Infectious diseases

Case detection of TB can be improved


Australian-led research has demonstrated that active case finding in household contacts of people with tuberculosis is more effective than the standard practice of waiting for family members to seek help for their symptoms.

Part of the risk with standard practice is that about a third of contacts with TB are asymptomatic and therefore not likely to seek health care despite being infectious.

The randomized controlled trial in eight provinces of Vietnam – two each in the northern, central and southern regions – identified almost 11,000 index patients and 26,000 contacts.

After two years, the cumulative incidence of TB cases more than doubled with active screening compared to standard passive case detection.

Active screening, which included a symptom questionnaire, physical examination and plain chest x-ray on enrolment and at six, 12 and 24 months, was also associated with higher rates of treatment completion among contacts diagnosed with TB.

A post-hoc analysis also found all-cause mortality was lower in the intervention group than the control group.

The findings will be used to inform WHO Global TB Program screening guidelines, according to Associate Professor Greg Fox from the Woolcock Institute of Medical Research.

“On the back of these results we can expect to see this approach widely implemented, dramatically reducing death and disability worldwide.”

“Australians can feel proud that our nation is at the cutting edge of such important work destined to change the TB landscape forever,” he told the limbic.

Called ‘a neglected epidemic’ in an accompanying NEJM editorial, TB is the world’s leading cause of death from infectious disease with 10 million new cases and 1.7 million deaths each year.

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