Decreasing household contribution to TB transmission with age: a retrospective geographic analysis of young people in a South African township

 

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dc.contributor.author Middelkoop, Keren en_ZA
dc.contributor.author Bekker, Linda-Gail en_ZA
dc.contributor.author Morrow, Carl en_ZA
dc.contributor.author Lee, Namee en_ZA
dc.contributor.author Wood, Robin en_ZA
dc.date.accessioned 2015-11-27T09:33:40Z
dc.date.available 2015-11-27T09:33:40Z
dc.date.issued 2014 en_ZA
dc.identifier.citation Middelkoop, K., Bekker, L. G., Morrow, C., Lee, N., & Wood, R. (2014). Decreasing household contribution to TB transmission with age: a retrospective geographic analysis of young people in a South African township. BMC Infectious Diseases, 14(1), 221. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15399
dc.identifier.uri http://dx.doi.org/10.1186/1471-2334-14-221
dc.description.abstract BACKGROUND: Tuberculosis (TB) transmission rates are exceptionally high in endemic TB settings. Adolescence represents a period of increasing TB infection and disease but little is known as to where adolescents acquire TB infection. We explored the relationship between residential exposure to adult TB cases and infection in children and adolescents in a South African community with high burdens of TB and HIV. METHODS: TB infection data were obtained from community, school-based tuberculin skin test (TST) surveys performed in 2006, 2007 and 2009. A subset of 2007 participants received a repeat TST in 2009, among which incident TB infections were identified. Using residential address, all adult TB cases notified by the community clinic between 1996 and 2009 were cross-referenced with childhood and adolescent TST results. Demographic and clinic data including HIV status were abstracted for TB cases. Multivariate logistic regression models examined the association of adult TB exposure with childhood and adolescent prevalent and incident TB infection. RESULTS: Of 1,100 children and adolescents included in the prevalent TB infection analysis, 480 (44%) were TST positive and 651 (59%) were exposed to an adult TB case on their residential plot. Prevalent TB infection in children aged 5-9 and 10-14 years was positively associated with residential exposure to an adult TB case (odds ratio [OR]:2.0; 95% confidence interval [CI]: 1.1-3.6 and OR:1.5; 95% CI: 1.0-2.3 respectively), but no association was found in adolescents [greater than or equal to]15years (OR:1.4; 95% CI: 0.9-2.0). HIV status of adult TB cases was not associated with TB infection (p=0.62). Of 67 previously TST negative children, 16 (24%) converted to a positive TST in 2009. These incident infections were not associated with residential exposure to an adult TB case (OR: 1.9; 95% CI: 0.5-7.3). CONCLUSIONS: TB infection among young children was strongly associated with residential exposure to an adult TB case, but prevalent and incident TB infection in adolescents was not associated with residential exposure. The HIV-status of adult TB cases was not a risk factor for transmission. The high rates of TB infection and disease among adolescents underscore the importance of identifying where infection occurs in this age group. en_ZA
dc.language.iso eng en_ZA
dc.publisher BioMed Central Ltd en_ZA
dc.rights This is an Open Access article distributed under the terms of the Creative Commons Attribution License en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_ZA
dc.source BMC Infectious Diseases en_ZA
dc.source.uri http://www.biomedcentral.com/bmcinfectdis/ en_ZA
dc.subject.other Tuberculosis en_ZA
dc.subject.other Infection en_ZA
dc.subject.other Transmission en_ZA
dc.subject.other Adolescents en_ZA
dc.title Decreasing household contribution to TB transmission with age: a retrospective geographic analysis of young people in a South African township en_ZA
dc.type Journal Article en_ZA
dc.rights.holder 2014 Middelkoop et al.; licensee BioMed Central Ltd. en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image


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This is an Open Access article distributed under the terms of the Creative Commons Attribution License Except where otherwise noted, this item's license is described as This is an Open Access article distributed under the terms of the Creative Commons Attribution License