A score to predict and stratify risk of tuberculosis in adult contacts of tuberculosis index cases: a prospective derivation and external validation cohort.

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Presentation transcript:

A score to predict and stratify risk of tuberculosis in adult contacts of tuberculosis index cases: a prospective derivation and external validation cohort study Dr Matthew J Saunders, MBChB, Tom Wingfield, PhD, Marco A Tovar, MD, Matthew R Baldwin, MD, Sumona Datta, MRCP, Karine Zevallos, MSc, Rosario Montoya, Lic, Teresa R Valencia, Tec, Prof Jon S Friedland, FRCP, Prof Larry H Moulton, PhD, Prof Robert H Gilman, MD, Prof Carlton A Evans, FRCP The Lancet Infectious Diseases Volume 17, Issue 11, Pages 1190-1199 (November 2017) DOI: 10.1016/S1473-3099(17)30447-4 Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 1 Characteristics of populations and study areas for the derivation and internal validation cohort and the external validation cohort Statistics are reported by the Peruvian Instituto Nacional de Estadistica e Informatica unless indicated otherwise. *Collected collaboratively from government-run health posts. The Lancet Infectious Diseases 2017 17, 1190-1199DOI: (10.1016/S1473-3099(17)30447-4) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 2 Study profile The Lancet Infectious Diseases 2017 17, 1190-1199DOI: (10.1016/S1473-3099(17)30447-4) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 3 A score to predict risk of tuberculosis in adult contacts of index cases (A) An example risk score for field use. (B) Predicted 10-year risk of tuberculosis plotted against risk scores. (C) Numbers needed to treat with preventive therapy to prevent one case of tuberculosis among contacts, by risk group. The Lancet Infectious Diseases 2017 17, 1190-1199DOI: (10.1016/S1473-3099(17)30447-4) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 4 Cumulative observed risk of tuberculosis among contacts, stratified by risk group (A) Ventanilla derivation cohort (n=2017). (B) Callao validation cohort (n=1910). Data are derived from Kaplan-Meier functions. Community risk was defined by the average tuberculosis case notification rate during corresponding years, corrected by 20% to assume under-reporting of cases treated outside the public system, as is the local practice. The Lancet Infectious Diseases 2017 17, 1190-1199DOI: (10.1016/S1473-3099(17)30447-4) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 5 TST results and 10-year observed risk of tuberculosis in the Ventanilla derivation cohort (A) TST results among contacts, stratified by risk group. (B) Observed 10-year risk of tuberculosis stratified by TST results and risk group. Tuberculosis risk was not significantly different within risk groups when stratified by TST result (negative, unknown, or positive), but was significantly different between risk groups for each TST result. Error bars represent 95% CIs. Data are derived from Kaplan-Meier functions. The p values represent log-rank tests for equality of survival functions. TST=tuberculin skin test. The Lancet Infectious Diseases 2017 17, 1190-1199DOI: (10.1016/S1473-3099(17)30447-4) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions