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.authorMiddelkoop, Kerenen_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.contributor.authorMorrow, Carlen_ZA
dc.contributor.authorLee, Nameeen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.date.accessioned2015-11-27T09:33:40Z
dc.date.available2015-11-27T09:33:40Z
dc.date.issued2014en_ZA
dc.description.abstractBACKGROUND: 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.identifier.apacitationMiddelkoop, K., Bekker, L., 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. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/15399en_ZA
dc.identifier.chicagocitationMiddelkoop, Keren, Linda-Gail Bekker, Carl Morrow, Namee Lee, and Robin Wood "Decreasing household contribution to TB transmission with age: a retrospective geographic analysis of young people in a South African township." <i>BMC Infectious Diseases</i> (2014) http://hdl.handle.net/11427/15399en_ZA
dc.identifier.citationMiddelkoop, 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.ris TY - Journal Article AU - Middelkoop, Keren AU - Bekker, Linda-Gail AU - Morrow, Carl AU - Lee, Namee AU - Wood, Robin AB - 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. DA - 2014 DB - OpenUCT DO - 10.1186/1471-2334-14-221 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Decreasing household contribution to TB transmission with age: a retrospective geographic analysis of young people in a South African township TI - Decreasing household contribution to TB transmission with age: a retrospective geographic analysis of young people in a South African township UR - http://hdl.handle.net/11427/15399 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15399
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-14-221
dc.identifier.vancouvercitationMiddelkoop K, Bekker L, Morrow C, Lee N, Wood R. Decreasing household contribution to TB transmission with age: a retrospective geographic analysis of young people in a South African township. BMC Infectious Diseases. 2014; http://hdl.handle.net/11427/15399.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2014 Middelkoop et al.; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherInfectionen_ZA
dc.subject.otherTransmissionen_ZA
dc.subject.otherAdolescentsen_ZA
dc.titleDecreasing household contribution to TB transmission with age: a retrospective geographic analysis of young people in a South African townshipen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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