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Am J Epidemiol 2003; 158:887-898.
Copyright © 2003 by Johns Hopkins Bloomberg School of Public Health

ORIGINAL CONTRIBUTIONS

Tuberculosis in Household Contacts of Infectious Cases in Kampala, Uganda

D. Guwatudde1, M. Nakakeeto2, E. C. Jones-Lopez3,4, A. Maganda3, A. Chiunda3, R. D. Mugerwa1, J. J. Ellner3,4, G. Bukenya3 and C. C. Whalen3,5 

1 Makerere University Medical School, Kampala, Uganda.
2 Mulago Hospital, Kampala, Uganda.
3 Tuberculosis Research Unit, Case Western Reserve University School of Medicine, Cleveland, OH.
4 Department of Medicine, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ.
5 Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH.

Tuberculosis remains a serious threat to public health, especially in sub-Saharan Africa. To determine the host and environmental factors responsible for tuberculosis in African households, the authors performed a prospective cohort study of 1,206 household contacts of 302 index cases with tuberculosis enrolled in Uganda between 1995 and 1999. All contacts were systematically evaluated for active tuberculosis and risk factors for active disease. Among the 1,206 household contacts, 76 secondary cases (6%) of tuberculosis were identified. Of these cases, 51 were identified in the baseline evaluation, and 25 developed during follow-up. Compared with index cases, secondary cases presented more often with minimal disease. The risk for secondary tuberculosis was greater among young children than adults (10% vs. 1.9%) and among human immunodeficiency virus-seropositive than -seronegative contacts (23% vs. 3.3%). Host risk factors could not be completely separated from the effects of environmental risk factors, suggesting that a household may represent a complex system of interacting risks for tuberculosis.

cohort studies; disease transmission; risk; risk factors; tuberculosis

Abbreviations: Abbreviations: BCG, Bacillus Calmette-Guérin; CI, confidence interval; HIV, human immunodeficiency virus; OR, odds ratio.


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