The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis
The Lancet·
- DOI
- 10.1016/s0140-6736(20)30166-5
- PMID
- 32199484
- PMCID
- PMC7289654
- OpenAlex
- W3011544320
- Study type
- Systematic review
- Publisher
- Elsevier BV
- Article type
- journal-article
- Integrity
- current
Why this research matters now
Findings indicate a very high risk of tuberculosis in exposed infants and young children and suggest that conventional post-exposure prophylaxis may be insufficient because many cases occur soon after contact investigation, motivating earlier preventive therapy via rapid adult case diagnosis or community-wide screening.
Structured evidence summary
Research question
The study investigated the risk of developing tuberculosis in children closely exposed to a tuberculosis case and evaluated the effectiveness of preventive therapy and BCG vaccination in this group.
Study design
This was a systematic review and individual-participant data meta-analysis of cohort studies published between January 1998 and April 2018, including 29 prospective and 17 retrospective cohort studies from 34 countries, with analysis using mixed-effects logistic and Poisson regression models and propensity score matching.
Population and setting
The analysis included 137,647 tuberculosis-exposed children under 19 years of age evaluated at baseline, with 130,512 followed for 429,538 person-years across 34 countries; children had household or close exposure to an individual with tuberculosis and were followed for at least six months.
Main findings
Among children not receiving preventive therapy, those with a positive tuberculosis infection test had significantly higher two-year cumulative tuberculosis incidence than those with a negative result, reaching 19.0% in children under five years. Preventive therapy effectiveness was 63% overall and 91% among children with a positive tuberculosis infection result. Most tuberculosis cases occurred within weeks of contact investigation initiation.
Public-health relevance
Findings indicate a very high risk of tuberculosis in exposed infants and young children and suggest that conventional post-exposure prophylaxis may be insufficient because many cases occur soon after contact investigation, motivating earlier preventive therapy via rapid adult case diagnosis or community-wide screening.
Important limitations
This summary is limited to the supplied single-article abstract and metadata; the original paper is required for decision-grade interpretation of methodology, heterogeneity, and any author-reported limitations.
GIDS interpretation
The article, indexed under tuberculosis transmission dynamics, treatment, vaccination, and outbreak investigation, contributes pooled epidemiologic context on pediatric post-exposure risk and is discoverable through GIDS classifications; no connection to a live surveillance signal is established from the supplied evidence.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 12 auditable classifier relationships to diseases, places, topics, and study design.