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June 12, 2002

Factors in Tuberculosis Contact Investigations—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(22):2944-2945. doi:10.1001/jama.287.22.2942

In Reply: We agree with Dr Reichler and colleagues that documented TST conversion provides the purest estimation of recent transmission. Unfortunately this event was uncommon in our study. Only 119 of 6113 contacts converted between the first and second TSTs. We eliminated from the analysis each contact who reported a positive TST result more than 60 days prior to case identification. For those indicating no previous positive result and an initial negative result, a second TST was performed 10 to 12 weeks later. If the result of either the first or second test was positive, the contact was classified as having a positive reaction. Prior TB exposure is confounded by race, sex, and age; therefore, our model with demographics included is designed to predict positive TST results. There are limitations to using this outcome as a surrogate for recent transmission, including the background rate of TB infection.

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