Should neighbours of tuberculosis (TB) cases be prioritised for active case finding in high TB-burden settings? A prospective molecular epidemiological study

IntroductionIn high tuberculosis (TB)-burden countries, considerable transmission of Mycobacterium tuberculosis (M. tb) likely occurs outside of households. We aimed to estimate the TB prevalence and incidence in households and neighbourhoods around known TB cases and to understand transmission patt...

Full description

Saved in:
Bibliographic Details
Published in:BMJ global health Vol. 10; no. 9; p. e019137
Main Authors: Koesoemadinata, Raspati C, McAllister, Susan, Huang, Chuan-Chin, Hartati, Sri, Djunaedy, Hanif, Dewi, Nury Fitri, Chaidir, Lidya, Lestari, Bony Wiem, Hadisoemarto, Panji Fortuna, Van Crevel, Reinout, Murray, Megan B, Alisjahbana, Bachti, Hill, Philip C
Format: Journal Article
Language:English
Published: England BMJ Publishing Group Ltd 22.09.2025
BMJ Publishing Group LTD
BMJ Publishing Group
Subjects:
Adolescent
Adult
Child
Child, Preschool
Cohort study
Contact Tracing - methods
Epidemiology
Family Characteristics
Female
Households
Humans
Incidence
Indonesia - epidemiology
Male
Middle Aged
Molecular Epidemiology
Mycobacterium tuberculosis - genetics
Mycobacterium tuberculosis - isolation & purification
Original research
Polymorphism, Single Nucleotide
Prevalence
Prospective Studies
Residence Characteristics - statistics & numerical data
Screening
Socioeconomic factors
Tuberculosis
Tuberculosis, Pulmonary - epidemiology
Tuberculosis, Pulmonary - transmission
Whole genome sequencing
Young Adult
Indonesia
United States > US
California
Screening
Tuberculosis
Epidemiology
Cohort study
ISSN:2059-7908, 2059-7908
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:IntroductionIn high tuberculosis (TB)-burden countries, considerable transmission of Mycobacterium tuberculosis (M. tb) likely occurs outside of households. We aimed to estimate the TB prevalence and incidence in households and neighbourhoods around known TB cases and to understand transmission patterns.MethodsHousehold and neighbourhood contacts of pulmonary TB index cases from contiguous areas in Bandung, Indonesia, were screened and followed up for 12 months. Sputum samples underwent smear microscopy, M. tb culture, Xpert MTB/RIF, DNA isolation and whole-genome sequencing (WGS). Pairwise single-nucleotide polymorphism (SNP) distance ≤12 defined transmission for pairs with known epidemiological links, or SNP≤3 for pairs without epidemiological link. An SNP=12 cut-off was used to characterise transmission clusters.ResultsFrom 213 index cases, 514 household and 4141 neighbourhood contacts underwent TB screening: 19 household (3.70%, 95% CI 2.24 to 5.71) and 45 neighbourhood (1.09%, 95% CI 0.79 to 1.45) contacts were identified with TB, of whom 18 (3.50%, 95% CI 2.20 to 5.48) and 38 (0.92%, 95% CI 0.65 to 1.13) respectively, were bacteriologically confirmed. During follow-up, 11 household and 13 neighbourhood contacts were identified with TB (incidence per 100 000 person-years: 2286 (95% CI 1286 to 4148) and 350 (95% CI 190 to 563)), of whom 6 and 8, respectively, were bacteriologically confirmed (incidence per 100 000 person-years: 1247 (95% CI 560 to 2776) and 201 (95% CI 101 to 402)). A total of 223 patient M. tb isolates underwent WGS. Of 15 intra-household pairs, 8 (53.3%) were transmission pairs. Of 24 neighbour to index case pairs, 1 (4.2%) was a transmission pair. 11 of 19 transmission pairs shared no epidemiological link. We identified 25 M. tb genetic clusters from 205 mono-TB isolates overall.ConclusionNeighbours have lower prevalence and incidence of TB than household contacts, but twice as many cases. Very few received M. tb from their index case, suggesting uncontrolled community-wide transmission. Whole population active case finding may be necessary in high TB-burden settings.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
content type line 23
ISSN:2059-7908
2059-7908
DOI:10.1136/bmjgh-2025-019137