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Vol. 43. Issue 6.
Pages 317-323 (January 2007)
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Vol. 43. Issue 6.
Pages 317-323 (January 2007)
Original Articles
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Longitudinal Incidence of Tuberculosis in a Cohort of Contacts: Factors Associated With the Disease
Visits
3758
Carlos Salinasa,
Corresponding author
csalinas@hgda.osakidetza.net

Correspondence: Dr. C. Salinas, Servicio de Neumología. Hospital de Galdakao. B.° Labeaga, s/n, 48960 Galdakao. Bizkaia. España
, Alberto Capelasteguia, Lander Altubea, Pedro Pablo Españaa, Rosa Díeza, Mikel Oribea, Isabel Urrutiaa, Urko Aguirreb
a Servicio de Neumología, Hospital de Galdakao, Galdakao, Bizkaia, Spain
b Unidad de Investigación, Hospital de Galdakao, Galdakao, Bizkaia, Spain
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OBJECTIVE

To investigate the incidence of tuberculosis (TB) in a cohort of contacts and to analyze the variables associated with the disease.

METHODS

A prospective analysis was undertaken of all the contact investigations carried out in a health district in the Basque Country in northern Spain between January 1, 1995 and December 31, 2004. The dependent variable was the number of cases of TB detected among the contacts. Independent variables were age, sex, tuberculin skin test result, and the degree of contact. In index cases, additional variables were the site of the disease and smear test result.

RESULTS

Analysis of 5444 contacts of 596 patients with TB yielded 66 secondary cases of TB (40 at the time of the contact investigation and 26 at a later stage); the majority (73%) developed the disease within 12 months. Multivariate analysis revealed a significant relationship between the detection of secondary cases and the following variables: close contact (odds ratio [OR], 3.05; 95% confidence interval [CI], 1.75-5.31), positive smear test (OR, 8.54; 95% CI, 2.06-35.43), induration of 10 mm or larger (OR, 10.18; 95% CI, 4.27-24.26), and age under 30 years (OR, 3.35; 95% CI, 1.88-5.98). The final predictive model constructed on the basis of these 3 variables had a sensitivity of 77.4%, a specificity of 80.3%, and an area under the curve of 0.83 (95% CI, 0.78-0.88).

CONCLUSIONS

The contact investigation is a valid strategy for the detection of new cases of TB. Prophylactic treatment should be implemented at an early stage, and priority should be given to young contacts of smear-positive patients using an induration size of 10 mm or more as a reference.

Key words:
Tuberculosis
Contact investigation
Risk factors
OBJETIVO

Conocer la incidencia de tuberculosis (TB) en una cohorte de contactos y analizar las variables asociadas a la enfermedad.

MÉTODOS

Se ha efectuado un análisis prospectivo de los estudios de contactos (EC) realizados en un área sanitaria del País Vasco del 1 de enero de 1995 al 31 de diciembre de 2004. La variable dependiente fue el número de casos de TB detectados entre los contactos. Las variables independientes fueron la edad, el sexo, la prueba de la tuberculina (PT) y el grado de contacto, y en los casos índice, la localización de la TB y la baciloscopia del esputo.

RESULTADOS

De los 5.444 contactos de 596 pacientes con TB que se estudiaron, se encontraron 66 casos secundarios de TB (40 en el momento del EC y 26 en el período posterior), la mayoría de ellos (73%) durante el primer año. El análisis multivariante demostró una relación significativa entre la detección de casos secundarios y las siguientes variables: contacto íntimo (odds ratio [OR] = 3,05; intervalo de confianza [IC] del 95%, 1,75-5,31), baciloscopia positiva (OR = 8,54; IC del 95%, 2,06-35,43), PT de 10 mm o mayor (OR = 10,18; IC del 95%, 4,27-24,26) y edad inferior a 30 años (OR = 3,35; IC del 95%, 1,88-5,98). El modelo predictivo final que se obtuvo utilizando estas 3 variables alcanzó una sensibilidad del 77,4%, una especificidad del 80,3% y un área bajo la curva de 0,83 (IC del 95%, 0,78-0,88).

CONCLUSIONES

El EC es una estrategia válida para la detección de nuevos casos de TB. La intervención profiláctica debería realizarse de forma precoz y dirigirse prioritariamente a los contactos jóvenes de pacientes bacilíferos, utilizando como referencia una PT de 10 mm o mayor.

Palabras clave:
Tuberculosis
Estudio de contactos
Factores de riesgo
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REFERENCES
[1]
Centers for Disease Control and Prevention (CDC).
Essential components of a tuberculosis prevention and control program. Recommendations of the Advisory Council for the Elimination of Tuberculosis.
MMWR Recomm Rep, 44 (1995), pp. 1-16
[2]
S Grzybowski, GD Barnett, K Styblo.
Contacts of cases of active pulmonary tuberculosis.
Bull Int Union Tuberc, 50 (1975), pp. 90-106
[3]
R Pitman, B Jarman, R Coker.
Tuberculosis transmission and the impact of intervention on the incidence of infection.
Int J Tuberc Lung Dis, 6 (2002), pp. 485-491
[4]
A Genewein, A Telenti, C Bernasconi, C Mordasini, S Weiss, AM Maurer, et al.
Molecular approach to identifying route of transmission of tuberculosis in the community.
Lancet, 342 (1993), pp. 817-818
[5]
CS Lambregts-van Weezenbeek, MM Sebek, PJ van Gerven, G de Vries, S Verver, NA Kalisvaart, et al.
Tuberculosis contact investigation and DNA fingerprint surveillance in the Netherlands: 6 years' experience with nation-wide cluster feedback and cluster monitoring.
Int J Tuberc Lung Dis, 7 (2003), pp. S463-SS70
[6]
J Solsona, JA Caylà, E Verdú, MP Estrada, S García, D Roca, et al.
Cooperative Group for Contact Study of Tuberculosis Patients in Ciutat Vella. Molecular and conventional epidemiology of tuberculosis in an inner city district.
Int J Tuberc Lung Dis, 5 (2001), pp. 724-731
[7]
K Dasgupta, K Schwartzman, R Marchand, TN Tennenbaum, P Brassard, D Menzies.
Comparison of cost-effectiveness of tuberculosis screening of close contacts and foreign-born populations.
Am J Respir Crit Care Med, 162 (2000), pp. 2079-2086
[8]
E Ziv, CL Daley, SM Blower.
Early therapy for latent tuberculosis infection.
Am J Epidemiol, 153 (2001), pp. 381-385
[9]
Centers for Disease Control and Prevention (CDC).
Advisory Council for the Elimination of tuberculosis. Tuberculosis elimination revisited: obstacles, opportunities, and a reviewed commitment.
MMWR, 48 (1999), pp. 1-13
[10]
JA Caminero Luna.
¿Es la quimioprofilaxis una buena estrategia para el control de la tuberculosis?.
Med Clin (Barc), 116 (2001), pp. 223-229
[11]
Grupo de Estudios de Contactos de la Unidad de Investigación de Tuberculosis de Barcelona (UITB).
Documento de consenso sobre el estudio de contactos en los pacientes tuberculosos.
Med Clin (Barc), 112 (1999), pp. 151-156
[12]
Grupo de trabajo de tuberculosis.
Documento de consenso. Programa de Prevención y Control de la Tuberculosis, Departamento de Sanidad, Gobierno Vasco, (2001),
[13]
Centers for Disease Control and Prevention (CDC).
Trends in tuberculosis morbidity-United States, 1992-2002.
MMWR, 52 (2003), pp. 217-222
[14]
Unidad de Vigilancia Epidemiológica de Bizkaia.
Memoria anual, Subdirección de Salud Pública. Dirección Territorial de Sanidad de Bizkaia, (2004),
[15]
S Capewell, AG Leitch.
The value of contact procedures for tuberculosis in Edinburgh.
Br J Dis Chest, 78 (1984), pp. 317-329
[16]
M Rubilar, MJ Brochwicz-Lewinski, M Anderson, AG Leitch.
The outcome of contact procedures for tuberculosis in Edinburgh, Scotland 1982-1991.
Med Respir, 89 (1995), pp. 113-120
[17]
LB Edwards, FA Acquaviva, VT Livesay.
Identification of tuberculous infected: dual tests and density of reaction.
Am Rev Respir Dis, 108 (1973), pp. 1334-1339
[18]
R Vidal, M Miravitlles, JA Caylà, M Torrella, N Martín, J de Gracia.
Estudio del contagio en 3.071 contactos familiares de enfermos con tuberculosis.
Med Clin (Barc), 108 (1997), pp. 361-365
[19]
R Menzies, B Vissandjee.
Effect of bacille Calmette-Guerin vaccination on tuberculin reactivity.
Am Rev Respir Dis, 145 (1992), pp. 621-625
[20]
CE Palmer, MW Long.
Effects of infection with atypical mycobacteria on BCG vaccination and tuberculosis.
Am Rev Respir Dis, 94 (1966), pp. 553-568
[21]
P Miret Cuadras, JM Pina Gutiérrez.
La prueba de la tuberculina en los vacunados con BCG.
Arch Bronconeumol, 34 (1998), pp. 421-424
[22]
L Altube, C Salinas, R Díez, I Arrizubieta, A Capelastegui.
¿Es necesario cambiar el punto de corte de la PPD?.
Arch Bronconeumol, 41 (2005), pp. 190-191
[23]
J Villate, B Ibáñez, V Cabriada, JI Pijoan, J Taboada, A Urkaregi.
Analysis of latent tuberculosis and Mycobacterium avium infection data using mixture models.
BMC Public Health, 6 (2006), pp. 240
[24]
MA Behr, PC Hopewell, EA Paz, LM Kawamura, GF Schecter, PM Small.
Predictive value of contact investigation for identifying recent transmission of Mycobacterium tuberculosis.
Am J Respir Crit Care Med, 158 (1998), pp. 465-469
[25]
MA Behr, SA Warren, H Salamon, PC Hopewell, A Ponce de León, CL Daley, et al.
Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli.
Lancet, 353 (1999), pp. 444-449
[26]
KK Liippo, K Kulmala, EO Tala.
Focusing tuberculosis contact tracing by smear grading of index cases.
Am Rev Respir Dis, 148 (1993), pp. 235-236
[27]
C Teale, DB Cundall, SB Pearson.
Time of development of tuberculosis in contacts.
Respir Med, 85 (1991), pp. 475-477
[28]
CR Macintyre, AJ Plant.
Preventability of incident cases of tuberculosis in recently exposed contacts.
Int J Tuberc Lung Dis, 2 (1998), pp. 56-61
[29]
M Alseda, P Godoy.
Factores asociados a la infección tuberculosa latente en los contactos de pacientes afectados.
Gac Sanit, 18 (2004), pp. 101-107
[30]
M Hortoneda, C Saiz, JI Alfonso, P Cortina, JI González, Sabater.
Prevention and early detection of tuberculosis.
Eur J Epidemiol, 12 (1996), pp. 413-419
[31]
A Martínez Sanchos, JL Calpe Calpe, G Llavador Ros, J Ena Muñoz, A Calpe Armero.
Prevención primaria y tratamiento de la infección tuberculosa latente con isoniacida: eficacia de un programa de control, 1997-2002.
Arch Bronconeumol, 41 (2005), pp. 27-33
[32]
Eustat (Instituto Vasco de Estadística).
Estadística de movimientos migratorios.
Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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