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

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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, Houben, Rein M G J·2021·Clinical Infectious Diseases

DOI 10.1093/cid/ciaa1402PMC PMC8326537

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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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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
ORCID: Richards, Alexandra S
Sossen, Bianca
Emery, Jon C
Odone, Anna
Law, Irwin
Onozaki, Ikushi
Esmail, Hanif
Houben, Rein M G J
Venue: Clinical Infectious Diseases
Publisher: Oxford University Press (OUP)
Published: 2020-09-16
Volume: 73
Issue: 3
Pages: e830-e841
ISSN: 1058-4838 (ISSN-L)
1537-6591
DOI: 10.1093/cid/ciaa1402
PMC: PMC8326537
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: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
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 › Infectious Diseases › Infectious Diseases and Tuberculosis
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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Subclinical Tuberculosis Disease—A Review and Analysis of Prevalence Surveys to Inform Definitions, Burden, Associations, and Screening Methodology

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