Mycobacterium tuberculosis Infection in Close Childhood Contacts of Adults with Pulmonary Tuberculosis is Increased by Secondhand Exposure to Tobacco

Ifedayo M. O. Adetifa Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom;
College of Medicine, University of Lagos, Lagos, Nigeria;
Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia;

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Lindsay Kendall Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia;

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Simon Donkor Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia;

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Moses D. Lugos Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia;
Department of Medical Laboratory Science, University of Jos, Plateau, Nigeria;

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Abdulrahman S. Hammond Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia;

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Patrick K. Owiafe Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia;

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Martin O. C. Ota World Health Organization-Regional Office for Africa, Brazzaville, Congo;

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Roger H. Brookes Bioprocess Research and Development, Sanofi Pasteur, Toronto, Ontario, Canada;

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Philip C. Hill Department of Preventive and Social Medicine, Centre for International Health and the Otago International Health Research Network, University of Otago School of Medicine, Dunedin, New Zealand

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Tobacco use is a major risk factor for tuberculosis (TB). Secondhand smoke (SHS) is also a risk factor for TB and to a lesser extent, Mycobacterium tuberculosis infection without disease. We investigated the added risk of M. tuberculosis infection due to SHS exposure in childhood contacts of TB cases in The Gambia. Participants were childhood household contacts aged ≤ 14 years of newly diagnosed pulmonary TB (PTB) cases. The intensity of exposure to the case was categorized according to whether contacts slept in the same room, same house, or a different house as the case. Contacts were tested with an enzyme-linked immunospot interferon gamma release assay. In multivariate regression models, M. tuberculosis infection was associated with increasing exposure to a case (odds ratios [OR]: 3.9, 95% confidence interval [CI]: 2.11–71.4, P < 0.001]) and with male gender (OR: 1.5 [95% CI: 1.12–2.11], P = 0.008). Tobacco use caused a 3-fold increase in the odds of M. tuberculosis infection in children who slept closest to a case who smoked within the same home compared with a nonsmoking case (OR: 8.0 [95% CI: 2.74–23.29] versus 2.4 [95% CI: 1.17–4.92], P < 0.001). SHS exposure as an effect modifier appears to greatly increase the risk of M. tuberculosis infection in children exposed to PTB cases. Smoking cessation campaigns may be important for reducing transmission of M. tuberculosis to children within households.

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Author Notes

Address correspondence to Ifedayo M. O. Adetifa, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom. E-mail: ifedayo.adetifa@lshtm.ac.uk

Financial support: The United Kingdom’s Medical Research Council funded this study through the Medical Research Council Unit, The Gambia.

Authors’ addresses: Ifedayo M. O. Adetifa, Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom, Medical Education and Development Unit, College of Medicine, University of Lagos, Nigeria, and Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia, Fajara, The Gambia, E-mail: Ifedayo.Adetifa@lshtm.ac.uk. Lindsay Kendall, Simon Donkor, Moses D. Lugos, Abdulrahman S. Hammond, and Patrick K. Owiafe, Disease Control and Elimination Theme, Medical Research Council Laboratories The Gambia, Fajara, The Gambia, E-mails: lindsay_kendall@hotmail.com, sdonkor@mrc.gm, mlugos2003@yahoo.com, abdulhammond@hotmail.com, and pkowiafe@uhas.edu.gh. Martin O. C. Ota, World Health Organization-Regional Office for Africa, Research, Publication and Library Services, Brazzaville, Congo, E-mail: otama@who.int. Roger H. Brookes, Sanofi Pasteur Ltd., Bioprocess Research and Development, Toronto, ON, Canada, E-mail: roger.brookes@sanofipasteur.com. Philip C. Hill, Department of Preventive and Social Medicine, University of Otago School of Medicine, Dunedin, Otago, New Zealand, E-mail: philip.hill@otago.ac.nz.

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