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Assessment of differentially culturable tubercle bacteria assays for the detection of tuberculosis infection in asymptomatic household contacts and the implications for intra-household transmission: a longitudinal cohort study.

BACKGROUND: Conventional culture methods for tuberculosis diagnosis miss differentially culturable tubercle bacteria (DCTB), which grow only in liquid assays supplemented with growth-enhancing factors. This limitation, combined with inadequate contact tracing and screening, often fails to identify asymptomatic individuals, with live bacilli detectable by enhanced culture methods. This shortfall results in undiagnosed reservoirs of bacteria, potentially fuelling ongoing transmission. In this study, we aimed to investigate whether DCTB assays provide greater sensitivity by detecting more Mycobacterium tuberculosis infections than conventional culture and whether this enhanced detection improves the resolution of intrahousehold transmission mapping. In addition, we sought to evaluate whether DCTB populations can progress to conventional culture positivity, thereby highlighting their clinical and epidemiological relevance. METHODS: In this prospective observational longitudinal cohort study, drug-susceptible or rifampicin-resistant tuberculosis index participants aged 12 years or older, were recruited from primary healthcare clinics from two South African districts. Inclusion criteria were informed consent, Xpert MTB/RIF Ultra-positive results, tuberculosis symptoms (>2 weeks), provision of baseline samples, at least one consenting household contact, and documented HIV status. Household contacts of the index patients and control households were also recruited. Sputum specimens were collected at baseline and 2, 4, 8, 12, and 16 months from the index participants and household contacts. Samples were analysed by conventional mycobacterial growth indicator tube (MGIT) culture, and colony-forming unit assays to identify viable bacteria. Enhanced culture to detect DCTB involved serial dilution of sputum in liquid culture, supplemented with M tuberculosis culture filtrate as a source of growth stimulatory factors. Whole-genome sequencing (WGS) of cultured isolates was performed to trace household transmission. FINDINGS: Between June 1, 2020, and Feb 6, 2024, 293 index participants (183 [62%] male), 701 household contacts (453 [65%] female), and 122 control participants (67 [55%] female) were enrolled. At baseline, 249 (85%) of 293 index participants and 110 (16%) of 701 household contact sputum samples were positive for M tuberculosis by MGIT conventional culture. For baseline MGIT-negative specimens, DCTB assays detected M tuberculosis in an additional 21 (7%) of 293 index participants and 26 (4%) of 701 household contacts. Over 16 months of follow-up, DCTB assays identified 61 (8·7%) of 701 additional tuberculosis-positive household contacts not detected by conventional culture. WGS-guided transmission mapping using conventional culture identified transmission in 16 (15%) of 104 households, whereas DCTB assays detected an additional 19 (18%) of 104 transmission events. No evidence of intrahousehold transmission was found in the remaining 69 (66%) of 104 tuberculosis-positive households. Over the 16-month follow-up period, conventional culture identified 233 positive household contacts, of which 195 (84%) were asymptomatic. DCTB assays detected an additional 94 cases of M tuberculosis positivity in household contacts, of which 79 (84%) were asymptomatic. In control households, tuberculosis prevalence at baseline was two (2%) of 122, with an additional three (3%) of 122 identified during follow-up. INTERPRETATION: DCTB assays provide substantial value by detecting asymptomatic individuals missed by conventional culture, revealing a potentially important reservoir of subclinical infection, which could sustain transmission. In addition, DCTB detection uncovers transmission linkages missed by conventional culture, providing a more comprehensive understanding of M tuberculosis transmission dynamics and highlighting the need to incorporate enhanced culture methods into diagnostic and surveillance strategies, to strengthen early case identification and tuberculosis control efforts. FUNDING: National Institutes of Health.

Humans

Variola minor in Braganca Paulista County, 1956: household aggregation of the disease and the influence of household size on the attack rate.

Household aggregation of cases, one possible characteristic of person-to-person transmitted disease, was formally tested in one epidemic of variola minor by using a pair statistic. A significant result was found for all households as well as for households grouped by the type of environment, or by the phase of the epidemic growth in time. Secondary attack rates, when related to household size (number of susceptibles) showed only a marginal trend in rural households but no trend in urban or semi-rural households.

Brazil

The epidemiology and household distribution of seroreactivity to Trypanosoma cruzi in a rural community in northeast Brazil.

The prevalence rates and household distribution of seroreactivity to Trypanosoma cruzi by complement fixation (CF) and indirect immunofluorescent antibody methods were determined in a population of 1,087 persons living in a rural area endemic for Chagas' disease in northeast Brazil. There was a gradual rise in the rate of seropositivity to 60% by age 20. Between ages 20 and 55 the prevalence rate remained at about 60%, but declined thereafter. The decline in the older age groups was not accompanied by a fall in geometric mean titer, suggesting that the decline might better be explained by an increased mortality among those seropositive than by a decrease in CF reactivity associated with age. There was variation in the rates of seropositivity in children among the geographic subunits, but the rates among adults were fairly uniform. Household clustering of seropositivity was demonstrated when both household size and age distribution were taken into account. The presence of a seropositive child less than 5 years of age was a good indicator of a household with a high rate of seropositivity; screening for young seropositive children might be a useful tool to locate high risk households. Seropositive children in households where the mother was seropositive but the father seronegative were significantly younger than seropositive children in households where the father was seropositive but the mother seronegative even though the age distribution and the overall rate of seropositivity in both groups of children were similar; thus, conversion to seropositivity earlier in life in children of seropositive mothers may not be due solely to increased exposure, but may indicate that the immunologic response in such children differed from that of children from seronegative mothers.

Adolescent

Lymphocyte transformation test in healthy contacts of patients with leprosy. I. Influence of exposure to leprosy within a household.

Fifty-three household contacts of lepromatous patients, 37 household contacts of tuberculoid patients, and 91 control persons were examined with the lymphocyte transformation test (LTT) for their responses to whole and sonicated antigen preparations from M. leprae, to BCG, M. avium, M. gordonae, and phytohemagglutinin (PHA). The study was carried out in the Gurage area of Ethiopia in 15 households with a leprosy patient and 15 matched control households. Household contacts of lepromatous patients showed significantly greater LTT responses to antigens from M. leprae than the controls, whereas household contacts of tuberculoid patients did not respond differently from controls. Household contacts of lepromatous patients had significantly greater responses to M. leprae antigens when the index patients were "active," i.e., highly bacilliferous, than when they were "inactive," i.e., having a low bacillary load. The degree of sensitization, as indicated by the LTT response, in different exposure groups paralleled the degree of probable infectivity of the index patient. A preparation of antigen from whole M. leprae proved to be more sensitive and more specific in the LTT than did a sonicated preparation. A significant degree of cross-reactivity was found among the various mycobacteria in their LTT responses.

Adolescent

Unveiling microbial risks in Chinese household dust: a comprehensive analysis from absolute abundance to virulence unit.

BACKGROUND: People spend the majority of their lives indoors, yet the risk and virulence potential of household microbiota remain largely unexplored, particularly in developing countries. RESULTS: Here, we conducted a nationwide survey on both dust samples and health information across 118 Chinese households. The microbiota composition and its functional units were analyzed using absolute 16S rRNA/ITS sequencing, metagenomics, and metaproteomics. Cross-domain network analysis of the core microbial communities revealed robust co-occurrence patterns in household dust. The mean absolute abundance of potentially pathogenic bacteria and fungi in households was 2.39 × 105 and 2.83 × 106 DNA copies/g dust. The potentially pathogenic community was primarily influenced by latitude, relative humidity, and average temperature. Although total absolute abundance was substantially lower in urban areas, the relative abundance of potentially pathogenic bacteria was markedly higher compared to rural environments. While urban-rural differences existed, the underlying statistical drivers were the environmental variables. The absolute abundance of potential pathogens was significantly associated with the prevalence of rhinitis, wheeze, and dermatitis in 266 participants. Children were identified as the highest-risk group from inhalation exposure of average daily dose. A total of 170 bacterial, 223 fungal virulence factors (VFs), and 370 antibiotic resistance genes (ARGs) were detected in dust and dust extracellular vesicle (EV)-associated DNA. EV-associated cargoes contributed 47.13% to the bacterial VF profiles, 11.90% to fungal VF profiles, and 44.45% to ARG profiles. Metaproteomic analysis confirmed the presence of VF profiles in dust EVs, which was further verified by curated proteomics data from 35 household pathogens. CONCLUSIONS: This study provides a comprehensive, quantitative framework linking indoor microbial exposure to health risks, highlighting EVs as a non-negligible, novel, extracellular mechanistic pathway for health impact in household environments. Video Abstract.

Child

Association of Baloxavir Treatment Timing with Serial Interval and Household Transmission of Influenza through a Likelihood-Based Analysis.

BACKGROUND: Baloxavir treatment is associated with reduced influenza transmission within households, and the serial interval varies by treatment status. However, it remains unclear how baloxavir-induced changes in the serial interval relate to household transmission. We aimed to quantify the model-based association between baloxavir treatment timing and the serial interval and household transmission risk. METHODS: We conducted a household survey of influenza cases in Japan between October 2018 and February 2019. We defined the likelihood-based model integrating the serial interval distribution by treatment status and the secondary attack rate (SAR) using individual-level data from index cases. Using this model, we estimated the reduction in the serial interval associated with baloxavir treatment. RESULTS: Compared with untreated index cases, baloxavir-treated cases were estimated to have a serial interval density reduced by 21.42% following treatment. Treatment within 24 hours was associated with a 0.1685 reduction in the area under the curve, with smaller reductions as treatment was delayed. Earlier treatment was associated with a shorter, more concentrated distribution, whereas treatment 72 hours after onset resembled untreated cases. CONCLUSIONS: Our findings highlight that baloxavir treatment is associated with a shorter serial interval and lower estimated secondary household transmission risk. We provide model-based estimates suggesting that earlier administration is associated with a greater reduction in serial interval density and estimated transmission risk, which may inform public health strategies for infection control.

Influenza

Diversity analysis of indoor and outdoor fungal bioaerosols in UK households: a prospective, observational, longitudinal study.

BACKGROUND: Long-term exposure to indoor fungal bioaerosols is a recognised risk factor for respiratory illness, particularly in damp and poorly ventilated housing. However, the diversity and seasonal variability of these fungal communities are poorly understood. As part of the West London Healthy Home and Environment Study (WellHome), this study aimed to characterise the composition, diversity, and temporal dynamics of indoor fungal bioaerosols in urban UK homes, as compared with outdoor air, to inform future exposure baselines and policy development. METHODS: In this prospective, community-based observational study, 118 households were recruited across West London, UK, via community networks and partner organisations, prioritising families with children aged 5-17 years with asthma or allergies, from diverse socioeconomic backgrounds. Sampling occurred between Oct 3, 2022, and June 14, 2024. Participant data were collected via questionnaires completed by household members, capturing demographics, building characteristics, and respiratory health. Passive-air samplers were used in living rooms for 28 days during two seasonal campaigns, with concurrent outdoor sampling at four fixed community sites. Fungal bioaerosols were identified by ITS2 amplicon sequencing and quantified using broad-range quantitative PCR targeting the 18S rRNA gene. Diversity indexes and temporal dynamics were analysed using ecological statistics and generalised additive models. FINDINGS: 118 households were enrolled, comprising 504 residents (263 women, 237 men, and four not reported). Among 504 participants who self-identified, the largest groups comprised individuals identifying as Black African (n=47), Somali (n=46), White British (n=42), and African (n=38), with additional representation from mixed race ethnic backgrounds (n=29), Black British (n=27), White (n=22), and Black Caribbean (n=18), alongside several other ethnicities each represented at lower frequencies. Of 118 households, 104 completed both seasonal campaigns and 14 completed one, yielding 262 air samples (222 indoor and 40 outdoor). DNA was successfully recovered from all samples, identifying 2027 fungal genera. Indoor environments showed significantly higher richness (mean 646 vs 495 amplicon sequence variants; p<0&#xb7;0001) and Shannon diversity (4&#xb7;21 vs 3&#xb7;53; p<0&#xb7;0001) than outdoors. Community composition differed markedly (permutational multivariate ANOVA p<0&#xb7;0001), with Penicillium, Aspergillus, and Wallemia enriched indoors. Indoor fungal communities presented stronger seasonal cycling (R2=0&#xb7;203) than outdoor communities (R2=0&#xb7;012). Fungal burden across all homes had a median 11&#x2009;043 genomic equivalence (GE); IQR 4598-20&#x2009;579 GE. The highest levels were observed in homes with visible mould; one household showed elevated Aspergillus exposure linked to repeated asthma hospitalisations in a sensitised resident. INTERPRETATION: Indoor fungal bioaerosols are more diverse and dynamic than outdoor communities in urban UK homes. These findings establish foundational exposure data and highlight the need for incorporating fungal bioaerosol monitoring into public health policy to mitigate mould-related health risks. FUNDING: UK Research and Innovation (UKRI) Strategic Priorities Fund (SPF) Clean Air Programme.

Humans

Haemophilus influenzae meningitis. A national study of secondary spread in household contacts.

To determine the risk of severe Haemophilus influenzae illness among household contacts of patients with H. influenzae meningitis, we studied prospective data obtained in 19 states from January 1, 1977, to June 30, 1978. H. influenzae meningitis was reported in 1403 patients, and 1147 (82 per cent) of the exposed families were investigated for the occurrence of H. influenzae disease within 30 days after its onset in the index patient. During this interval, nine of 1687 household contacts (0.5 per cent) under the age of six years had systemic disease confirmed to be caused by H. influenzae Type b. The risk in children less than one year of age was 6 per cent, and the risk in those less than four years of age was 2.1 per cent. None of 2624 contacts above the age of five was affected. In the 30 days after onset of meningitis, the risk of this infection alone, aside from other types of serious H. influenzae disease, is 585 times greater in household contacts than the age-adjusted risk in the general population. The risk of H. influenzae disease in household contacts under six years of age is similar to the risk of secondary meningococcal disease in all household contacts--indicating a need for effective antimicrobial prophylaxis.

Adolescent

[Contribution on household dust allergy (author's transl)].

In 1970 the allergy out-patient department of the First Otolaryngological University Hospital of Vienna reported for the first time about the increasing significance of mould fungus allergies in the respiratory tract. RAST now makes in possible to analyze the indivudual fractions of a household dust sensitization by way of experiments. We have seen that in the case of positive RAST reactions to household dust, which is a mixed antigen unspecific as such, evidence can be found for at least one of the antigens "mould fungus", "household dust mite", or "animal hair" in positive RAST categories. Among the 107 cases of the RAST categories 2 und 3 with respect to household dust (h3) a household-dust mite sensitization was evidenced in 88 percent, the respective figures for animal hair sensitization being 49 percent and for mould fungus sensitization 43 percent.

Austria

Contagiousness of acute hepatitis B. Secondary attack rates in household contacts.

In order to define the hazard of household exposure to patients with acute hepatitis B, in the absence of persistent hepatitis B surface antigen (HBSAg), 98 household contacts of 42 patients with the acute disease were interviewed and tested for HBSAg, antibody to HBSAg (anti-HBS), and serum transaminases shortly after identification and at 3-month intervals for at least 12 months. Most of the index cases with acute hepatitis B were young men and many had used illicit drugs parenterally before the onset of illness. Three of the household contacts had HBSAg detected on initial testing, and 2 of these were carriers with elevated serum transaminase levels. The 3rd HBSAg-positive contact developed acute hepatitis within 2 weeks. This appeared to represent a coprimary infection. Fourteen contacts had anti-HBS on initial evaluation and were considered immune as a result of prior experience with hepatitis B. Of 81 susceptible contacts (neither HBSAg nor anti-HBS on initial screening), 13 were spouses or sexual partners and 2 of these developed acute hepatitis B at 4 and 6 months after the onset of illness in their respective index cases; another developed anti-HBS at 6 months. Thus, 3 (23%) of 13 exposed spouses or sexual partners developed evidence of hepatitis B infection during the surveillance period. In contrast, no evidence of hepatitis B infection related to household exposure was found in 68 parents, siblings, and other domestic contacts. These data confirm the contagiousness of hepatitis B for household contacts of acute cases and suggest that the risk is confined to spouses and sexual partners. These persons appear to be prime candidates for prophylaxis with hepatitis B immune globulin.

Acute Disease

Machakos Project Studies: agents affecting health of mother and child in a rural area of Kenya. Viii. food resources and eating habits of the Akamba household.

In two ecologically dissimilar locations in Machakos District, Kenya, investigations were carried out on the nutritional state of infants, pre-school children and mothers in two different seasons. The methods applied and findings on the specific age groups are reported elsewhere. The results presented are observations made on factors conditioning the pattern of foods and food availability, food consumption, and household economy. In the year of study, harvests were fair. Corresponding, qualitatively good diets were observed in the two areas during both seasons. The relatively well-off households of small farmers in a mixed economy on the West side, consumed daily maize and beans only partly derived from their own fields. Household incomes, farm-and non-farm alike, were spent largely on the purchase of additional staple foods and milk, vegetables, fat and sugar. The poorer households in the Eastern part derived their daily foods (maize, legumes and milk) for the most part from own production; vegetables, fat and sugar were purchased and required a relatively large part of total income. In spite of the satisfactory food intake pattern, the latter people remain in a vulnerable situation; years of crop failure regularly occur and total income does not allow for increasing expenditure. Similarities and differences in respect of the food pattern now and half a century ago are described. Future prospects and constraints are discussed.

Adolescent

Generalisations of two tests for the detection of household aggregation of disease.

Two statistical tests have been suggested to detect household aggregation of disease. Mathen and Chakraborty [1950] proposed counting the number of households, Z, in which there were no cases of the disease, and Walter [1974] proposed counting the number of pairs, N, of cases within households. As originally formulated, both of these methods suffer from the limitation that it is assumed, in the null case, that all members of the population, who are assumed to be susceptible, are at equal risk to disease. In this paper we generalise these tests to the situation in which different population strata are at different risks to disease. Formulae are given for the first four moments of Z. The revised Walter's test is shown to be a special case of a test of Pike and Smith [1974] which enables the expectation and variance of N to be directly evaluated. A similar relationship is noted between Walter's test and Knox's [1964] test for space-time clustering. A further test statistic is suggested: the number of cases, T, in households containing two or more cases.

Brazil

The fall in household size and the rise of the primary individual in the United States.

The long-term fall in household size in the United States is discussed within the framework of the aging of the population, continuing as the effects of fertility and mortality decline accumulate. Using distributions of households by size from U.S. census data 1790-1970 and a components of change analysis on primary individuals for 1950-1974, household changes are related to demographic change for the periods 1790-1900, 1900-1950, and 1950-1974. Fertility and mortality declines have unambiguous impact on household size until the increases in primary individuals begin. But these, too, have a theoretically interesting, if indirect relationship to population structure.

Adolescent

T and B lymphocytes in patients with acute anterior uveitis and ankylosing spondylitis, and in their household contacts.

During episodes of acute anterior uveitis, patients had a T-lymphopenia and a temporary increase in B-lymphocytes. The T-lymphopenia was not present in patients investigated early in their first attacks, and it persisted after the patients recovered clinically. In household contacts of patients with uveitis, there was a temporary T-lymphopenia. A similar degree of T-lymphopenia was present in patients with ankylosing spondylitis who had not had uveitis, but not in their household contacts. In patients with spondylitis, there was no greater reduction of T-cells when they had episodes of uveitis. In all groups of subjects studied, T-lymphopenia could be abolished, in vitro, with thymosin, a bovine thymic-hormone estract. The finding of T-lymphocyte depletion in the contacts of uveitis patients, as well as in the patients themselves, suggests that there may be lateral transmission of an infective agent (or agents) in the households during (or before) attacks of uveitis.

Acute Disease

Acceptability of alcohol-based hand rub during neonatal care in rural Ugandan households: a qualitative study nested within the BabyGel trial.

BACKGROUND: Poor access to water, sanitation and hygiene exacerbates the spread of infections among newborns. The BabyGel cluster randomised trial assessed the effectiveness of a community-level alcohol-based hand rub with a training component in reducing infection or death rates among newborns in Uganda. OBJECTIVE: Nested in the BabyGel trial, this study investigated the acceptability of the BabyGel intervention among mothers and household members in Eastern Uganda, using the Theoretical Framework of Acceptability. METHODS: In 2022, we conducted individual semistructured interviews with mothers, and group interviews with mothers and other household members, all recruited from intervention-arm clusters. Thematic analysis combined inductive and deductive coding, structured by the framework's seven constructs: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness and self-efficacy. RESULTS: Twenty mothers and 14&#xa0;household members participated in 10 individual and 10 small group interviews. Participants found the intervention generally acceptable, appreciating its convenience and perceived protection against infection. Many described hand hygiene changes that persisted beyond the intervention period. However, concerns related to its harmful effects, spiritual beliefs and social tensions with visitors occasionally influenced its use. CONCLUSION: Alcohol-based hand rub combined with a training component was generally well accepted, driven by perceived health and practical benefits, although concerns related to safety, belief systems and social dynamics remained. Because data collection coincided with the COVID-19 pandemic, a period of heightened hygiene awareness, the acceptability observed could differ in nonpandemic periods. Culturally adapted education, community engagement and reinforcement of correct use may enhance acceptability and sustainability in similar settings.

Humans

Prevention of childhood household injuries: a controlled clinical trial.

Injuries claim the lives of more children each year than the next six leading pediatric disorders combined, and produce injuries that require medical attention for one in three children. In the preschool age group, 91 per cent of these accidents and over one-half the resultant fatalities occur in the home. This paper reports the results of a controlled clinical trial conducted to evaluate the implementation of a health education program intended to reduce the risk of childhood household injuries. The study population was randomly assigned into two demographically comparable groups. Only the experimental group mothers received an educational intervention consisting of a tutorial, home safety-proofing assignments, and follow-up. The homes of the two groups were later assessed for hazards during an unannounced visit by an interviewer who did not know to which group each home belonged. A home safety score mean for the two groups was almost identical. The program stimulated heightened interest and stated intent to improve, but did not result in actual reduction of household hazards. Active health education, as used and evaluated in this study, appears to have limited effectiveness when applied to home safety. Approaches such as "passive" measures may offer greater potential for household injury reduction.

Accidents, Home

Trypanosoma cruzi infection in dogs and cats and household seroreactivity to T. cruzi in a rural community in northeast Brazil.

The prevalence of Trypanosoma cruzi parasitemia as determined by xenodiagnosis on domestic dogs and cats was correlated with household rates of seroreactivity to T. cruzi and household Panstrongylus megistus infestation in a rural area in northeast Brazil where P. megistus was the only domiciliary triatomine vector. T. cruzi infection was present in about 18% of domestic dogs and cats. Two-thirds of seroreactive children below age 10 resided in houses with T. cruzi-infected animals. In houses with a T. cruzi-infected dog or cat, as well as at least one infected P. megistus, the household rate of seroreactivity to T. cruzi was five times greater than in houses with non-infected domestic animals and no infected triatomine vectors. Domestic dogs and cats are important reservoirs of T. cruzi in an endemic area where P. megistus is the only domiciliary triatomine vector.

Adult