@article {Huergaarchdischild-2018-315411, author = {Helena Huerga and Elisabeth Sanchez-Padilla and Nara Melikyan and Hakob Atshemyan and Armen Hayrapetyan and Ani Ulumyan and Mathieu Bastard and Naira Khachatryan and Catherine Hewison and Francis Varaine and Maryline Bonnet}, title = {High prevalence of infection and low incidence of disease in child contacts of patients with drug-resistant tuberculosis: a prospective cohort study}, elocation-id = {archdischild-2018-315411}, year = {2018}, doi = {10.1136/archdischild-2018-315411}, publisher = {BMJ Publishing Group Ltd}, abstract = {Objective We aimed to measure the prevalence and incidence of latent tuberculosis infection (LTBI) and tuberculosis (TB) disease in children in close contact with patients with drug-resistant TB (DR-TB) in a country with high DR-TB prevalence.Design and setting This is a prospective cohort study of paediatric contacts of adult patients with pulmonary DR-TB in Armenia. Children were screened using tuberculin skin test, interferon-gamma release assay and chest X-ray at the initial consultation, and were reassessed every 3{\textendash}6 months for a period of 24 months. Children did not receive preventive treatment.Main outcome measures Prevalence and incidence of LTBI and TB disease; factors associated with prevalent LTBI.Results At initial evaluation, 3 of the 150 children included were diagnosed with TB disease (2.0\%). The prevalence of LTBI was 58.7\%. The incidence of LTBI was 19.9 per 100 children per year, and was especially high during the first 6 months of follow-up (33.3 per 100 children per year). No additional cases with incident disease were diagnosed during follow-up. After adjustment, prevalent LTBI was significantly associated with the child{\textquoteright}s age, sleeping in the same house, higher household density, the index case{\textquoteright}s age, positive smear result and presence of lung cavities.Conclusions Children in close contact with patients with DR-TB or in contact with very contagious patients had an increased risk of prevalent LTBI. Although none of the children developed TB disease during a 2-year follow-up period, screening for symptoms of TB disease, based on the prevalence of disease at recruitment, together with follow-up and repeated testing of non-infected contacts, is highly recommended in paediatric contacts of patients with DR-TB.}, issn = {0003-9888}, URL = {https://adc.bmj.com/content/early/2018/12/06/archdischild-2018-315411}, eprint = {https://adc.bmj.com/content/early/2018/12/06/archdischild-2018-315411.full.pdf}, journal = {Archives of Disease in Childhood} }