Academic journal article Bulletin of the World Health Organization

A Controlled Study of the Influence of Segregation of Tuberculous Patients for One Year on the Attack Rate of Tuberculosis in a 5-Year Period in Close Family Contacts in South India(*)

Academic journal article Bulletin of the World Health Organization

A Controlled Study of the Influence of Segregation of Tuberculous Patients for One Year on the Attack Rate of Tuberculosis in a 5-Year Period in Close Family Contacts in South India(*)

Article excerpt

In 1956-57, a controlled study was undertaken at the Tuberculosis Chemotherapy Centre, Madras (1959), to compare the efficacy of treatment at home and treatment in sanatorium for one year with a standard regimen of isoniazid plus PAS; the response to treatment in the home series was almost as satisfactory as that in the sanatorium series (Tuberculosis Chemotherapy Centre, Madras, 1959). Subsequently, all the patients were managed almost entirely on a domiciliary basis. Of the patients with bacteriologically quiescent disease at one year, about one quarter received maintenance chemotherapy with isoniazid alone for two years, another quarter received isoniazid alone for one year and the rest received no specific chemotherapy; the relapse rates in the home and the sanatorium series over a 4-year period of follow-up have also been reported to be similar (Dawson et al., 1966 (1)).

Patients with an unsatisfactory response in the first year and those who had a bacteriological relapse in the second or subsequent years were usually retreated with reserve regimens, first with streptomycin plus pyrazinamide and, if this was ineffective, with cycloserine plus ethionamide. Considering all patients originally admitted to the home and sanatorium study, it was found that the proportion of patients with bacteriologically quiescent disease at five years was practically the same in the two series (Dawson et al., 1966 (1)). These studies have firmly established the value of domiciliary chemotherapy for tuberculous patients in the Madras community.

As part of the same investigation, it was decided to study the risk of contracting tuberculosis for contacts of patients treated at home and for contacts of patients segregated in sanatorium during the first year of treatment. The attack rates of tuberculosis during the first two years did not suggest any special risk to the contacts of patients treated at home (Andrews et al., 1960; Ramakrishnan et al., 1961a). The present report gives the findings for the contacts for the whole 5-year period.

The great majority of patients in the chemotherapy study came from the lowest income groups in Madras city. Living conditions were poor, the majority of the homes being overcrowded, and the nutritional standards low (Tuberculosis Chemotherapy Centre, Madras, 1959; Ramakrishnan et al., 1961b, 1966 (1)). It was under these conditions that the patients lived and their contacts were exposed to the risk of infection.

DEFINITIONS USED IN THIS REPORT

The index case was defined as the first member of the family suffering from pulmonary tuberculosis to be registered at the Centre.

Close family contacts were defined as those related by blood or marriage and living, cooking and feeding in the same hut or house (or portion of the house) as the index case for at least the three months immediately prior to the start of treatment. The contacts of patients treated at home are termed "home contacts" while those of patients treated during the first year in sanatorium are termed "sanatorium contacts ".

A single-infection family was defined as a family with only one infectious member, namely the index case, at the prevalence survey.

A multiple-infection family was defined as a family with one or more infectious members, in addition to the index case, at the prevalence survey.

I. PLAN AND CONDUCT OF THE CONTACT STUDY

The plan of the contact study, the routine for the initial and follow-up examinations of the close family contacts and the procedures adopted when a radiographic abnormality was found have already been described in detail (Andrews et al., 1960; Ramakrishnan et al., 1961a). Briefly, the contacts were to be examined by radiography and tuberculin testing at the start of treatment for the index case, and were to be followed routinely by serial radiography and tuberculin testing for a 5-year period. The first contact was admitted to the study in September 1956 and the last one in September 1957. …

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