Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 27, Number 3—March 2021
CME ACTIVITY - Research

Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan

Amyn A. MalikComments to Author , Neel R. Gandhi, Timothy L. Lash, Lisa M. Cranmer, Saad B. Omer, Junaid F. Ahmed, Sara Siddiqui, Farhana Amanullah, Aamir J. Khan, Salmaan Keshavjee, Hamidah Hussain1, and Mercedes C. Becerra1
Author affiliations: Emory University Rollins School of Public Health, Atlanta, Georgia, USA (A.A. Malik, N.R. Gandhi, T.L. Lash); Yale University, New Haven, Connecticut, USA (A.A. Malik, S.B. Omer); Global Health Directorate, Indus Health Network, Karachi, Pakistan (A.A. Malik, J.F. Ahmed, S. Siddiqui); Interactive Research and Development, Singapore (A.A. Malik, A.J. Khan, H. Hussain); Emory University School of Medicine, Atlanta (N.R. Gandhi, L.M. Cranmer); Emory + Children’s Pediatric Institute, Atlanta (L.M. Cranmer); The Indus Hospital, Karachi (F. Amanullah); Harvard University, Cambridge, Massachusetts, USA (A.J. Khan, S. Keshavjee, M.C. Becerra); Partners In Health, Boston, Massachusetts, USA (S. Keshavjee, M.C. Becerra); Brigham and Women’s Hospital, Boston (S. Keshavjee, M.C. Becerra)

Main Article

Table 4

Incidence rate comparison of effectiveness of preventive therapy for tuberculosis in published studies in study of persons exposed at home to drug-resistant tuberculosis, Karachi, Pakistan*

Characteristic Becerra et al. (25) Fox et al. (22) Reichler et al. (26) Martin-Sanchez et al. (27)
No. expected cases 4.7 3.9 6.6 6.6
Expected IR per 1,000 p-y 15 12 20 20
IRR (95% CI) 0.40 (0.05–2.0) 0.50 (0.06–2.8) 0.29 (0.04–1.3) 0.29 (0.04–1.3)
IR difference per 1,000 p-y (95% CI) −8.0 (–23.0 to 7.1) −5.7 (–20.0 to 8.5) −14 (–31.0 to 3.4) −14 (–31.0 to 3.4)
NNT 64 91 37 37
Preventive fraction in exposed, % 57.5 48.7 69.5 69.7

*IR, incidence rate; IRR, incidence rate ratio; NNT, number needed to treat; p-y, person-years.

Main Article

References
  1. World Health Organization. Global tuberculosis control report 2019. 2019 [cited 2020 Sep 1]. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-report-2019
  2. Cegielski  JP, Nahid  P, Sotgiu  G. The continued hunt for the elusive standard short regimen for treatment of multidrug-resistant tuberculosis. Eur Respir J. 2020;55:2000224. DOIPubMedGoogle Scholar
  3. Rodina  O, Borisov  SE, Ivanova  D. Adverse events in patients with MDR TB, treated by three types of the chemotherapy regimens. Eur Respir J. 2019;54:PA5278.
  4. Diel  R, Loddenkemper  R, Zellweger  J-P, Sotgiu  G, D’Ambrosio  L, Centis  R, et al.; European Forum for TB Innovation. Old ideas to innovate tuberculosis control: preventive treatment to achieve elimination. Eur Respir J. 2013;42:785801. DOIPubMedGoogle Scholar
  5. Gebreselassie  N, Hutubessy  R, Vekemans  J, den Boon  S, Kasaeva  T, Zignol  M. The case for assessing the full value of new tuberculosis vaccines. Eur Respir J. 2020;55:1902414. DOIPubMedGoogle Scholar
  6. Keshavjee  S, Nicholson  T, Khan  AJ, Ditiu  L, Farmer  PE, Becerra  MC. Tuberculosis epidemic control: a comprehensive strategy to drive down tuberculosis. In: Friedman L, Dedicoat M, Davies PDO, editors. Clinical tuberculosis. 6th ed. Boca Raton (FL): CRC Press; 2020. p. 401–12.
  7. Shah  NS, Yuen  CM, Heo  M, Tolman  AW, Becerra  MC. Yield of contact investigations in households of patients with drug-resistant tuberculosis: systematic review and meta-analysis. Clin Infect Dis. 2014;58:38191. DOIPubMedGoogle Scholar
  8. Matteelli  A, Lönnroth  K, Getahun  H, Falzon  D, Migliori  GB, Raviglione  M. Numbers needed to treat to prevent tuberculosis. Eur Respir J. 2015;46:18389. DOIPubMedGoogle Scholar
  9. Chiang  SS, Brooks  MB, Jenkins  HE, Rubenstein  D, Seddon  JA, van de Water  BJ, et al. Concordance of drug resistance profiles between persons with drug-resistant tuberculosis and their household contacts: a systematic review and meta-analysis. Clin Infect Dis. 2020;ciaa613; Epub ahead of print. DOIPubMedGoogle Scholar
  10. World Health Organization. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. 2018 [cited 2020 Sep 1]. https://www.who.int/tb/publications/2018/latent-tuberculosis-infection
  11. Adler-Shohet  FC, Low  J, Carson  M, Girma  H, Singh  J. Management of latent tuberculosis infection in child contacts of multidrug-resistant tuberculosis. Pediatr Infect Dis J. 2014;33:6646. DOIPubMedGoogle Scholar
  12. Bamrah  S, Brostrom  R, Dorina  F, Setik  L, Song  R, Kawamura  LM, et al. Treatment for LTBI in contacts of MDR-TB patients, Federated States of Micronesia, 2009-2012. Int J Tuberc Lung Dis. 2014;18:9128. DOIPubMedGoogle Scholar
  13. Feja  K, McNelley  E, Tran  CS, Burzynski  J, Saiman  L. Management of pediatric multidrug-resistant tuberculosis and latent tuberculosis infections in New York City from 1995 to 2003. Pediatr Infect Dis J. 2008;27:90712. DOIPubMedGoogle Scholar
  14. Schaaf  HS, Gie  RP, Kennedy  M, Beyers  N, Hesseling  PB, Donald  PR. Evaluation of young children in contact with adult multidrug-resistant pulmonary tuberculosis: a 30-month follow-up. Pediatrics. 2002;109:76571. DOIPubMedGoogle Scholar
  15. Seddon  JA, Hesseling  AC, Finlayson  H, Fielding  K, Cox  H, Hughes  J, et al. Preventive therapy for child contacts of multidrug-resistant tuberculosis: a prospective cohort study. Clin Infect Dis. 2013;57:167684. DOIPubMedGoogle Scholar
  16. Seddon  JA, Fred  D, Amanullah  F, Schaaf  HS, Starke  JR, Keshavjee  S, et al. Post-exposure management of multidrug-resistant tuberculosis contacts: evidence-based recommendations. Policy Brief No. 1. Dubai (United Arab Emirates): Harvard Medical School Center for Global Health Delivery–Dubai; 2015.
  17. Trieu  L, Proops  DC, Ahuja  SD. Moxifloxacin Prophylaxis against MDR TB, New York, New York, USA. Emerg Infect Dis. 2015;21:5003. DOIPubMedGoogle Scholar
  18. Marks  SM, Mase  SR, Morris  SB. Systematic review, meta-analysis, and cost-effectiveness of treatment of latent tuberculosis to reduce progression to multidrug-resistant tuberculosis. Clin Infect Dis. 2017;64:16707. DOIPubMedGoogle Scholar
  19. Joint United Nations Programme on HIV/AIDS. Pakistan. 2020 [cited 2020 Sep 1]. https://www.unaids.org/en/regionscountries/countries/pakistan
  20. Malik  AA, Fuad  J, Siddiqui  S, Amanullah  F, Jaswal  M, Barry  Z, et al. Tuberculosis preventive therapy for individuals exposed to drug-resistant tuberculosis: feasibility and safety of a community-based delivery of fluoroquinolone-containing preventive regimen. Clin Infect Dis. 2020;70:195865. DOIPubMedGoogle Scholar
  21. Malik  AA, Becerra  MC, Lash  TL, Cranmer  LM, Omer  SB, Fuad  J, et al. Risk factors for adverse events in household contacts prescribed preventive treatment for drug-resistant TB exposure. Clin Infect Dis. 2020;ciaa327; Epub ahead of print. DOIPubMedGoogle Scholar
  22. Fox  GJ, Barry  SE, Britton  WJ, Marks  GB. Contact investigation for tuberculosis: a systematic review and meta-analysis. Eur Respir J. 2013;41:14056. DOIPubMedGoogle Scholar
  23. Becerra  MC, Huang  CC, Lecca  L, Bayona  J, Contreras  C, Calderon  R, et al. Transmissibility and potential for disease progression of drug resistant Mycobacterium tuberculosis: prospective cohort study. BMJ. 2019;367:l5894. DOIPubMedGoogle Scholar
  24. Becerra  MC, Appleton  SC, Franke  MF, Chalco  K, Arteaga  F, Bayona  J, et al. Tuberculosis burden in households of patients with multidrug-resistant and extensively drug-resistant tuberculosis: a retrospective cohort study. Lancet. 2011;377:14752. DOIPubMedGoogle Scholar
  25. Becerra  MC, Franke  MF, Appleton  SC, Joseph  JK, Bayona  J, Atwood  SS, et al. Tuberculosis in children exposed at home to multidrug-resistant tuberculosis. Pediatr Infect Dis J. 2013;32:1159. DOIPubMedGoogle Scholar
  26. Reichler  MR, Khan  A, Sterling  TR, Zhao  H, Chen  B, Yuan  Y, et al.; Tuberculosis Epidemiologic Studies Consortium Task Order 2 Team. Tuberculosis Epidemiologic Studies Consortium Task Order 2 Team. Risk factors for tuberculosis and effect of preventive therapy among close contacts of persons with infectious tuberculosis. Clin Infect Dis. 2020;70:156272. DOIPubMedGoogle Scholar
  27. Martin-Sanchez  M, Brugueras  S, de Andrés  A, Simon  P, Gorrindo  P, Ros  M, et al.; Contact Tracing Group of the Tuberculosis Investigation Unit of Barcelona. Tuberculosis incidence among infected contacts detected through contact tracing of smear-positive patients. PLoS One. 2019;14:e0215322. DOIPubMedGoogle Scholar
  28. Sloot  R, Schim van der Loeff  MF, Kouw  PM, Borgdorff  MW. Risk of tuberculosis after recent exposure. A 10-year follow-up study of contacts in Amsterdam. Am J Respir Crit Care Med. 2014;190:104452. DOIPubMedGoogle Scholar
  29. Saunders  MJ, Wingfield  T, Tovar  MA, Baldwin  MR, Datta  S, Zevallos  K, et al. A score to predict and stratify risk of tuberculosis in adult contacts of tuberculosis index cases: a prospective derivation and external validation cohort study. Lancet Infect Dis. 2017;17:11909. DOIPubMedGoogle Scholar
  30. Smieja  MJ, Marchetti  CA, Cook  DJ, Smaill  FM. Isoniazid for preventing tuberculosis in non-HIV infected persons. Cochrane Database Syst Rev. 2000;1999:CD001363.PubMedGoogle Scholar
  31. Amanullah  F, Ashfaq  M, Khowaja  S, Parekh  A, Salahuddin  N, Lotia-Farrukh  I, et al. High tuberculosis prevalence in children exposed at home to drug-resistant tuberculosis. Int J Tuberc Lung Dis. 2014;18:5207. DOIPubMedGoogle Scholar

Main Article

1These authors contributed equally to this article.

Page created: January 11, 2021
Page updated: February 19, 2021
Page reviewed: February 19, 2021
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external