{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T16:27:22Z","timestamp":1764174442915},"reference-count":21,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,2,7]]},"abstract":"<jats:p>Primary <jats:italic>Mycobacterium tuberculosis<\/jats:italic> transmission is an important driver of the global epidemic of resistance to tuberculosis drugs. A few studies have compared tuberculosis infection in contacts of index cases with different drug-resistant profiles, suggesting that contacts of multidrug-resistant (MDR) tuberculosis cases are at higher risk. Repeated tuberculosis exposure in contacts of MDR tuberculosis patients through recurrent tuberculosis may modify this relationship. We compared tuberculosis infection in household contacts of MDR and drug-susceptible (DS) tuberculosis patients from six cities in southeastern China and investigated whether repeated tuberculosis exposure was a mediating factor. Tuberculosis infection was defined as a tuberculin skin test induration \u2265 10 mm. In all, 111 (28.0%) of 397 household contacts of MDR tuberculosis patients and 165 (24.7%) of 667 contacts of DS tuberculosis index cases were infected with tuberculosis. In a multivariate model not including the previous tuberculosis exposure, contacts of MDR tuberculosis patients had a higher likelihood of tuberculosis infection (adjusted odds ratio [AOR] = 1.37; 95% confidence interval [CI] = 1.01\u20131.84; <jats:italic>P<\/jats:italic> = 0.041). In a separate multivariate model adjusted for the previous tuberculosis exposure, the odds ratio of tuberculosis infection flipped and contacts of MDR cases were now at lower risk for tuberculosis infection (AOR = 0.55; 95% CI = 0.38\u20130.81; <jats:italic>P<\/jats:italic> = 0.003). These findings suggest prior tuberculosis exposure in contacts strongly mediates the relationship between tuberculosis infection and the index drug resistance profile. Prior studies showing lower risk of developing tuberculosis among contacts of MDR tuberculosis patients may be partially explained by a lower rate of tuberculosis infection at baseline.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0325","type":"journal-article","created":{"date-parts":[[2017,12,5]],"date-time":"2017-12-05T07:00:34Z","timestamp":1512457234000},"page":"364-371","source":"Crossref","is-referenced-by-count":5,"title":["Mediating Effect of Repeated Tuberculosis Exposure on the Risk of Transmission to Household Contacts of Multidrug-Resistant Tuberculosis Patients"],"prefix":"10.4269","volume":"98","author":[{"given":"Peng","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People\u2019s Republic of China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyan","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People\u2019s Republic of China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People\u2019s Republic of China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People\u2019s Republic of China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonardo","family":"Martinez","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of Georgia School of Public Health, Athens, Georgia;"},{"name":"School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiansheng","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Xuzhou City, Jiangsu Province, China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Nantong City, Jiangsu Province, China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chongqiao","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Lianyungang City, Jiangsu Province, China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Zhenjiang City, Jiangsu Province, China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changdong","family":"Miao","sequence":"additional","affiliation":[{"name":"Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Taizhou City, Jiangsu Province, China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Limei","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Chronic Communicable Disease, Center 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