{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T18:18:01Z","timestamp":1784312281364,"version":"3.55.0"},"reference-count":27,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"unspecified","delay-in-days":133,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100023885","name":"All of Us Research Program","doi-asserted-by":"publisher","award":["K24AI182647"],"award-info":[{"award-number":["K24AI182647"]}],"id":[{"id":"10.13039\/100023885","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100023885","name":"All of Us Research Program","doi-asserted-by":"publisher","award":["R01 AI130058"],"award-info":[{"award-number":["R01 AI130058"]}],"id":[{"id":"10.13039\/100023885","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100023885","name":"All of Us Research Program","doi-asserted-by":"publisher","award":["R01 AI149620"],"award-info":[{"award-number":["R01 AI149620"]}],"id":[{"id":"10.13039\/100023885","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["404182\/2019-4"],"award-info":[{"award-number":["404182\/2019-4"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,10,16]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Understanding determinants of\n                      <jats:italic>Mycobacterium tuberculosis<\/jats:italic>\n                      transmission is critical to devising effective strategies to reduce its burden. Whether and to what extent symptoms influence transmission remains poorly understood.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between 2020 and 2022, we systematically screened persons deprived of liberty (PDL) from three prisons in Brazil for tuberculosis (TB) by symptom assessment and sputum testing with Xpert MTB\/RIF Ultra. We performed QuantiFERON-TB Gold Plus (QFT) testing among cell contacts of individuals with TB and in cells with no TB case identified. We evaluated the relationship between TB exposure (symptomatic, asymptomatic and none) and QFT positivity using Bayesian generalised linear mixed models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We screened 7641 PDL for TB and identified 290 cases, yielding a prevalence of 3.8% (290\/7641). After applying the exclusion criteria, 686 participants were included for the QFT analysis: 132 contacts of 42 individuals with symptomatic TB, 224 exposed to 52 individuals with asymptomatic TB and 330 with no recent cell exposure. The odds of QFT positivity were higher in symptomatic (adjusted OR (aOR) 2.50, 95% credible interval (CrI) 1.51 to 4.16) and asymptomatic (aOR 1.61, 95% CrI 1.06 to 2.45) exposure groups than in those unexposed. QFT positivity in contacts of symptomatic and asymptomatic TB did not differ (aOR 1.56, 95% CrI 0.92 to 2.63). These associations may be underestimated because of infections acquired outside cell assignments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Approximately two-thirds of individuals with TB lacked symptoms, and their contacts and symptomatic TB contacts had similarly increased risk of QFT positivity compared with individuals without recent cell exposure. These findings indicate that symptom-based screening misses many TB cases. Effective TB control requires systematic screening irrespective of symptoms to interrupt transmission and accelerate diagnosis in high-burden settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003218","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T12:55:22Z","timestamp":1763038522000},"page":"e003218","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Role of tuberculosis symptoms in transmission risk to cell contacts in prisons"],"prefix":"10.1136","volume":"3","author":[{"given":"Wanessa da Silva Peres","family":"Bezerra","sequence":"first","affiliation":[{"name":"Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Jung","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana Garcia","family":"Croda","sequence":"additional","affiliation":[{"name":"Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7996-8011","authenticated-orcid":false,"given":"Roberto Dias de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Nursing Course, State University of Mato Grosso do Sul, Dourados, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea da Silva","family":"Santos","sequence":"additional","affiliation":[{"name":"Health Science Research Laboratory, Federal University of Grande Dourados, Dourados, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Henrique","family":"Tsuha","sequence":"additional","affiliation":[{"name":"Funda\u00e7\u00e3o Oswaldo Cruz, Campo Grande, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Cesar Pereira dos","family":"Santos","sequence":"additional","affiliation":[{"name":"Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunice Atsuko Totumi","family":"Cunha","sequence":"additional","affiliation":[{"name":"Laboratory of Bacteriology of Central Laboratory, Health State Department of Mato Grosso do Sul, Campo Grande, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6665-6825","authenticated-orcid":false,"given":"Julio Henrique Rosa","family":"Croda","sequence":"additional","affiliation":[{"name":"Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil"},{"name":"Funda\u00e7\u00e3o Oswaldo Cruz, Campo Grande, Brazil"},{"name":"Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason Randolph","family":"Andrews","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"2026010703073692000_3.2.e003218.1","unstructured":"World Health Organization . Global tuberculosis report 2023. 2023."},{"key":"2026010703073692000_3.2.e003218.2","unstructured":"World Health Organization . 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