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June 12, 2002

Factors in Tuberculosis Contact Investigations

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

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

To the Editor: We completely agree with all of the points that Drs Moehle-Boetani and Flood made in their Editorial1 about our study2 of contact investigation, but I would like to clarify the intent of our article. Moehle-Boetani and Flood emphasize that "[t]he finding that child contacts were less likely to have an initial positive TST result could be a consequence of the lower likelihood of remote infection in children, and not a lower likelihood of recent infection." Our model was developed to predict TST results. Although the TST result can be used as a surrogate for recent transmission there are several limitations including the background rate of TB infection. Our response to Reichler et al describes our policy in Alabama. Mohle-Boetani and Flood also wondered about the 11% of contacts with a positive TST result who would not be identified by our model. In fact, approximately one third of these individuals were younger than 15 years and would have been investigated under our policy.