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SDG 3: Tuberculosis

Abstract

BACKGROUND

Contact investigation of index cases is important for tuberculosis (TB) control in low-incidence countries, yet key performance metrics have not been evaluated in Germany.

AIM

We aimed to assess the yield of TB contact investigations, compliance with national guidelines and risk factors for infection among contacts.

METHODS

We analysed anonymised data of TB patients and their contacts collected between 2018 and 2022 in Upper Bavaria, Germany. We assessed testing coverage, latent TB infection (LTBI), TB yield, primary prophylaxis and preventive treatment coverage. Risk factors for infection (positive tuberculin skin test (TST) / interferon-gamma release assay (IGRA) and/or TB diagnosis) among contacts were identified using multivariable logistic regression and classification tree.

RESULTS

Of the 2,186 contacts of 174 TB patients, 2,022 (92.5%) had a valid TST/IGRA result and/or a TB diagnosis. Of these, 308 (15.2%) had infection, including 10 (0.5%) with TB. Of 241 contacts with LTBI, 66 (28.2%) completed preventive treatment. Among 124 children < 5 years, testing coverage was 75.8%, 16.9% received an immediate chest X-ray and 72.7% primary prophylaxis. Key predictors of infection were born outside Germany (odds ratio (OR) = 2.85; 95% confidence interval (CI): 1.94–4.21) and exposure in community housing (OR = 2.65; 95% CI: 1.65–4.30; reference: exposure at work) or household/family (OR = 2.62; 95% CI: 1.74–4.00).

CONCLUSION

We observed high screening coverage of contacts and yield and risk factors comparable to other low-incidence settings. There is room for improvement regarding preventive treatment and screening of children < 5 years.

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2025-10-02
2026-04-11
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References

  1. Sutherland I. Recent studies in the epidemiology of tuberculosis, based on the risk of being infected with tubercle bacilli. Adv Tuberc Res. 1976;19:1-63. PMID: 823803 
  2. Comstock GW, Livesay VT, Woolpert SF. The prognosis of a positive tuberculin reaction in childhood and adolescence. Am J Epidemiol. 1974;99(2):131-8.  https://doi.org/10.1093/oxfordjournals.aje.a121593  PMID: 4810628 
  3. Brodhun B, Altmann D, Hauer B, Kröger S, Haas W. Bericht zur Epidemiologie der Tuberkulose in Deutschland für 2022. [Report on the Epidemiology of Tuberculosis in Germany for 2022]. Berlin: Robert-Koch-Institut; 2023. German. Available from: https://www.rki.de/DE/Themen/Infektionskrankheiten/Infektionskrankheiten-A-Z/T/Tuberkulose/Archiv_Berichte_TB_in_Dtl_tab.html
  4. Lönnroth K, Migliori GB, Abubakar I, D’Ambrosio L, de Vries G, Diel R, et al. Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Respir J. 2015;45(4):928-52.  https://doi.org/10.1183/09031936.00214014  PMID: 25792630 
  5. European Centre for Disease Prevention and Control (ECDC). Programmatic management of latent tuberculosis infection in the European Union. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/programmatic-management-latent-tuberculosis-infection-european-union
  6. Erkens CG, Kamphorst M, Abubakar I, Bothamley GH, Chemtob D, Haas W, et al. Tuberculosis contact investigation in low prevalence countries: a European consensus. Eur Respir J. 2010;36(4):925-49.  https://doi.org/10.1183/09031936.00201609  PMID: 20889463 
  7. Velen K, Shingde RV, Ho J, Fox GJ. The effectiveness of contact investigation among contacts of tuberculosis patients: a systematic review and meta-analysis. Eur Respir J. 2021;58(6):2100266.  https://doi.org/10.1183/13993003.00266-2021  PMID: 34016621 
  8. Scharlach M, Brakensiek K. Tuberkulose-Umgebungsuntersuchungen: Acht Jahre Erfahrung mit dem QuantiFERON-TB®Gold In-Tube in Niedersachsen. [Tuberculosis Contact Investigation: Eight Years of Experience with the QuantiFERON-TB®Gold In-Tube in Lower Saxony, Germany]. Gesundheitswesen. 2017;79(4):273-8. German. PMID: 27855476 
  9. Diel R, Loddenkemper R, Meywald-Walter K, Niemann S, Nienhaus A. Predictive value of a whole blood IFN-gamma assay for the development of active tuberculosis disease after recent infection with Mycobacterium tuberculosis. Am J Respir Crit Care Med. 2008;177(10):1164-70.  https://doi.org/10.1164/rccm.200711-1613OC  PMID: 18276940 
  10. Dwenger LV, Funke N, Stephany P, Suarez I, Wiesmüller GA, Neuhann F. Latente Tuberkulose unter Kontaktpersonen inzidenter Tuberkulosepatienten: Häufigkeit und Risikofaktoren in Köln 2012–2016. [Frequency Distribution and Risk Factors for Latent Tuberculosis in Contact Persons: Cologne 2012-2016]. Pneumologie. 2021;75(8):567-76. PMID: 33971674 
  11. Herzmann C, Sotgiu G, Bellinger O, Diel R, Gerdes S, Goetsch U, et al. Risk for latent and active tuberculosis in Germany. Infection. 2017;45(3):283-90.  https://doi.org/10.1007/s15010-016-0963-2  PMID: 27866367 
  12. Bayerisches Landesamt für Statistik. Einwohnerzahlen am 31. Dezember 2022. [Population numbers as of 31 December 2022]. Schweinfurt: Bayerisches Landesamt für Statistik. [Accessed: 2 Sep 2025]. German. Available from: https://www.statistik.bayern.de/mam/produkte/veroffentlichungen/statistische_berichte/a1200c_202244.pdf
  13. Diel R, Loytved G, Nienhaus A, Castell S, Detjen A, Geerdes-Fenge H, et al. Neue Empfehlungen für die Umgebungsuntersuchungen bei Tuberkulose. [New recommendations for contact tracing in tuberculosis. German Central Committee against Tuberculosis]. Pneumologie. 2011;65(6):359-78. German.  https://doi.org/10.1055/s-0030-1256439  PMID: 21560113 
  14. Schaberg T, Bauer T, Brinkmann F, Diel R, Feiterna-Sperling C, Haas W, et al. S2k-Leitlinie: Tuberkulose im Erwachsenenalter. Eine Leitlinie zur Diagnostik und Therapie, einschließlich Chemoprävention und -prophylaxe des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose e.V. im Auftrag der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V. [Tuberculosis Guideline for Adults - Guideline for Diagnosis and Treatment of Tuberculosis including LTBI Testing and Treatment of the German Central Committee (DZK) and the German Respiratory Society (DGP)]. Pneumologie. 2017;71(6):325-97. German. PMID: 28651293 
  15. Feiterna-Sperling C, Brinkmann F, Adamczick C, Ahrens F, Barker M, Berger C, et al. S2k-Leitlinie zur Diagnostik, Prävention und Therapie der Tuberkulose im Kindes- und Jugendalter. [Consensus-Based Guidelines for Diagnosis, Prevention and Treatment of Tuberculosis in Children and Adolescents - A Guideline on Behalf of the German Society for Pediatric Infectious Diseases (DGPI)]. Pneumologie. 2017;71(10):629-80. German. https://doi.org/10.1016/j.ijid.2020.02.013  PMID: 29017219 
  16. Robert Koch Institute (RKI). Falldefinitionen des Robert-Koch-Instituts zur Übermittlung von Erkrankungs- oder Todesfällen und Nachweisen von Krankheitserregern. [Case definitions of the Robert Koch Institute for the notification of cases of illness or death and the detection of pathogens]. Berlin: RKI; 2023. German. Available from: https://www.rki.de/DE/Themen/Infektionskrankheiten/Meldewesen/Falldefinitionen/falldefinitionen-node.html#doc16790226bodyText1
  17. Therneau TM, Atkinson EJ. An introduction to recursive partitioning using the RPART routine. Mayo Clinic, Section of Statistics; 1997. Available from: https://www.mayo.edu/research/documents/biostat-61pdf/doc-10026699
  18. Lausen B, Sauerbrei W, Schumacher M. Classification and regression trees (CART) used for the exploration of prognostic factors measured on different scales. In: Dirschedl P, Ostermann R, editors. Computational Statistics. Heidelberg: Physica; 1994. p. 483-97.
  19. Beyerlein A, Kusian D, Ziegler AG, Schaffrath-Rosario A, von Kries R. Classification tree analyses reveal limited potential for early targeted prevention against childhood overweight. Obesity (Silver Spring). 2014;22(2):512-7.  https://doi.org/10.1002/oby.20628  PMID: 24115762 
  20. Cavany SM, Sumner T, Vynnycky E, Flach C, White RG, Thomas HL, et al. An evaluation of tuberculosis contact investigations against national standards. Thorax. 2017;72(8):736-45.  https://doi.org/10.1136/thoraxjnl-2016-209677  PMID: 28389598 
  21. van de Berg S, Erkens C, Mulder C. Tuberculosis contact investigation following the stone-in-the-pond principle in the Netherlands - Did adjusted guidelines improve efficiency? Euro Surveill. 2021;26(45):2001828.  https://doi.org/10.2807/1560-7917.ES.2021.26.45.2001828  PMID: 34763753 
  22. Gasser N, Fritschi N, Egger JM, Ritz N, Schoch OD, Zellweger JP. Tuberculosis case detection and guideline adherence among child contacts in Switzerland: a retrospective observational study. Respiration. 2023;102(11):934-43.  https://doi.org/10.1159/000534362  PMID: 37899038 
  23. Diel R, Breuer C, Bös L, Geerdes-Fenge H, Günther A, Häcker B, et al. Umgebungsuntersuchungen bei Tuberkulose – Update 2023. [Recommendations for contact tracing for tuberculosis - update 2023]. Pneumologie. 2023;77(9):607-31. PMID: 37536363 
  24. Schmidt-Ott R, Erat C, Velleuer L. Tuberkulose in Kindertagesstätten – zwei Erfahrungsberichte aus Bayern. [Tuberculosis in day care centres – two case reports from Bavaria]. Epid Bull.2021;11:11-6. German. Available from: https://edoc.rki.de/bitstream/handle/176904/7920/EB-11-21-Tuberkulose%20in%20Kindertagesst%C3%A4tten.pdf?sequence=1&isAllowed=y
  25. Mulder AC, Slump E, de Vries G. Evaluatie van het bron- en contactonderzoek bij tuberculosepatiënten in Nederland 2017-2021. [Evaluation of source tracing and contact investigation for tuberculosis patients in the Netherlands, 2017-2021]. Bilthoven: Rijksinstituut voor Volksgezondheid en Milieu; 2023. Dutch. Available from: https://www.rivm.nl/publicaties/evaluatie-van-bron-en-contactonderzoek-bij-tuberculosepatienten-in-nederland-2017-2021
  26. Ogata T, Nagasu N, Uehara R, Ito K. Association of low sputum smear positivity among tuberculosis patients with interferon-gamma release assay outcomes of close contacts in Japan. Int J Environ Res Public Health. 2019;16(19):3713.  https://doi.org/10.3390/ijerph16193713  PMID: 31581622 
  27. Borraccino A, Migliore E, Piccioni P, Baussano I, Carosso A, Bugiani M. Yield of tuberculosis contact investigation in a low-incidence country. J Infect. 2014;68(5):448-54.  https://doi.org/10.1016/j.jinf.2013.12.005  PMID: 24418415 
  28. Sloot R, Schim van der Loeff MF, Kouw PM, Borgdorff MW. Yield of tuberculosis contact investigations in Amsterdam: opportunities for improvement. Eur Respir J. 2014;44(3):714-24.  https://doi.org/10.1183/09031936.00009114  PMID: 25063246 
  29. Zellweger JP, Sotgiu G, Block M, Dore S, Altet N, Blunschi R, et al. Risk assessment of tuberculosis in contacts by IFN-γ release assays. a Tuberculosis Network European Trials Group Study. Am J Respir Crit Care Med. 2015;191(10):1176-84.  https://doi.org/10.1164/rccm.201502-0232OC  PMID: 25763458 
  30. Korthals Altes H, Kloet S, Cobelens F, Bootsma M. Latent tuberculosis infection in foreign-born communities: Import vs. transmission in The Netherlands derived through mathematical modelling. PLoS One. 2018;13(2):e0192282.  https://doi.org/10.1371/journal.pone.0192282  PMID: 29444122 
  31. Altet N, Dominguez J, Souza-Galvão ML, Jiménez-Fuentes MA, Milà C, Solsona J, et al. Predicting the development of tuberculosis with the tuberculin skin test and QuantiFERON testing. Ann Am Thorac Soc. 2015;12(5):680-8.  https://doi.org/10.1513/AnnalsATS.201408-394OC  PMID: 25699406 
  32. Sloot R, Schim van der Loeff MF, Kouw PM, Borgdorff MW. Risk of tuberculosis after recent exposure. A 10-year follow-up study of contacts in Amsterdam. Am J Respir Crit Care Med. 2014;190(9):1044-52.  https://doi.org/10.1164/rccm.201406-1159OC  PMID: 25265362 
  33. Schaberg T, Brinkmann F, Feiterna-Sperling C, Geerdes-Fenge H, Hartmann P, Häcker B, et al. [Tuberculosis in adulthood - The Sk2-Guideline of the German Central Committee against Tuberculosis (DZK) and the German Respiratory Society (DGP) for the diagnosis and treatment of adult tuberculosis patients]. Pneumologie. 2022;76(11):727-819. German. PMID: 36384164 
  34. Saunders MJ, Wingfield T, Tovar MA, Baldwin MR, Datta S, Zevallos K, et al. A score to predict and stratify risk of tuberculosis in adult contacts of tuberculosis index cases: a prospective derivation and external validation cohort study. Lancet Infect Dis. 2017;17(11):1190-9.  https://doi.org/10.1016/S1473-3099(17)30447-4  PMID: 28827142 
  35. Zellweger JP. Is the EU model for contact investigation applicable to high TB burden settings? Int J Infect Dis. 2020;92S:S55-9.  https://doi.org/10.1016/j.ijid.2020.02.013  PMID: 32114191 
Tuberculosis contact investigation: an evaluation of yield and guideline adherence, Upper Bavaria, Germany, 2018 to 2022
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Sarah+van+de+Berg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van de Berg Sarah</a>, <a href="/search?value1=Andreas+Beyerlein&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Beyerlein Andreas</a>, <a href="/search?value1=Johannes+Stephani&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stephani Johannes</a>, <a href="/search?value1=Beatrix+B%C3%A4umler-Merl&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bäumler-Merl Beatrix</a>, <a href="/search?value1=Manuela+J%C3%A4ger&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jäger Manuela</a>, <a href="/search?value1=Dagmar+K%C3%B6niger&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Königer Dagmar</a>, <a href="/search?value1=Ruprecht+Schmidt-Ott&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schmidt-Ott Ruprecht</a></span>. Tuberculosis contact investigation: an evaluation of yield and guideline adherence, Upper Bavaria, Germany, 2018 to 2022. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(39):pii=2500096. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.39.2500096" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.39.2500096</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 06 Feb 2025;&nbsp;&nbsp; <span class="generated">Accepted</span>: 02 May 2025 </span> </p>
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