Active case finding in contacts of people with tuberculosis
Abstract
Background
Tuberculosis is a major global health challenge that is caused by a
bacteria which is spread by airborne droplets. Mostly patients are
identified in high-burden countries when they visit health care
facilities ('passive case finding'). Contacts of tuberculosis patients
are a high-risk group for developing the disease. Actively screening
contacts of people with confirmed tuberculosis may improve case
detection rates and control of the disease.
Objectives
This study aims to compare whether active case finding among contacts of
people with confirmed tuberculosis increases case detection compared to
usual practice.
Search strategy
In April 2011 we searched CENTRAL (The Cochrane Library 2011, Issue 2),
MEDLINE, EMBASE, LILACS and mRCT. We also checked article reference
lists, the International Journal of Tuberculosis and Lung Disease and
contacted relevant researchers and organizations.
Selection criteria
Randomized and quasi-randomized trials of active case finding to detect
tuberculosis disease among close and casual contacts of patients with
microbiologically proven pulmonary tuberculosis (by sputum smear and/or
culture).
Data collection and analysis
Two authors independently assessed eligibility and the methodological
quality of the trials that were extracted using a search method that was
outlined previously.
Main results
No trials met the inclusion criteria for this review. One RCT did test
the effect of active case finding in contacts, but the intervention in
that trial also included screening for, and treatment of, LTBI in
contacts; and the separate effect of active case finding could not be
estimated.
Authors' conclusions
There are currently insufficient data from randomized controlled trials
or quasi-randomized controlled trials to evaluate the effect of active
case finding for tuberculosis among contacts of patients with confirmed
disease. While observational studies show that contacts have a higher
risk of developing tuberculosis than the general population, further
research is needed to determine whether active case finding among
contacts significantly increases case detection rates.
Plain Language Summary
Tuberculosis is a serious infectious disease that affects over nine
million people each year. The disease is spread by airborne droplets,
which arise in the infected lungs of tuberculosis patients. Despite
widespread availability of treatment with effective antibiotic
therapies, the disease remains common in many resource limited settings.
This review aimed to determine whether systematic screening all the
direct contacts with people with proven TB disease increases the early
detection of tuberculosis. The review found that there are not currently
any suitable randomized controlled trials to answer this question and
there is insufficient evidence to show whether screening programmes for
tuberculosis will improve the rate of diagnosis among contacts of
tuberculosis patients or reduce the rate of tuberculosis in the
community.Therefore there is a need for further research to determine
the benefits of systematic screening of the contacts of tuberculosis
patients.
Citation
Fox, G. J.; Dobler, C. C.; Marks, G. B. Active case finding in contacts of people with tuberculosis. Cochrane Database of Systematic Reviews (2011) (Issue 9) Art. No.: CD008477. [DOI: 10.1002/14651858.CD008477.pub2]