Managing household contacts could help prevent 20% of MDR-TB cases in children

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According to a new modeling study published in The Lancet Global Health, one in five cases of multidrug-resistant tuberculosis (MDR) in children under 15 could be prevented each year by managing household contacts.

Research from the London School of Hygiene & Tropical Medicine (LSHTM), University of Sheffield and Imperial College London, suggests this test-and-treat strategy could prevent up to 3,950 deaths and 5,870 cases in children under 15 years of age. She also believes that tracing household contacts of people with MDR-TB is most likely cost-effective in most places with high TB ​​prevalence.

Contact management, which involves working with TB patients to encourage their household contacts to be screened for TB and to offer preventive treatment to those who are eligible, is not implemented as often as it should being. The reasons are complex. In many resource-limited settings, the management of household contacts is not considered a priority because many TB programs focus primarily on treating symptomatic TB patients who present in health facilities. Moreover, advice on how to manage healthy contacts of MDR-TB is inconsistent and based on low-quality evidence.

The researchers say this study could be a turning point in showing the effectiveness of this strategy in terms of low cost and substantial impact in preventing disease and death.

Dr Finn McQuaid, Assistant Professor at LSHTM and one of the study’s authors, said: “Children are a marginalized group in TB care and are highly vulnerable to MDR-TB. Managing household contacts appears to be an underutilized approach that could make a significant difference. . Our work has shown that these interventions can be cost-effective in most countries.”

Recent WHO estimates suggest that more than a million children contract TB every year, but only about half of them are diagnosed and treated. Nearly a quarter of children with TB die; nearly all go undiagnosed, making TB one of the leading causes of infant death. Of the estimated 30,000 people who develop MDR-TB, only around 15% are diagnosed, with untreated people also at high risk of death. However, if treated appropriately, the outcomes of MDR-TB are very good.

Exact figures on the amount of TB transmission that can be attributed to household infection are not known, but estimates vary between 10% and 30%, with no data available for multidrug-resistant TB. This has likely increased due to the COVID-19 pandemic, with more time spent at home and fewer people being diagnosed. The percentage of cases resulting from family transmission is much lower in adults.

The study used mathematical modeling to examine the impact and cost-effectiveness for 213 countries of contact tracing children with MDR-TB to see if they have TB, and providing preventive treatment to contacts who do not have the disease but who are at risk of developing it.

This document could provide guidance to policy makers in the selection of TB interventions, such as contact tracing and provision of preventive treatment, considering which treatment regimens to provide and to whom. It highlights how the relative importance of these elements changes depending on the context.”


Dr. Finn McQuaid, Assistant Professor at LSHTM

Dr James Seddon, Reader in Global Child Health at Imperial and another of the study’s authors, added: “International and national policy makers could use our findings to advocate for better interventions, as well than more targeted and relevant in terms of household protection. management of multidrug-resistant tuberculosis and preventive treatment.

As the primary beneficiaries of TB preventive treatment, this study was limited in its focus to children. However, the high cost of treating multidrug-resistant tuberculosis means that this intervention could also be cost-effective in adults.

Dr Seddon said: “I would like to see research funders and national TB programs use this study to motivate further context-specific research to determine whether the management of household contacts for multidrug-resistant tuberculosis could be a useful tool to reduce the burden of multidrug-resistant tuberculosis in children. “

The authors acknowledge the limitations of the study, in particular that the impact of the intervention on the prevention of onward transmission of Mycobacterium tuberculosis was not considered. This would further increase benefits and profitability. However, the study assumed maximum intervention coverage, which may not be achievable in practice.

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