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Paediatric tuberculosis transmission outside the household: challenging historical paradigms to inform future public health strategies
Open accessAbstract
Tuberculosis is a major cause of death and disability among children globally, yet children have been neglected in global tuberculosis control efforts. Historically, tuberculosis in children has been thought of as a family disease, and because of this, household contact tracing of children after identification of an adult tuberculosis case has been emphasised as the principal public health intervention. However, the population-level effect of household contact tracing is predicated on the assumption that most paediatric tuberculosis infections are acquired within the household. In this Personal View, we focus on accumulating scientific evidence indicating that the majority of Mycobacterium tuberculosis transmission to children in high-burden settings occurs in the community, outside of households in which a person has tuberculosis. We estimate the population-attributable fraction of M tuberculosis transmission to children due to household exposures to be between 10% and 30%. M tuberculosis transmission from the household was low (<30%) even in children younger than age 5 years. We propose that an effective public health response to childhood tuberculosis requires comprehensive, community-based interventions, such as active surveillance in select settings, rather than contact tracing alone. Importantly, the historical paradigm that most paediatric transmission occurs in households should be reconsidered on the basis of the scientific knowledge presented.
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Most tuberculosis transmission among children occurs outside the household.
“most tuberculosis transmission among children occurs outside the household,62”
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Metadata
- Authors
- Martinez, L., Lo, N. C., Cords, O., Hill, P. C., Khan, P., Hatherill, M., Mandalakas, A., Kay, A., Croda, J., Horsburgh, C. R., Zar, H. J., & Andrews, J. R.
- Affiliations
- Stanford Medicine (US)
- University of Otago (NZ)
- London School of Hygiene & Tropical Medicine (GB)
- University of Cape Town (ZA)
- Baylor College of Medicine (US)
- Boston University (US)
- South African Medical Research Council (ZA)
- ORCID
- Venue
- The Lancet Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2019-06
- Volume
- 7
- Issue
- 6
- Pages
- 544-552
- ISSN
- 2213-2600 (ISSN-L)
- PMC
- PMC7323920
- OpenAlex
- W2944812374
- Cited by
- 85
- References
- 56
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 13 · 2023: 11 · 2022: 11 · 2021: 11 · 2020: 17 · 2019: 3
- FWCI
- 8.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet Respiratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Funders
- International Maternal Pediatric Adolescent AIDS Clinical Trials Network
- Medical Research Council (MR/R007942/1)
- National Institute of Allergy and Infectious Diseases (T32AI052073)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › HIV, TB, and STIs Epidemiology
- Health Sciences › Medicine › Infectious Diseases › Diagnosis and treatment of tuberculosis
- Keywords
- pediatric tuberculosis, tuberculosis transmission, household transmission, community transmission, contact tracing, population attributable fraction, community-based intervention, young children, tuberculosis control
- MeSH terms
- Adolescent, Child, Child, Preschool, Environmental Exposure, Female, Humans, Infant, Male, Mycobacterium tuberculosis, Public Health, Risk Factors, Tuberculosis, Disease Transmission, Infectious
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