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      The Risk of Tuberculosis in Children After Close Exposure: An Individual-Participant Meta-analysis Including 137,647 Children from 46 Cohort Studies

      research-article
      , Pediatric TB Contact Studies Consortium
      Lancet (London, England)
      tuberculosis, children, prevention, pediatrics

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          Abstract

          Background.

          Tens of millions of children are exposed to Mycobacterium tuberculosis globally every year; however, there are no contemporary estimates of the risk of developing tuberculosis in exposed children. The effectiveness of contact investigations and preventive therapy remains poorly understood.

          Methods.

          We conducted an individual participant data meta-analysis of cohort studies in which children (<19 years of age) with close tuberculosis exposure were investigated for tuberculosis and followed for incident disease. We estimated the odds of prevalent tuberculosis with mixed-effects logistic models, and estimated adjusted hazard ratios (AHR) for incident tuberculosis with mixed-effects Poisson regression models. The effectiveness of preventive therapy against incident tuberculosis was estimated through propensity score matching.

          Findings.

          We pooled participant-level data from 46 cohort studies in 34 countries. We included 137,647 exposed children followed for 429,538 child-years, during which 1,299 prevalent and 999 incident cases were diagnosed. The two-year risk of developing tuberculosis among infected children not receiving preventive therapy was 19.0% from 0 to 5 years of age. The effectiveness of preventive therapy was 63% (AHR, 0.37, 95% confidence intervals [CI], 0.30–0.47) among all exposed children, and 85% (AHR, 0.15, 95% CI, 0.11–0.20) among those with a positive test of infection. Among all children <5 years of age who developed tuberculosis, 83% were diagnosed within 90 days of the baseline visit.

          Interpretation.

          The risk of developing tuberculosis among exposed infants and young children is very high. The majority of cases occurred within weeks of contact investigation initiation and may not be preventable through prophylaxis. This suggests that alternative strategies for prevention, such as earlier initiation of preventive therapy through earlier diagnosis of adult cases or community-wide screening approaches, are needed.

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          Author and article information

          Contributors
          Journal
          2985213R
          5470
          Lancet
          Lancet
          Lancet (London, England)
          0140-6736
          1474-547X
          20 May 2020
          21 March 2020
          21 March 2021
          : 395
          : 10228
          : 973-984
          Affiliations
          Stanford University, School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford, California, United States.
          Department of Medicine, Boston University School of Medicine, Boston, USA; Department of Epidemiology, Biostatistics and Global Health, Boston University School of Public Health, Boston, United States.
          Stanford University, School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford, California, United States.
          Author notes

          Contributions.

          Contributors:

          All authors contributed to the acquisition of the work. Leonardo Martinez and Olivia Cords conducted the systematic search, screened and identified studies, and made final decisions regarding study inclusion. Leonardo Martinez, Olivia Cords, Sanjay Basu, and Jason Andrews designed the analyses. Leonardo Martinez received and checked data, conducted analyses, and had full access to all materials and results. Jason Andrews conducted analyses and created figures. Olivia conducted analyses and helped create tables and figures. Leonardo Martinez, Olivia Cords, Jason R. Andrews wrote the first draft of the report. All writing committee members helped revise the drafted version before and after circulation to collaborators. All authors read and edited the drafted manuscript for important intellectual content and assisted in data interpretation. All authors approved the final version of the manuscript.

          Primary Analysis and Writing Group:

          Stanford University, School of Medicine, Division of Infectious Diseases and Geographic Medicine

          Leonardo Martinez, Olivia Cords, C. Robert Horsburgh, Jason R. Andrews

          Advisory Committee:

          C. Robert Horsburgh, Sanjay Basu, Nathan C. Lo, Ted Cohen, Mark Hatherill, Heather J. Zar

          All other authors of the Pediatric TB Contact Studies Consortium:

          Orvalho Augusto, Carlos Acuna-Villaorduna, Shama Desai Ahuja, Neus Altet, Davit Baliashvili, Sanjay Basu, Mercedes Becerra, Maryline Bonnet, W. Henry Boom, Martien Borgdorff, Fadila Boulahbal, Anna Cristina C. Carvalho, Joan A. Cayla, Tsira Chakhaia, Ted Cohen, Pei-Chun Chan, Julio Croda, Sumona Datta, Helena del Corral, Justin T. Denholm, Reynaldo Dietze, Claudia C. Dobler, Simon Donkor, Uzochukwu Egere, Jerrold J. Ellner, Marcos Espinal, Carlton A. Evans, Chi-Tai Fang, Katherine Fielding, Greg J. Fox, Luis F. García, Alberto L. García-Basteiro, Steffen Geis, Stephen M. Graham, Louis Grandjean, Djohar Hannoun, Mark Hatherill, Anja M. Hauri, Anneke C. Hesseling, Philip C. Hill, Li-Min Huang, Helena Huerga, Rabia Hussain, Leah Jarlsberg, Edward C. Jones-López, Seiya Kato, Midori Kato-Maeda, Beate Kampmann, H. Lester Kirchner, Afrânio Kritski, Christoph Lange, Meng-Rui Lee, Li-Na Lee, Chih-Hsin Lee, Antonio Carlos Lemos, Christian Lienhardt, Du-Lin Ling, Qiao Liu, Nathan C. Lo, Richard Long, Elisa Lopez-Varela, Peng Lu, Matthew Magee, LaShaunda L. Malone, Anna M. Mandalakas, Neil A. Martinson, Rufaida Mazahir, Megan B. Murray, Eduardo Martins Netto, Larissa Otero, Julie Parsonnet, Arthur Reingold, H. Simon Schaaf, James A. Seddon, Surendra Sharma, Jitendra Singh, Sarman Singh, Rosa Sloot, Giovanni Sotgiu, Catherine M. Stein, Najeeha Talat Iqbal, Rina Triasih, Lisa Trieu, Maarten F Schim van der Loeff, Patrick Van der Stuyft, Cari van Schalkwyk, Richa Vashishtha, Lilly Verhagen, Julian A. Villalba, Jann-Yuan Wang, Christopher C. Whalen, Takashi Yoshiyama, Heather J. Zar, Jean-Pierre Zellweger, Limei Zhu

          Institutional Affiliations.

          Leonardo Martinez, Ph.D., Olivia Cords, M.S., Nathan C. Lo, M.D., Jason R. Andrews, M.D. – Stanford University, School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford, California, United States.

          Sanjay Basu, M.D. – Center for Primary Care, Harvard University

          Nathan C. Lo, M.D. – Stanford University School of Medicine, Division of Epidemiology, Stanford, CA, USA

          Eduardo Martins Netto, M.D. – Universidade Federal da Bahia

          Arthur Reingold, M.D. – University of California, Berkeley, Berkeley, CA

          Marcos Espinal – Director, Pan American Health Organization, Communicable Diseases and Health Analysis.

          Anna Mandalakas, M.D. – The Global TB Program, Texas Children’s Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA

          Anna Cristina C. Carvalho – Laboratory of Innovations in Therapies, Education and Bioproducts (LITEB), Oswaldo Cruz Institute (IOC), FioCruz, Rio de Janeiro, Brazil.

          Afrânio L. Kritski, Ph.D., – Tuberculosis Academic Program-Medical School-Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

          Heather J. Zar, M.D. – Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Medical Research Council Unit on Child and Adolescent Health

          Mark Hatherill, M.D. – South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease & Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa.

          Ted Cohen, M.D. – Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America

          C. Robert Horsburgh, M.D. – Department of Medicine, Boston University School of Medicine, Boston, USA; Department of Epidemiology, Biostatistics and Global Health, Boston University School of Public Health, Boston, United States.

          Alberto L. García-Basteiro, M.D. – Manhiça Health Research Centre (CISM), Maputo, Mozambique; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.

          Luis Garcia, M.D. – Grupo de Inmunología Celular e Inmunogenética, Facultad de Medicina, Sede de Investigación Universitaria, Universidad de Antioquia, Medellín, Colombia

          Julio Croda, M.D. – Faculty of Health Sciences, Federal University of Grande Dourados, Brazil.

          Rufaida Mazahir, M.D. – Department of Pediatrics, Jawaharlal Nehru Medical College Aligarh, India.

          Justin T. Denholm, M.D. – Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria, Australia; Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria, Australia.

          Edward C. Jones-López, M.D. – Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, United States of America

          Reynaldo Dietze, M.D. – Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil, Global Health & Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal

          Professor Li-Na Lee, M.D. – Department of Laboratory Medicine, Catholic Fu-Jen University College of Medicine and Hospital, New Taipei City, Taiwan.

          Dr. Chih-Hsin Lee, M.D. – Division of Pulmonary Medicine, Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.

          Dr. Jann-Yuan Wang, M.D. – Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

          Julie Parsonnet, M.D. – Stanford University, School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford, California, United States.

          Neus Altet – Unidad de Tuberculosis, Vall d’Hebron-Drassanes, Hospital Universitari Vall d’Hebron; Instituto de Investigacion en Atencion Primaria Jordi Gol.

          Joan Cayla, M.D. – Universitat Autonoma de Barcelona; Agencia de Salud Publica de Barcelona; Unidad de Investigacion en Tuberculosis de Barcelona del Servicio de Epidemiologıa de la Agencia de Salud Publica de Barcelona, Barcelona, Spain.

          Orvalho Augusto – Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique.

          Shama D. Ahuja, Lisa Trieu – Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York.

          Richard Long, M.D. – Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.

          Carlos Acuña-Villaorduña, M.D., Jerrold J. Ellner, M.D. – Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America; Boston University, School of Medicine, Boston, Massachusetts, United States of America.

          Elisa López-Varela, M.D. – Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique.

          Greg J. Fox, Ph.D. – Sydney Medical School, Australia; University of Sydney, Camperdown, New South Wales, Australia, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.

          Louis Grandjean, M.D. – The Wellcome Centre for Clinical Tropical Medicine, Imperial College, London, United Kingdom; Laboratorios de Investigación y Desarrollo, Departamento de Microbiología, Facultad de Ciencias, Universidad Peruana Cayetano Heredia, Lima, Peru.

          Matthew Magee, M.D. – Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA

          Davit Baliashvili, M.D. – Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA

          Davit Baliashvili, M.D. – National Center for Disease Control and Public Health, Tbilisi, Georgia Mercedes Becerra, M.D., Megan B. Murray, M.D. – Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts

          Maryline Bonnet, M.D. – Institut de Recherche pour le Developpement, Unite Mixte Internationale 233 Translationnelles sur le VIH et les Maladies Infectieuses, Institut National de la Sante et de la Recherche Medicale Unite 1175, Montpellier, France.

          Midori Kato-Maeda, M.D. – Curry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA;

          Leah Jarlsberg, B.A. – Curry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA

          Tsira Chakhaia, M.D. – University Research Co., LLC. Branch in Georgia, USAID Georgia TB Prevention Project, Tbilisi, Georgia

          Sumona Datta, M.D., Carlton A. Evans, M.D. – Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Infectious Diseases and Immunity and Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom; Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru.

          Helena del Corral, Ph.D. – Grupo de Epidemiologıa, Universidad de Antioquia, Medellin, Colombia; Escuela de Microbiologia, Universidad de Antioquia, Medellin, Colombia; Grupo de Inmunologıa Celular e Inmunogenetica, Universidad de Antioquia, Medellin, Colombia; Centro Colombiano de Investigacion en Tuberculosis, Medellin, Colombia.

          Larissa Otero, M.D. – Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.

          Patrick Van der Stuyft, Ph.D. – Department of Public Health, Faculty of Medicine, Ghent University, Ghent, Belgium; Department of Public Health, Ghent University, Ghent, Belgium.

          Philip C. Hill, M.D. –University of Otago Medical School, Dunedin, New Zealand; University of Otago Medical School, Dunedin, New Zealand.

          Najeeha Talat Iqbal – Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.

          Pei-Chun Chan, M.D. – Division of Chronic Infectious Disease, Third Division, Centers for Disease Control, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

          Chi-Tai Fang – Institute of Epidemiology and Preventive Medicine, College of Public Health; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

          Li-Min Huang – College of Medicine and College of Public Health, National Taiwan University Chief, Division of Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital

          Simon Donkor, Msc – Vaccines and Immunity Theme, Medical Research Council Unit, Banjul, Gambia.

          Helena Huerga, M.D. – Epicentre, Epidemiology and Population Health, Paris, France.

          Christian Lienhardt, M.D. – Unité Mixte Internationale TransVIHMI (UMI 233 IRD–U1175 INSERM, Université de Montpellier), Institut de Recherche pour le Développement (IRD), Montpellier, France

          Takashi Yoshiyama, M.D., Seiya Kato, M.D. – Respiratory Diseases Center, Fukujuji Hospital, Kiyose City, Japan.

          Rabia Hussain, Ph.D. – Department of Pathology and Microbiology, Aga Khan University, Stadium Road, P.O. BOX 3500, Karachi, Pakistan.

          Katherine Fielding, Ph.D. – Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.

          H. Simon Schaaf, M.D. – Desmond Tutu Tuberculosis Centre, Stellenbosch University, Tygerberg, South Africa.

          James A. Seddon, M.D. – Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, South Africa; Department of Infectious Diseases, Imperial College London, United Kingdom.

          Jean-Pierre Zellweger, M.D. – TB competence center, Swiss Lung Association, Berne, Switzerland

          Giovanni Sotgiu, M.D. – Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy; Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari-Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy.

          Christoph Lange, M.D. – Division of Clinical Infectious Diseases, Medical Clinic, Research Center Borstel, Borstel, Germany; International Health/Infectious Diseases, University of Lubeck, Lubeck, Germany; Tuberculosis Unit, German Center for Infection Research, Borstel, Germany; Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia; Department of Medicine, Karolinska Institute, Stockholm, Sweden.

          Surendra K. Sharma, M.D. – Former Senior Professor and Head, Department of Internal Medicine,[WHO Collaborating Centre for Research and Training in Tuberculosis Centre of Excellence for Extrapulmonary TB Ministry of Health and Family Welfare, Government of India], All India Institute of Medical Sciences, New Delhi, India

          Current affiliations: Department of Molecular Medicine,Jamia Hamdard Institute of Molecular Medicine Jamia Hamdard [Deemed to be University],New Delhi, India; Departments of General Medicine and Respiratory, Medicine Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences [Deemed to be University],Wardha, Maharashtra, India

          Anja M. Hauri, M.D. – Hessiane State Health Office, Dillenburg, Germany.

          Steffen Geis, M.D. – Institute for Medical Microbiology and Hospital Hygiene, Philipps University of Marburg, Marburg, Germany.

          Claudia C. Dobler, M.D. – Centre for Research in Evidence-Based Practice, Bond University, Robina, Queensland, Australia; Department of Respiratory Medicine, Liverpool Hospital, Sydney, New South Wales, Australia

          Fadila Boulahbal, M.D. – Pasteur Institute of Algeria. Microbiologist, Coordonnateur du groupe de recherche sur la tuberculose latente, Laboratoire National de Référence pour la Tuberculose National Institute of Public Health

          Dr Djohar Hannoun, M.D. – Epidemiologist, Department of Information, Algeria

          Du–Lin Ling – Centers for Disease Control, Department of Health, Taipei, Taiwan.

          Rina Triasih, Ph.D. – Department of Pediatrics, Dr Sardjito Hospital and Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.

          Stephen Graham, M.D. – Centre for International Child Health, University of MelbourneInstitute Department of Paediatrics, Melbourne, Australia.

          Du-Lin Ling – Third Branch, Centers for Disease Control, Taiwan.

          Maarten Schim van der Loeff, M.D. – Department of Infectious Diseases, Infectious Diseases Research & Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.

          Cari van Schalkwyk – The South African Department of Science and Technology/National Research Foundation (DST/NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa.

          Neil Martinson, M.D. – Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Center for TB Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.

          Martien W. Borgdorff, M.D. – Department of Clinical Epidemiology, Biostatistics and Bioinformatics; Center for Infections and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands.

          Anneke C. Hesseling, M.D. – Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

          Rosa Sloot, Ph.D. – Department of Clinical Epidemiology, Biostatistics and Bioinformatics; Center for Infections and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

          Julian A. Villalba, M.D. – Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela.

          Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

          Christopher C. Whalen, M.D. – Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, United States; Institute of Global Health, University of Georgia, Athens, Georgia, United States.

          LaShaunda L Malone, W. Henry Boom, M.D. – Division of Infectious Disease, Department of Medicine and Tuberculosis Research Unit; Case Western Reserve University, Cleveland, Ohio

          Luis F. García, M.D. – Grupo de Inmunologıa Celular e Inmunogenetica, Universidad de Antioquia, Medellın, Colombia; Centro Colombiano de Investigacion en Tuberculosis, Medellın, Colombia

          LaShaunda L Malone, Catherine M. Stein, Ph.D., W. Henry Boom, M.D. – Uganda–CWRU Research Collaboration, Makerere University and Mulago Hospital, Kampala, Uganda.

          Catherine M. Stein, Ph.D. – Department of Population and Quantitative Health Sciences, Tuberculosis Research Unit & Department of Medicine.

          H. Lester Kirchner, Ph.D. – Geisinger, Genomic Medicine Institute, Danville, PA, USA

          Seiya Kato – Research Institute of Tuberculosis, Kiyose City, Japan

          Jitendra Singh, Ph.D. – Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India.

          Sarman Singh, M.D. – Director & chief executive officer, All India Institute of Medical Sciences, Bhopal, India.

          Beate Kampmann, M.D. – Vaccines and Immunity Theme, Medical Research Council (MRC) Unit–The Gambia, Banjul, The Gambia; Centre for International Child Health Academic Department of Paediatrics St Mary’s Campus, Imperial College London, London, United Kingdom.

          Uzochukwu Egere, Ph.D. – Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool

          Richa Vashishtha, Ph.D. – Programme Management Unit, Biotechnology Assistance Research Council, Lodhi Road, New Delhi, India.

          Peng Lu, Ph.D., Qiao Liu, M.D., Limei Zhu, M.D. – Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR China.

          Qiao Liu, M.D. – Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, PR China.

          Meng-Rui Lee – Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.

          Lilly Verhagen, M.D. – Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela; Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands

          Afrânio Kritski, M.D. – Tuberculosis Academic Program-Medical School-Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

          Antonio Carlos Lemos M.D. – Prof. Edgard Santos Universitary Hospital, Federal University of Bahia, Salvador/BA, Brazil.

          Full Professors.

          Julio Croda, Christopher C. Whalen, Antonio Carlos Lemos, Philip C. Hill, Megan Murray, Sarman Singh, W. Henry Boom, Anneke C. Hesseling, Martien W. Borgdorff, Beate Kampmann, Stephen Graham, Djohar Hannoun, Surendra K. Sharma, H. Simon Schaaf, Rabia Hussain, Katherine Fielding, Patrick Van der Stuyft, Christoph Lange, Giovanni Sotgiu, Carlton A. Evans, Mercedes Becerra, Jerrold J. Ellner, Reynaldo Dietze, Richard Long, Arthur Reingold, Anna Mandalakas, Heather J. Zar, Li-Na Lee, Seiya Kato, Mark Hatherill, Afrânio L. Kritski, Julie Parsonnet, C. Robert Horsburgh

          [*]

          All authors and affiliations for all authors are listed at the end of the manuscript.

          Correspondence: Leonardo Martinez, PhD, MPH, Stanford University School of Medicine, Division of Infectious Diseases and Geographic Medicine, 300 Pasteur Drive, Lane L141, Stanford, CA 94305, USA
          Article
          PMC7289654 PMC7289654 7289654 nihpa1579967
          10.1016/S0140-6736(20)30166-5
          7289654
          32199484
          a79eca5c-ae46-4ffd-a85e-4121040b0637
          History
          Categories
          Article

          pediatrics,tuberculosis,children,prevention
          pediatrics, tuberculosis, children, prevention

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