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Egere, U.; Togun, T.; Sillah, A.; Mendy, F.; Otu, J.; Hölscher, M.; Heinrich, N.; Hill, P. C.; Kampmann, B. (2017): Identifying children with tuberculosis among household contacts in The Gambia. In: International Journal of Tuberculosis and Lung Disease, Vol. 21, No. 1: pp. 46-52
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SETTING: Greater Banjul Area of the Gambia. OBJECTIVES: To identify co-prevalent tuberculosis (TB) among child contacts of adults with smear-positive TB. DESIGN: Child contacts aged <15 years in the immediate household and compound were prospectively enrolled and evaluated for TB disease using screening questionnaires and the tuberculin skin test (TST). Symptomatic and/or TST-positive (>= 10 mm) contacts were further investigated. RESULTS: Of 4042 child contacts who underwent symptom screening and TST, 3339 (82.6%) were diagnosed as TB-exposed but not infected, 639 (15.8%) were latently infected and 64 (1.6%) had co prevalent TB. Of the 64 TB cases, 50 (78.1%) were from within the immediate household of the index case, and 14 (21.9%) from within the same compound. Of the 27 asymptomatic but TST-positive children diagnosed with TB, 7 were microbiologically confirmed. The median age of the TB cases was 4.4 years (interquartile range 1.9-6.9);53.1% were aged <5 years. Of the 4042 child contacts, 206 (5%) slept in the same bed as the index case;28.1% of all TB cases occurred in this group. Symptom screening alone would have detected only 57.8% of the co-prevalent cases. CONCLUSION: In our community setting, if contact tracing is restricted to symptom screening and immediate households only, nearly half of all co-prevalent TB disease in child contacts would be missed.