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Subclinical Tuberculosis Disease—A Review and Analysis of Prevalence Surveys to Inform Definitions, Burden, Associations, and Screening Methodology
Open accessAbstract
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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“Prevalence surveys from 23 African and Asian countries show that 36–80% of individuals with TB disease have no TB symptoms. (12)”
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Metadata
- 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
- 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
- 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
- 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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