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Screening People in Contact With Children May Help Prevent Tuberculosis

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"Contact screening was not effective in identifying undiagnosed active cases, but it was highly effective in identifying tuberculin-positive candidates for preventive therapy," says Karen Soren, MD, the study's lead researcher and assistant professor of pediatrics at Columbia University. "So the study has policy implications for tuberculosis prevention efforts in high-risk populations."

The chief investigator of a similar study agrees. "We studied contact screening in San Francisco with an Asian population and our findings were comparable," says Paul Sullam, MD, an infectious diseases specialist and associate professor of medicine at University of California, San Francisco. "Contact screening may well be a good strategy, but it's got to be cost-effective because resources are limited. As a next step, we ought to look at the potential cost savings of contact screening."

"Some of our data depends on the verbal reports of participants, and this is certainly a limitation of the study. We found a very low incidence of IV drug abuse, HIV infection, and jail history, which are all associated with TB," says Soren. "And it's entirely possible that these risk factors were underreported. It's also possible that some skin tests were positive due to the boosting effect of BCG vaccinations." Controlling for these variables in the future will help validate and expand the body of data.

The study was supported by the New York State Department of Health, the Center for Community Health, and the National Institutes of Health.

Vital Information:

  • People who have been in contact with someone infected with TB can be screened to determine whether they have been exposed to the disease.
  • In a recent study, no active cases of TB were identified during contact screening, but more than 30% of contacts had positive skin tests, making them eligible for preventive therapy.
  • Further research is needed to determine whether contact screening is cost-effective and is a reasonable allocation of resources.
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