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Tuberculosis Epidemiologic Studies Consortium (TBESC)
Task Order 2: Prospective Evaluation of immunogenetic and
immunologic markers for susceptibility to M. tuberculosis
infection and progression from M. tuberculosis
infection to active
TB
Task order 2 assesses human immunologic and genetic factors that
may predispose persons to getting infected with M. tuberculosis
if
exposed and developing active TB disease if infected. In an effort
to identify risk factors for Mycobacterium tuberculosis transmission
from cases to contacts in various settings, the study also seeks to
determine the characteristics of adults with active culture-positive
pulmonary tuberculosis, their contacts, the environment in which
contact occurred, and the organisms associated with defined rates of
M. tuberculosis
transmission.
Sites
American Lung Association of Metropolitan Chicago, Arkansas
Department of Health, University of British Columbia, Charles Felton
National Tuberculosis Center, Denver Department of Health and
Hospitals, Emory University, University of Manitoba, Maryland
Department of Health and Mental Hygiene, Mississippi State
Department of Health, New Jersey Department of Health, and Tennessee
Department of Health/Vanderbilt University.
Study Objectives
- Identify risk factors (case, contact, environmental, and
organism-specific) for transmission of Mycobacterium
tuberculosis from cases to contacts.
- Utilize data from this study to better define the following
aspects of contact investigation:
- Extent of contact investigation needed in various settings;
- Extent of M. tuberculosis
transmission for smear-positive
vs. smear-negative TB cases;
- When and how to prioritize contact investigations;
- Which risk factor data should routinely be collected from
cases;
- Time period of case infectiousness relative to specific
symptoms;
- Which risk factor and exposure data should routinely be
collected from contacts;
- Extent of M. tuberculosis
transmission in various
environments; and
- Which environmental data should routinely be collected
during contact investigations
- Identify surrogate immunologic markers for protective
immunity to Mycobacterium tuberculosis.
- Identify genetic determinants of susceptibility to
tuberculosis infection and disease.
Study design
Incident cases of culture-positive pulmonary tuberculosis among
persons 15 years of age and older reported from April 1, 1999 -
April 1, 2000 (enrollment went through December 31, 2006) and all
identified contacts of these cases were included. The prospective
study involved case interviews, contact tuberculin skin test (TST)
screening and interviews, laboratory record review, and data
abstraction from medical records. Infected contacts were offered
preventive therapy according to CDC recommendations. All identified
contacts will be cross-matched with state TB registries at the end
of study enrollment, one year after the end of enrollment, and two
years after the end of enrollment to determine the proportion of
patients who developed active TB subsequent to initial
investigation. HIV testing was offered to all cases and contacts at
the time of enrollment so that HIV status could be factored into
decisions regarding anti-tuberculous therapy for cases and
preventive therapy for contacts, and in order to stratify by HIV
status when evaluating risk factors for TB infection and progression
to TB disease among contacts. All cases and contacts will also be
cross-matched to state HARS registries.
Study progress
The current enrollment is 1986 genetic contacts, 2250 immunologic
contacts, 970 epidemiologic cases, and 7000 epidemiologic contacts.
Assays for 26 out of 33 candidate genes have been developed at CDC
and assays are under development for the remaining 7 candidate
genes. Data entry for 910 of the 970 epidemiologic cases and 6500 of
the 7000 contacts has been completed. Data cleaning is expected to
begin soon and when completed, data analysis will begin. Four
writing teams (contact investigation outcomes, epidemiologic risk
factors, immunologic markers, and genetic determinants) have been
formed, with more than 15 manuscripts planned.
Last Modified: 07/25/2007
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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