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Published ahead of print on May 28, 2003, doi:10.1164/rccm.200212-1483OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 4, August 2003, 448-455

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Submitted on January 17, 2003
Accepted on May 25, 2003

Risk Factors for Tuberculosis Infection in Sub-Saharan Africa: a Contact Study in The Gambia

Christian Lienhardt1*, Katherine Fielding2, Jackson Sillah3, Abdulaye Tunkara4, Simon Donkor4, Kebba Manneh2, David Warndorff4, Keith P McAdam4, and Steve Bennett5

1 Programme Tuberculose, Institut de Recherche pour le Developpement, Dakar, Senegal; Tuberculosis Programme, Medical Research Council Laboratories, Fajara, Banjul, Gambia, 2 Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom, 3 Tuberculosis Programme, Medical Research Council Laboratories, Fajara, Banjul, Gambia; National Tuberculosis Control Programme, Banjul, Gambia, 4 Tuberculosis Programme, Medical Research Council Laboratories, Fajara, Banjul, Gambia, 5 National Tuberculosis Control Programme, Banjul, Gambia

* To whom correspondence should be addressed. E-mail: lienhardt{at}dakar.ird.sn.

Few studies have investigated risk factors for tuberculosis infection in highly endemic countries. We conducted a household study in The Gambia, in which a tuberculin skin test (TST) was performed in members of the households of 315 smear-positive pulmonary TB cases and 305 community controls. The risk of being TST positive (>=10 mm) was higher in contacts of cases than in contacts of controls. It increased with age, male sex, duration of stay in the household, but was not associated with the presence of a BCG scar. Within the households of the TB cases, the risk of TST positivity was higher in males and increased with age, social proximity to the case and the radiological extent of the disease in the case's chest X-ray. Adjusting on these, the risk of TST positivity was higher in first-degree relatives compared with more distant relatives and non-genetically related household members, but the effect was not statistically significant. In highly endemic areas, the risk of TB infection in contacts of TB infectious cases is associated with age, sex, intensity of exposure to the case and severity of disease in the case, but it is possible that genetic factors contribute to the susceptibility to M. tuberculosis infection
Key words: Tuberculosis infection, tuberculin skin test, Mantoux test, contact investigation




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