Recommendations for Investigating Contacts of Persons with Infectious Tuberculosis in Low- and Middle-Income Countries

Book excerpt: The main purpose of these recommendations is to assist national and local public health tuberculosis (TB) control programmes in low- and middle-income countries to develop and implement case finding among people exposed to infectious cases of TB. Systematic evaluation of people who have been exposed to potentially infectious cases of tuberculosis (TB) can be an efficient, targeted approach to intensified TB case finding that is within the purview of TB control programmes. There are, however, no comprehensive global recommendations for programmes. WHO, the International Union against Tuberculosis and Lung Disease and the International Standards for Tuberculosis Care all recommend that children under 5 years of age and persons living with HIV (PLHIV) who are exposed to infectious cases of TB be evaluated for active TB and considered for treatment of latent tuberculosis infection (LTBI) if active TB is excluded. With these exceptions, there are no recommendations at global level to: 1. define the epidemiological and programme conditions under which contact investigation is indicated;2. describe TB index patients on whom contact investigation should be focused;3. identify TB contacts who should be investigated (other than children under 5 years of age and PLHIV);and recommend the procedures to be used for identifying, screening and tracking TB contacts. The following recommendations are based on recent systematic reviews of the literature on contact investigation in low- and middle-income countries.