Abstract
Background
Subclinical tuberculosis has been increasingly recognized as a separate state in the spectrum of the disease. However, evidence on the transmissibility of subclinical tuberculosis is still inconclusive.
Methods
We reanalysed the data from the 2007 combined tuberculosis prevalence and tuberculin surveys in Vietnam. Poisson regression with robust standard errors was conducted to assess the effect of clinical presentation of tuberculosis patients in the household on tuberculin skin test (TST) positivity among children aged 6-14 years who participated in the tuberculin survey, adjusting for child's age, smear status of the index patient, and other covariates.
Results
In the multivariate analysis, we found significantly increased risks for TST positivity in children living with clinical, smear-positive tuberculosis patients, compared with those living without tuberculosis patients (adjusted risk ratio 3.04, 95%CI 2.00-4.63) and with those living with subclinical tuberculosis patients adjusting for index smear status (aRR 2.26, 95%CI 1.03-4.96). Among children aged 6-10 years, those living with clinical, smear-positive tuberculosis patients, and those living with subclinical, smear-positive tuberculosis patients, had similarly increased risks of TST positivity compared with those living without tuberculosis patients, with aRRs of 3.56 (95%CI 1.91-6.62) and 3.11 (95%CI 1.44-6.72), respectively.
Conclusion
Our findings support the hypothesis that smear-positive subclinical tuberculosis contributes to
Mycobacterium tuberculosis transmission. To eliminate tuberculosis in 2035, control strategies need to address subclinical presentations of the disease.
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