Cited by 315Tuberculosis Research and EpidemiologyInfectious Diseases and TuberculosisHIV, TB, and STIs Epidemiology

Subclinical Tuberculosis Disease—A Review and Analysis of Prevalence Surveys to Inform Definitions, Burden, Associations, and Screening Methodology

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Frascella, Beatrice, Richards, Alexandra S, Sossen, Bianca, Emery, Jon C, Odone, Anna, Law, Irwin, Onozaki, Ikushi, Esmail, Hanif +1 more·2021·Clinical Infectious Diseases

Abstract

While it is known that a substantial proportion of individuals with tuberculosis disease (TB) present subclinically, usually defined as bacteriologically-confirmed but negative on symptom screening, considerable knowledge gaps remain. Our aim was to review data from TB prevalence population surveys and generate a consistent definition and framework for subclinical TB, enabling us to estimate the proportion of TB that is subclinical, explore associations with overall burden and program indicators, and evaluate the performance of screening strategies. We extracted data from all publicly available prevalence surveys conducted since 1990. Between 36.1% and 79.7% (median, 50.4%) of prevalent bacteriologically confirmed TB was subclinical. No association was found between prevalence of subclinical and all bacteriologically confirmed TB, patient diagnostic rate, or country-level HIV prevalence (P values, .32, .4, and .34, respectively). Chest Xray detected 89% (range, 73%–98%) of bacteriologically confirmed TB, highlighting the potential of optimizing current TB case-finding policies.

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  1. [3]World Health Organization. Systematic screening for active tuberculosis: principles and recommendations. Geneva, Switzerland: World Health Organization, 2013. 25996015

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Authors
Frascella, B., Richards, A. S., Sossen, B., Emery, J. C., Odone, A., Law, I., Onozaki, I., Esmail, H., & Houben, R. M. G. J.
Affiliations
  • Vita-Salute San Raffaele University (IT)
  • London School of Hygiene & Tropical Medicine (GB)
  • University of Cape Town (ZA)
  • World Health Organization (CH)
Corresponding author
Houben, Rein M G J
Venue
Clinical Infectious Diseases
Published
2020-09-16
Volume
73
Issue
3
Pages
e830-e841
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
OpenAlex
W3087646693
Cited by
315
References
27
Citations by year
2026: 49 · 2025: 65 · 2024: 63 · 2023: 57 · 2022: 46 · 2021: 30 · 2020: 5
FWCI
4.53
Type
journal article
Language
en
Open access
Locations
  • Clinical Infectious Diseases (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion, cc-by-nc-sa)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion, cc-by-nc-sa)
  • UCL Discovery (University College London) (submittedVersion)
Funders
European Research Council starting (757699)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
  • Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
  • Social Sciences › General Social Sciences › HIV, TB, and STIs Epidemiology
Keywords
subclinical tuberculosis, bacteriologically confirmed tuberculosis, prevalence survey, tuberculosis screening, chest radiography, case finding, HIV coinfection, diagnostic rate, tuberculosis burden
MeSH terms
Humans, Mass Screening, Surveys and Questionnaires, Thorax, Tuberculosis, Prevalence

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