and Arnold S. Monto. "997. Protection of Unvaccinated Individuals by Influenza Vaccine Coverage of Household Contacts." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S296—S297. http://dx.doi.org/10.1093/ofid/ofy210.834.
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Abstract Background The evidence that influenza vaccination programs provide some protection to unvaccinated members of a community (i.e., indirect effects) is lacking. We sought to determine the indirect effects of influenza vaccine in prospective cohort study of households with children. Methods We used longitudinal data over six influenza seasons from the Household Influenza Vaccine Evaluation (HIVE) study. We categorized households each season based on the proportion of members who received a seasonal influenza vaccination: unvaccinated (0%), low coverage (1–50%), moderate coverage (50–99%), and fully vaccinated (100%). We used mixed-effect Poisson regression models adjusted for age group and sex with random effects to account for household clustering and repeated measures. We estimated the association between the proportion of vaccinated household members and the incidence of influenza virus infection in the entire cohort. We then estimated the indirect effects of influenza vaccination by comparing unvaccinated members of households with low levels of vaccination to unvaccinated members of households with higher levels of vaccination. Results During 7,286 person-seasons of follow-up, we detected 578 cases (8 per 100/season) of influenza virus infection. The seasonal incidence rate was highest in completely unvaccinated households (10 per 100/seasons) and lower at all other levels of vaccine coverage (Figure 1). Individuals in fully vaccinated households had a 29% lower seasonal incidence rate of influenza infection compare to those in unvaccinated households (IRR 0.72, 95% CI 0.56–0.93). The estimated indirect VE comparing unvaccinated individuals in completely unvaccinated households to those in households with moderate vaccine coverage was 40 % (95% CI −4 to 65). Conclusion We demonstrate that vaccination of close contacts can reduce incidence of influenza in unvaccinated members of a community. Despite insufficient evidence, guidance from public health authorities currently suggests that vaccination protects close contacts. Our findings quantifying the protective effects of seasonal influenza vaccination of household contacts in unvaccinated individuals can provide clearer evidence for global vaccine recommendations. Disclosures All authors: No reported disclosures.
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Kontturi, Antti, Satu Kekomäki, Eeva Ruotsalainen, and Eeva Salo. "Tuberculosis contact investigation results among paediatric contacts in low-incidence settings in Finland." European Journal of Pediatrics 180, no. 7 (March 2, 2021): 2185–92. http://dx.doi.org/10.1007/s00431-021-04000-7.
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AbstractTuberculosis (TB) risk is highest immediately after primary infection, and young children are vulnerable to rapid and severe TB disease. Contact tracing should identify infected children rapidly and simultaneously target resources effectively. We conducted a retrospective review of the paediatric TB contact tracing results in the Hospital District of Helsinki and Uusimaa from 2012 to 2016 and identified risk factors for TB disease or infection. Altogether, 121 index cases had 526 paediatric contacts of whom 34 were diagnosed with TB disease or infection. The maximum delay until first contact investigation visit among the household contacts under 5 years of age with either TB disease or infection was 7 days. The yield for TB disease or infection was 4.6% and 12.8% for household contacts, 0.5% and 0% for contacts exposed in a congregate setting and 1.4% and 5.0% for other contacts, respectively. Contacts born in a TB endemic country (aOR 3.07, 95% CI 1.10–8.57), with household exposure (aOR 2.96, 95% CI 1.33–6.58) or a sputum smear positive index case (aOR 3.96, 95% CI 1.20–13.03) were more likely to have TB disease or infection.Conclusions: Prompt TB investigations and early diagnosis can be achieved with a well-organised contact tracing structure. The risk for TB infection or disease was higher among contacts with household exposure, a sputum smear positive index case or born in a TB endemic country. Large-scale investigations among children exposed in congregate settings can result in a very low yield and should be cautiously targeted. What is Known:• Vulnerable young children are a high priority in contact tracing and should be evaluated as soon as possible after TB exposure What is New:• Prompt investigations for paediatric TB contacts and early diagnosis of infected children can be achieved with a well-organised contact tracing structure• Large-scale investigations among children exposed in congregate settings can result in a very low yield and should be cautiously targeted
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Pan, Dongxiang, Mei Lin, Rushu Lan, Edward Graviss, Dingwen Lin, Dabin Liang, Xi Long, et al. "Tuberculosis Transmission in Households and Classrooms of Adolescent Cases Compared to the Community in China." International Journal of Environmental Research and Public Health 15, no. 12 (December 10, 2018): 2803. http://dx.doi.org/10.3390/ijerph15122803.
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The aim of this paper is to evaluate the link between the history of exposure to tuberculosis (TB) in the household and diagnosed TB cases at school, and to compare the detection rate of active TB among household contacts and classroom contacts of adolescent TB cases with the rates among contacts of healthy controls. From November 2016 to December 2017, a prospective matched case-control study was conducted using passively identified index adolescent student cases from the TB surveillance system and healthy controls (matched by county, school type, sex, age and ethnicity). Contacts in households and classrooms of index cases and of controls were investigated. Matched tabulation of 117 case-control pairs revealed exposure to TB in the household as a strong risk factor (odds ratio (OR) = 21.0, 95% confidence interval (CI): 3.4, 868.6). Forty-five (case detection rate 0.69%) and two (case detection rate 0.03%) new active TB cases were detected among 6512 and 6480 classroom contacts of the index cases and controls, respectively. Having an index case in the classroom significantly increased the risk of classmates contracting active TB (OR = 22.5, 95% CI: 5.9, 191.4). Our findings suggested that previous exposure to TB in the household could lead a child to catch TB at school, then spread TB to classmates.
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Zayar, Nyi-Nyi, Rassamee Sangthong, Saw Saw, Si Thu Aung, and Virasakdi Chongsuvivatwong. "Combined Tuberculosis and Diabetes Mellitus Screening and Assessment of Glycaemic Control among Household Contacts of Tuberculosis Patients in Yangon, Myanmar." Tropical Medicine and Infectious Disease 5, no. 3 (June 29, 2020): 107. http://dx.doi.org/10.3390/tropicalmed5030107.
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Background: This study aimed to identify the prevalence of diabetes mellitus (DM) and tuberculosis (TB) among household contacts of index TB patients in Yangon, Myanmar. Method: Household contacts were approached at their home. Chest X-ray and capillary blood glucose tests were offered based on World Health Organization and American Diabetes Association guidelines. Crude prevalence and odds ratios of DM and TB among household contacts of TB patients with and without DM were calculated. Results: The overall prevalence of DM and TB among household contacts were (14.0%, 95% CI: 10.6–18.4) and (5%, 95% CI: 3.2–7.6), respectively. More than 25% of DM cases and almost 95% of TB cases among household contacts were newly diagnosed. Almost 64% of known DM cases among household contacts had poor glycaemic control. The risk of getting DM among household contacts of TB patients with DM was significantly higher (OR—2.13, 95% CI: 1.10–4.12) than those of TB patients without DM. There was no difference in prevalence of TB among household contacts of TB patients with and without DM. Conclusion: Significant proportions of the undetected and uncontrolled DM among household contacts of index TB patients indicate a strong need for DM screening and intervention in this TB–DM dual high-risk population.
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DOYLE, T. J., and R. S. HOPKINS. "Low secondary transmission of 2009 pandemic influenza A (H1N1) in households following an outbreak at a summer camp: relationship to timing of exposure." Epidemiology and Infection 139, no. 1 (June 21, 2010): 45–51. http://dx.doi.org/10.1017/s095026881000141x.
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SUMMARYFollowing an outbreak of 2009 pandemic influenza A (H1N1) at a residential summer camp for boys aged 10–16 years, we assessed secondary household transmission of the novel virus after their return home. Of 212 study participants who attended camp, 49 had confirmed or probable influenza for a primary attack rate of 23%. Of 87 exposed household contacts who did not attend camp, only three instances of probable transmission were observed, for a household secondary attack rate of 3·5%. All secondary cases occurred in households where the ill camp attendee returned home 1 day after onset of illness, with an attack rate of 14·3% in household contacts in this category. Returning home after peak infectivity to others and advanced warning prior to reintegration of sick individuals into the household probably contributed to the overall low secondary attack rate observed.
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Wingfield, Tom, Peter MacPherson, Paul Cleary, and L. Peter Ormerod. "High prevalence of TB disease in contacts of adults with extrapulmonary TB." Thorax 73, no. 8 (November 16, 2017): 785–87. http://dx.doi.org/10.1136/thoraxjnl-2017-210202.
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UK guidelines no longer recommend routine screening of household contacts of adult patients with extrapulmonary TB (EPTB). From 27 March 2012 to 28 June 2016, we investigated the prevalence of active TB disease in household contacts of 1023 EPTB index cases in North West England, and compared estimates with: published new entrant migrant screening programme prevalence (~147/100 000 person-years); London-based contact screening data (700/100 000 contacts screened); and National Institute for Health and Care Excellence (NICE) new entrant TB screening thresholds (TB prevalence >40/100 000 people). Active TB disease prevalence in EPTB contacts was 440/100 000 contacts screened, similar to UK new entrant screening programmes, London EPTB contact prevalence and >10 times NICE’s threshold for new entrant screening. The decision to no longer recommend routine screening of EPTB contacts should be re-evaluated and cost-effectiveness analyses of screening strategies for EPTB contacts should be performed.
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Arsyad, Yuniarti, Friska Jifanti, Muhammad Dali Amiruddin, Anis Irawan Anwar, Dinar Adriaty, Ratna Wahyuni, Iswahyudi Iswahyudi, and Indropo Agusni. "COMPARATIVE STUDY ON THE INTENSITY OF Mycobacterium leprae EXPOSURE BETWEEN HOUSEHOLD AND NONHOUSEHOLD CONTACT OF LEPROSY." Indonesian Journal of Tropical and Infectious Disease 3, no. 1 (June 16, 2016): 1. http://dx.doi.org/10.20473/ijtid.v3i1.192.
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Leprosy stills a public health problem in West Sulawesi which has a Case Detection Rate (CDR) around 43.69/100.000 population. Household contacts of leprosy are a high risk group to be infected, due to droplet infection mode of transmission of the disease. A nose swab examination and serological study was conducted to detect exposure of M. leprae of people who live in leprosy endemic area. Detection of M. leprae in the nasal cavity will represent the exposure rate from outside and the measurement of specific antibody is represented the result of exposure to the immune system. Two group of inhabitants (30 household contacts of leprosy and 30 nonhousehold contacts) were involved in the study. They live in Banggae district, a leprosy endemic area of Majene Regency, West Sulawesi. Sixty nose swab samples and sixty capillary blood samples from the same invidividuals of the two groups were collected and sent to Leprosy laboratory of the Institute of Tropical Disease, Airlangga University Surabaya. A Polymerase Chain Reaction (PCR) was performed to the nose swab samples for detection of M. leprae. The blood samples were examined serologically to measure the level of anti PGL-1 antibody. PCR examination of nose swab samples showed 1/30 positive result in the household contact group and also 1/30 positive result in non-household contact of leprosy (statistically no significant difference, p > 0.05). Serological study showed higher sero-positive result in the household contact group (15/30 or 50%) compared to non-household contact (11/30 or 36%), but statistical calculation revealed no significant difference between the two groups (p > 0.05) on sero-positive results of leprosy. It is concluded that household and non-household contact in leprosy have the same risk to be affected by the disease. The term of household and non-household contact need to be redefined. The possible role of exposure from the environment was also discussed, especially from non-human resource of M. leprae.
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Reichler, Mary R., Dana Bruden, Harold Thomas, Bobbie Rae Erickson, Barbara Knust, Nadia Duffy, John Klena, et al. "Ebola Patient Virus Cycle Threshold and Risk of Household Transmission of Ebola Virus." Journal of Infectious Diseases 221, no. 5 (December 19, 2019): 707–14. http://dx.doi.org/10.1093/infdis/jiz511.
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Abstract Background Identifying risk factors for household transmission of Ebola virus (EBOV) is important to guide preventive measures during Ebola outbreaks. Methods We enrolled all confirmed persons with EBOV disease who were the first case patient in a household from December 2014 to April 2015 in Freetown, Sierra Leone, and their household contacts. Index patients and contacts were interviewed, and contacts were followed up for 21 days to identify secondary cases. Epidemiologic data were linked to EBOV real-time reverse-transcription polymerase chain reaction cycle threshold (Ct) data from initial diagnostic specimens obtained from enrolled index case patients. Results Ct data were available for 106 (71%) of 150 enrolled index patients. Of the Ct results, 85 (80%) were from blood specimens from live patients and 21 (20%) from oral swab specimens from deceased patients. The median Ct values for blood and swab specimens were 21.0 and 24.0, respectively (P = .007). In multivariable analysis, a Ct value from blood specimens in the lowest quintile was an independent predictor of both increased risk of household transmission (P = .009) and higher secondary attack rate among household contacts (P = .03), after adjustment for epidemiologic factors. Conclusions Our findings suggest the potential to use Ct values from acute EBOV diagnostic specimens for index patients as an early predictor of high-risk households and high-risk groups of contacts to help prioritize EBOV disease investigation and control efforts.
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Li, Ruoran, Francesco Nordio, Chuan-Chin Huang, Carmen Contreras, Roger Calderon, Rosa Yataco, Jerome T. Galea, et al. "Two Clinical Prediction Tools to Improve Tuberculosis Contact Investigation." Clinical Infectious Diseases 71, no. 8 (January 6, 2020): e338-e350. http://dx.doi.org/10.1093/cid/ciz1221.
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Abstract Background Efficient contact investigation strategies are needed for the early diagnosis of tuberculosis (TB) disease and treatment of latent TB infections. Methods Between September 2009 and August 2012, we conducted a prospective cohort study in Lima, Peru, in which we enrolled and followed 14 044 household contacts of adults with pulmonary TB. We used information from a subset of this cohort to derive 2 clinical prediction tools that identify contacts of TB patients at elevated risk of progressing to active disease by training multivariable models that predict (1) coprevalent TB among all household contacts and (2) 1-year incident TB among adult contacts. We validated the models in a geographically distinct subcohort and compared the relative utilities of clinical decisions based on these tools to existing strategies. Results In our cohort, 296 (2.1%) household contacts had coprevalent TB and 145 (1.9%) adult contacts developed incident TB within 1 year of index patient diagnosis. We predicted coprevalent disease using information that could be readily obtained at the time an index patient was diagnosed and predicted 1-year incident TB by including additional contact-specific characteristics. The area under the receiver operating characteristic curves for coprevalent TB and incident TB were 0.86 (95% confidence interval [CI], .83–.89]) and 0.72 (95% CI, .67–.77), respectively. These clinical tools give 5%–10% higher relative utilities than existing methods. Conclusions We present 2 tools that identify household contacts at high risk for TB disease based on reportable information from patient and contacts alone. The performance of these tools is comparable to biomarkers that are both more costly and less feasible than this approach.
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Diaz, Gustavo, Angela María Victoria, Amanda J. Meyer, Yessenia Niño, Lucy Luna, Beatriz E. Ferro, and John Lucian Davis. "Evaluating the Quality of Tuberculosis Contact Investigation in Cali, Colombia: A Retrospective Cohort Study." American Journal of Tropical Medicine and Hygiene 104, no. 4 (April 7, 2021): 1309–16. http://dx.doi.org/10.4269/ajtmh.20-0809.
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ABSTRACTTuberculosis (TB) contact investigation facilitates earlier TB diagnosis and initiation of preventive therapy, but little data exist about the quality of its implementation. We conducted a retrospective cohort study to evaluate processes of TB contact investigation for index TB patients diagnosed in Cali, Colombia, in 2017, including dropout at each stage and overall yield. We constructed multivariable models to identify predictors of completing 1) the baseline household visit and 2) a follow-up clinic visit for TB evaluation among referred contacts. Sixty-eight percent (759/1,120) of registered TB patients were eligible for contact investigation; 77% (582/759) received a household visit. Odds of completing a household visit were significantly lower among men (adjusted odds ratio [aOR]: 0.6; 95% CI: 0.4–0.9; P = 0.009) and patients living in Cali’s western zone (aOR: 0.5; 95% CI: 0.3–0.8; P = 0.008). Among 1880 screened contacts, 31% (n = 582) met the criteria for clinic referral, 47% (n = 271) completed a clinic visit, and 85% (231/271) completed testing. After adjusting for clustering by index patient, odds of completing referral were higher among contacts with cough (aOR: 22; 95% CI: 7.1–66; P < 0.001) and contacts living in the western zone (aOR: 4.1; 95% CI: 1.2–15; P = 0.03). The cumulative probability of a symptomatic contact from an eligible household completing TB evaluation was only 28%. The yield of active TB patients among contacts was only 0.3% (5/1880). Only 16% (17/103) of children aged < 5 years and none of the eight persons living with HIV, reported preventive therapy initiation. Routine monitoring of process indicators may facilitate quality improvement to close gaps in contact tracing and increase yield.
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De, Debalina, Aarti Kinikar, P. S. Adhav, Sunanda Kamble, Prasanna Sahoo, Hari Koli, Savita Kanade, et al. "Source Case Investigation for Children with TB Disease in Pune, India." Tuberculosis Research and Treatment 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/182836.
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Setting.Contact tracing is broadly encouraged for tuberculosis (TB) control. In many high-burden countries, however, little effort is made to identify contacts of newly diagnosed TB patients. This failure puts children, many of whom live in poor crowded communities, at special risk.Objectives.To perform source-case investigations for 50 pediatric TB cases in Pune, India.Design.A descriptive cross-sectional observational study of pediatric TB cases < 5 years of age. Information was collected about the index case and household contacts.Results.In 15 (30%) of the 50 pediatric index cases, the household contained known TB contacts, 14 (86%) of whom were adults. Prior to their own diagnosis of TB, only one of the 15 pediatric index cases who met criteria for isoniazid preventive therapy received it. The index cases with known household TB contacts had a longer delay in initiating TB treatment than those without TB contacts (17.5 versus 2 days;P=0.03). Use of contact tracing identified 14 additional household TB suspects, 8 (57%) of whom were children.Conclusions.This study identified missed opportunities for TB prevention, as contact tracing is poorly implemented in resource-limited countries, like India. Further strategies to improve the implementation of TB prevention, especially in young children, are urgently needed.
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Kyaw, Nang Thu Thu, Aung Sithu, Srinath Satyanarayana, Ajay M. V. Kumar, Saw Thein, Aye Myat Thi, Pyae Phyo Wai, et al. "Outcomes of Community-Based Systematic Screening of Household Contacts of Patients with Multidrug-Resistant Tuberculosis in Myanmar." Tropical Medicine and Infectious Disease 5, no. 1 (December 25, 2019): 2. http://dx.doi.org/10.3390/tropicalmed5010002.
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Screening of household contacts of patients with multidrug-resistant tuberculosis (MDR-TB) is a crucial active TB case-finding intervention. Before 2016, this intervention had not been implemented in Myanmar, a country with a high MDR-TB burden. In 2016, a community-based screening of household contacts of MDR-TB patients using a systematic TB-screening algorithm (symptom screening and chest radiography followed by sputum smear microscopy and Xpert-MTB/RIF assays) was implemented in 33 townships in Myanmar. We assessed the implementation of this intervention, how well the screening algorithm was followed, and the yield of active TB. Data collected between April 2016 and March 2017 were analyzed using logistic and log-binomial regression. Of 620 household contacts of 210 MDR-TB patients enrolled for screening, 620 (100%) underwent TB symptom screening and 505 (81%) underwent chest radiography. Of 240 (39%) symptomatic household contacts, 71 (30%) were not further screened according to the algorithm. Children aged <15 years were less likely to follow the algorithm. Twenty-four contacts were diagnosed with active TB, including two rifampicin- resistant cases (yield of active TB = 3.9%, 95% CI: 2.3%–6.5%). The highest yield was found among children aged <5 years (10.0%, 95% CI: 3.6%–24.7%). Household contact screening should be strengthened, continued, and scaled up for all MDR-TB patients in Myanmar.
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Francis, S., J. Rowland, K. Rattenbury, D. Powell, W. N. Rogers, L. Ward, and S. R. Palmer. "An outbreak of paratyphoid fever in the UK associated with a fish-and-chip shop." Epidemiology and Infection 103, no. 3 (December 1989): 445–48. http://dx.doi.org/10.1017/s0950268800030843.
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SUMMARYAn outbreak of Salmonella paratyphi B infection in the UK associated with a fish-and-chip shop is reported. The source of infection for the first three cases was believed to be a food handler who was infected overseas 6 years earlier. His wife whose faeces and urine were originally culture negative continued to run the shop but subsequently her faeces became positive on one occasion. She was considered to have been the source of two further cases, and secondary household spread of infection from these two cases resulted in one symptomatic and two asymptomatic infections. A second household contact of the proprietor also became a faecal excretor 2 months later. We recommend that food handlers living in households or in intimate contact with eases or carriers of S. paratyphi B should be put off work until all household contacts cease excreting the organism.
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Rosenberg, Eli S., Kate Doyle, Jorge L. Munoz-Jordan, Liore Klein, Laura Adams, Matthew Lozier, Kevin Weiss, Tyler M. Sharp, and Gabriela Paz-Bailey. "Prevalence and Incidence of Zika Virus Infection Among Household Contacts of Patients With Zika Virus Disease, Puerto Rico, 2016–2017." Journal of Infectious Diseases 220, no. 6 (December 13, 2018): 932–39. http://dx.doi.org/10.1093/infdis/jiy689.
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Abstract Background Little is known about the prevalence or incidence of Zika virus (ZIKV) infection in settings affected by the 2015–2016 Zika pandemic and associated risk factors. We assessed these factors among household contacts of patients with ZIKV disease enrolled in a cohort study in Puerto Rico during 2016–2017. Methods Household contacts of index case patients completed a questionnaire and gave specimens for real-time polymerase chain reaction (RT-PCR) and immunoglobulin M enzyme-linked immunosorbent assay testing to detect ZIKV infection. We measured the prevalence of ZIKV infection among contacts and associated individual and household factors, examined sexual transmission using a sexual-networks approach, and assessed incident infection among initially uninfected household contacts 2–4 months later. Results Of 366 contacts, 34.4% had evidence of ZIKV infection at enrollment, including 11.2% by RT-PCR. Having open doors and windows that were either screened (prevalence ratio [PR], 2.1 [95% confidence interval {CI}, 1.2–3.6]) or unscreened (PR, 2.5 [95% CI, 1.5–4.1]) was associated with increased prevalence. Sexual partners were more likely to both be RT-PCR positive relative to other relationships (odds ratio, 2.2 [95% CI, 1.1–4.5]). At follow-up, 6.1% of contacts had evidence of incident infection. Conclusions This study identified sexual contact as a risk factor for ZIKV infection. Persons living with ZIKV-infected individuals should be a focus of public health efforts.
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Wang, Saibin. "Development of a Predictive Model of Tuberculosis Transmission among Household Contacts." Canadian Journal of Infectious Diseases and Medical Microbiology 2019 (July 30, 2019): 1–7. http://dx.doi.org/10.1155/2019/5214124.
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Background. Household contacts of patients with tuberculosis (TB) are at great risk of TB infection. The aim of this study was to develop a predictive model of TB transmission among household contacts. Method. This was a secondary analysis of data from a prospective cohort study, in which a total of 700 TB patients and 3417 household contacts were enrolled between 2010 and 2013 at two study sites in Peru. The incidence of secondary TB cases among household contacts of index cases was recorded. The LASSO regression method was used to reduce the data dimension and to filter variables. Multivariate logistic regression analysis was applied to develop the predictive model, and internal validation was performed. A nomogram was constructed to display the model, and the AUC was calculated. The calibration curve and decision curve analysis (DCA) were also evaluated. Results. The incidence of TB disease among the contacts of index cases was 4.4% (149/3417). Ten variables (gender, age, TB history, diabetes, HIV, index patient’s drug resistance, socioeconomic status, spoligotypes, and the index-contact share sleeping room status) filtered through the LASSO regression technique were finally included in the predictive model. The model showed good discriminatory ability, with an AUC value of 0.761 (95% CI, 0.723–0.800) for the derivation and 0.759 (95% CI, 0.717–0.796) for the internal validation. The predictive model showed good calibration, and the DCA demonstrated that the model was clinically useful. Conclusion. A predictive model was developed that incorporates characteristics of both the index patients and the contacts, which may be of great value for the individualized prediction of TB transmission among household contacts.
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Ng, Wil, Amna Faheem, Allison McGeer, Andrew E. Simor, Antonella Gelosia, Barbara M. Willey, Christine Watt, et al. "Community- and Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Strains: An Investigation Into Household Transmission, Risk Factors, and Environmental Contamination." Infection Control & Hospital Epidemiology 38, no. 1 (November 8, 2016): 61–67. http://dx.doi.org/10.1017/ice.2016.245.
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OBJECTIVETo measure transmission frequencies and risk factors for household acquisition of community-associated and healthcare-associated (HA-) methicillin-resistant Staphylococcus aureus (MRSA).DESIGNProspective cohort study from October 4, 2008, through December 3, 2012.SETTINGSeven acute care hospitals in or near Toronto, Canada.PARTICIPANTSTotal of 99 MRSA-colonized or MRSA-infected case patients and 183 household contacts.METHODSBaseline interviews were conducted, and surveillance cultures were collected monthly for 3 months from household members, pets, and 8 prespecified high-use environmental locations. Isolates underwent pulsed-field gel electrophoresis and staphylococcal cassette chromosome mec typing.RESULTSOverall, of 183 household contacts 89 (49%) were MRSA colonized, with 56 (31%) detected at baseline. MRSA transmission from index case to contacts negative at baseline occurred in 27 (40%) of 68 followed-up households. Strains were identical within households. The transmission risk for HA-MRSA was 39% compared with 40% (P=.95) for community-associated MRSA. HA-MRSA index cases were more likely to be older and not practice infection control measures (P=.002–.03). Household acquisition risk factors included requiring assistance and sharing bath towels (P=.001–.03). Environmental contamination was identified in 78 (79%) of 99 households and was more common in HA-MRSA households.CONCLUSIONHousehold transmission of community-associated and HA-MRSA strains was common and the difference in transmission risk was not statistically significant.Infect Control Hosp Epidemiol 2016;1–7
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HELLENBRAND, W., G. HANQUET, S. HEUBERGER, S. NIELSEN, P. STEFANOFF, and J. M. STUART. "What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?" Epidemiology and Infection 139, no. 11 (August 11, 2011): 1645–55. http://dx.doi.org/10.1017/s0950268811001439.
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SUMMARYWe performed a systematic literature review to assess the effectiveness of chemoprophylaxis for contacts of sporadic cases of invasive meningococcal disease (IMD) in educational settings. No studies directly compared IMD risk in contacts with/without chemoprophylaxis. However, compared to the background incidence, an elevated IMD risk was identified in settings without a general recommendation for chemoprophylaxis in pre-schools [pooled risk difference (RD) 58·2/105, 95% confidence interval (CI) 27·3–89·0] and primary schools (pooled RD 4·9/105, 95% CI 2·9–6·9) in the ~30 days after contact with a sporadic IMD case, but not in other educational settings. Thus, limited but consistent evidence suggests the risk of IMD in pre-school contacts of sporadic IMD cases is significantly increased above the background risk, but lower than in household contacts (pooled RD for household contacts with no chemoprophylaxis vs. background incidence: 480·1/105, 95% CI 321·5–639·9). We recommend chemoprophylaxis for pre-school contacts depending on an assessment of duration and closeness of contact.
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LEUNG, Y. H., M. P. LI, and S. K. CHUANG. "A school outbreak of pandemic (H1N1) 2009 infection: assessment of secondary household transmission and the protective role of oseltamivir." Epidemiology and Infection 139, no. 1 (June 21, 2010): 41–44. http://dx.doi.org/10.1017/s0950268810001445.
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SUMMARYIn mid-June 2009, an outbreak of pandemic (H1N1) 2009 (pH1N1) infection occurred in a secondary school in Hong Kong. We carried out an epidemiological investigation to delineate the characteristics of the outbreak, gauge the extent of secondary household transmission, and assess the protective role of oseltamivir in household contacts. We interviewed pH1N1-confirmed cases using a standardized questionnaire. Sixty-five of 511 students in the school were affected. Of the 205 household contacts identified, 12 were confirmed as cases. All cases recovered. The estimated secondary household attack rate was 5·9% (95% CI 2·7–9·1). Household contacts aged <18 years were about 15 times more likely to be infected than older contacts. Household contacts who had received oseltamivir prophylaxis were less likely to acquire a secondary infection than those who had not (odds ratio=0). The estimated mean household serial interval of pH1N1 virus was 2·8 days (95% CI 2·1–3·4 days).
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Craig, Rodger, Elizabeth Kunkel, Natasha S. Crowcroft, Meagan C. Fitzpatrick, Hester de Melker, Benjamin M. Althouse, Tod Merkel, et al. "Asymptomatic Infection and Transmission of Pertussis in Households: A Systematic Review." Clinical Infectious Diseases 70, no. 1 (June 29, 2019): 152–61. http://dx.doi.org/10.1093/cid/ciz531.
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AbstractWe conducted a systematic review to describe the frequency of mild, atypical, and asymptomatic infection among household contacts of pertussis cases and to explore the published literature for evidence of asymptomatic transmission. We included studies that obtained and tested laboratory specimens from household contacts regardless of symptom presentation and reported the proportion of cases with typical, mild/atypical, or asymptomatic infection. After screening 6789 articles, we included 26 studies. Fourteen studies reported household contacts with mild/atypical pertussis. These comprised up to 46.2% of all contacts tested. Twenty-four studies reported asymptomatic contacts with laboratory-confirmed pertussis, comprising up to 55.6% of those tested. Seven studies presented evidence consistent with asymptomatic pertussis transmission between household contacts. Our results demonstrate a high prevalence of subclinical infection in household contacts of pertussis cases, which may play a substantial role in the ongoing transmission of disease. Our review reveals a gap in our understanding of pertussis transmission.
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Hugo Johansson, P. J., Eva B. Gustafsson, and Håkan Ringberg. "High prevalence of MRSA in household contacts." Scandinavian Journal of Infectious Diseases 39, no. 9 (January 2007): 764–68. http://dx.doi.org/10.1080/00365540701302501.
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Drosten, Christian, Benjamin Meyer, Marcel A. Müller, Victor M. Corman, Malak Al-Masri, Raheela Hossain, Hosam Madani, et al. "Transmission of MERS-Coronavirus in Household Contacts." New England Journal of Medicine 371, no. 9 (August 28, 2014): 828–35. http://dx.doi.org/10.1056/nejmoa1405858.
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Mollema, F. P. N., J. H. Richardus, M. Behrendt, N. Vaessen, W. Lodder, W. Hendriks, H. A. Verbrugh, and M. C. Vos. "Transmission of Methicillin-ResistantStaphylococcus aureusto Household Contacts." Journal of Clinical Microbiology 48, no. 1 (November 18, 2009): 202–7. http://dx.doi.org/10.1128/jcm.01499-09.
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Adane, Abinet, Melake Damena, Fitsum Weldegebreal, and Hussein Mohammed. "Prevalence and Associated Factors of Tuberculosis among Adult Household Contacts of Smear Positive Pulmonary Tuberculosis Patients Treated in Public Health Facilities of Haramaya District, Oromia Region, Eastern Ethiopia." Tuberculosis Research and Treatment 2020 (January 27, 2020): 1–7. http://dx.doi.org/10.1155/2020/6738532.
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Background. Tuberculosis is an infectious airborne disease caused by Mycobacterium tuberculosis. It still remains a major public health problem which affects all age groups. Risk of exposure is higher in household contact than members of the general population. Objective. The aim of this study was to assess the prevalence and associated factors of tuberculosis among adult household contacts of smear positive pulmonary tuberculosis in Haramaya district, Oromia Region, Eastern Ethiopia from February to March, 2019. Method. A community based cross-sectional study design was conducted. A total of 454 study participants were selected using systematic sampling method from all adult household contacts of smear positive pulmonary tuberculosis patients treated from July 2017 to December 2018. Data were collected using a pretested and structured questionnaire; and laboratory examination was processed using fluorescent smear microscope. Logistic regression analysis was used to identify the factors associated with the infection of pulmonary tuberculosis and a statistically significant association was declared at P-value < 0.05. Result. The overall prevalence of pulmonary tuberculosis among adult household contacts was 7.8% (95% CI: 5.8–10.0). The risk factors for tuberculosis infection among household contacts were eating meals less than three times per day (AOR = 4.31; 95% CI: 1.61, 11.55), drinking raw milk (AOR = 4.12; 95% CI: 1.43, 11.90), having family history of tuberculosis with more than one index case (AOR = 2.7; 95% CI: 1.02, 6.92), living in poor ventilated houses (AOR = 4.02; 95% CI: 1.38, 11.76), and living in inadequate size of living room (AOR = 3.4; 95% CI: 1.30, 8.86). Conclusion. In this study, the prevalence of tuberculosis among adult household contacts of smear positive pulmonary tuberculosis is high. Eating meals less than three times per day, drinking raw milk, living in poor ventilated houses, and inadequate sizes of the rooms were identified as contributing factors. Therefore, we recommend that the transmission of tuberculosis can potentially be reduced by a better contact tracing and treatment strategies along with appropriate health education.