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The objective of this multinational study was to estimate the proportion of household contacts resistant to M. tuberculosis (resisters).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a longitudinal study enrolling index patients enrolled in treatment for pulmonary multidrug- or rifampin-resistant tuberculosis and their household contacts. Contacts were tested for tuberculosis infection with a tuberculin skin test (TST) and interferon-gamma release assay (IGRA) at baseline and after 1 year. Exposure was quantified based on index patients\u2019 infectiousness, index patient and household contact interaction, and age. We explored multiple definitions of resistance to tuberculosis infection by varying TST negativity cutoffs (0 vs &amp;lt;5 mm), classification of missing test results, and exposure level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 1016 contacts were evaluated from 284 households; 572 contacts aged \u22655 years had TST and longitudinal IGRA results available. And 77 (13%) or 71 (12%) contacts were classified as resisters with a &amp;lt;5 mm or 0 mm TST threshold, respectively. Among 263 highly exposed contacts, 29 (11%) or 26 (10%) were classified as resisters using TST cutoffs of &amp;lt;5 mm and 0 mm, respectively. The prevalence of resisters did not differ substantially by sex, age, human immunodeficiency virus (HIV) coinfection, or comorbid conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>At least 10% of household contacts can be classified as resistant to tuberculosis infection, depending on the definition used, including those with high exposure. Further studies to understand genetic or immunologic mechanisms underlying the resister phenotype may inform novel strategies for therapeutics and vaccines.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciab269","type":"journal-article","created":{"date-parts":[[2021,3,24]],"date-time":"2021-03-24T20:11:25Z","timestamp":1616616685000},"page":"1037-1045","source":"Crossref","is-referenced-by-count":17,"title":["Resistance to<i>Mycobacterium tuberculosis<\/i>Infection Among Household Contacts: A Multinational Study"],"prefix":"10.1093","volume":"73","author":[{"given":"Davit","family":"Baliashvili","sequence":"first","affiliation":[{"name":"Emory Rollins School of Public Health, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neel R","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Emory Rollins School of Public Health, Atlanta, Georgia, USA"},{"name":"Emory School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soyeon","family":"Kim","sequence":"additional","affiliation":[{"name":"Frontier Science Foundation, Brookline, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hughes","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidya","family":"Mave","sequence":"additional","affiliation":[{"name":"Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Mendoza-Ticona","sequence":"additional","affiliation":[{"name":"Asociacion Civil Impacta Salud y Educacion, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Gonzales","sequence":"additional","affiliation":[{"name":"Asociacion Civil Impacta Salud y Educacion, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Narunsky","sequence":"additional","affiliation":[{"name":"UCT Lung Institute, Cape Town, South 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