Risk of Tuberculosis Infection in Young Children Exposed to Multidrug-resistant Tuberculosis in the TB-CHAMP Multi-site Randomized Controlled Trial.

BACKGROUND: Young children have a high risk of developing tuberculosis (TB) disease following infection with Mycobacterium tuberculosis in the absence of preventive treatment. Infection prevalence and risk factors for infection impact delivery of prevention strategies. We aimed to determine the prevalence of infection in child household contacts aged <5 years exposed to adults with confirmed pulmonary multidrug-resistant (MDR)-TB and to determine risk factors for infection.

METHODS: TB-CHAMP was a trial of MDR-TB prevention that recruited children younger than age 5 years, regardless of M. tuberculosis infection status. All children enrolled had an interferon-gamma release assay (IGRA) at baseline. We described M. tuberculosis infection prevalence, developed directed acyclic graphs to clarify causal relationships, and used modified Poisson regression models to assess the relationship between risk factors and IGRA positivity.

RESULTS: Of 785 included children, 160 (20.4%) had a positive IGRA. Duration of cough and drug misuse in the index patient, age of the child, relationship between the child and the index patient, and study site were significantly associated with risk of infection.

CONCLUSIONS: The prevalence of infection was lower than observed in previous studies. This may be related to improved diagnosis and treatment of MDR-TB in the study setting and/or test limitations and has implications for TB preventive treatment. When considering TB preventive treatment for child contacts, healthcare providers should be especially concerned about any young child exposed to an adult index patient who is his/her parent/primary caregiver, has a chronic cough, and/or a history of drug misuse.