Published ahead of print on February 8, 2008, doi:10.1164/rccm.200711-1756OC
© 2008 American Thoracic Society doi: 10.1164/rccm.200711-1756OC
Evaluation of a Model for Efficient Screening of Tuberculosis Contact Subjects 1 Service de Pédiatrie, and 2 Centre de Lutte Anti-Tuberculeuse, Centre Hospitalier Intercommunal de Créteil, Créteil, France; 3 Association Clinique et Thérapeutique Infantile du Val de Marne, Saint Maur des Fossés, France; 4 INSERM U550, Faculté Necker-Enfants Malades, Paris 5, Paris, France; 5 Institut de Veille Sanitaire, Département des Maladies Infectieuses, Saint Maurice, France; 6 INSERM, U841, Créteil, France; and 7 Université Paris 12, Faculté de Médecine, IFR10, Créteil, France Correspondence and requests for reprints should be addressed to Christophe Delacourt, M.D., Ph.D., Service de Pédiatrie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France. E-mail: christophe.delacourt{at}chicreteil.fr Rationale: Contact tracing is an important component of tuberculosis (TB) control programs. Standardization of contact investigation protocols can make them more efficient. Objectives: To develop a model to select contact subjects for screening. Methods: We prospectively collected standardized data on 325 TB index cases and their 2,009 contacts. Factors that independently influenced the risk of TB infection were included in the model, which was then validated in a second prospective cohort of 88 cases of TB and their 618 contacts.
Measurements and Main Results: A total of eight independent risk factors were identified (odds ratio; 95% confidence interval): age, with three subgroups: 6–14 years (3.6; 1.6–8.0); 15–29 years (3.7; 1.8–7.7); Conclusions: This study provides a standardized contact screening model which reduces resources required without negatively affecting disease control.
Key Words: tuberculosis • contact screening • tuberculin skin test
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30 years (4.1; 2.0–8.5); cavitation on the index case's chest radiograph (1.6; 1.1–2.2); an index case sputum smear with 100 or more acid-fast bacilli per field (1.8; 1.2–2.8); household contact at night (2.1; 1.3–3.2); first-degree family relationship with the index case (2.1; 1.3–3.3); active smoking by the contact (1.6; 1.1–2.4); free health care (2.0; 1.2–3.2); and birth in a country with TB incidence rate higher than 25 of 100,000 (2.2; 1.5–3.2). Predictive probabilities were chosen to ensure false-negative rates lower than estimated TB infection background. The number of contacts to be investigated was reduced by 26% while maintaining a false-negative rate of 8%. 
