Contact Investigation

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Contact investigation is a procedure for identifying people who were exposed to someone with infectious TB disease, evaluating these people for active TB disease or latent TB infection (LTBI) and providing appropriate treatment for those with TB disease as well as LTBI. The purpose of contact investigation is to find persons who have active TB disease and at the same time identify eligible contacts for TB Preventive Treatment (TPT) among children and adults.

The contact investigation procedure will be used for early case finding of TB including Drug Resistant TB (DR TB), as a way of preventing on going transmission of TB, both in the household and in the community.

In addition, it is important to closely follow up contacts of patients with multidrug-resistant tuberculosis (MDR-TB) or extensively drug-resistant tuberculosis (XDR-TB) in order to prevent further spread of drug-resistant TB.

Standard Definitions of commonly used terms:

Index patient (index case) of TB: is the initially identified person of any age with new or recurrent TB in a specific household or other comparable setting in which others may have been exposed. An index patient is the person on whom a contact investigation is centered but is not necessarily the source.

  1. Source case or patient: The case or person who was the original source of infection for secondary cases or contacts - can be, but is not necessarily, the index case
  2. Contact: is any individual who was exposed to a person with TB disease.
  3. Close contact: is a person who is not in the household but shared an enclosed space, such as at a social gathering, workplace or facility, for extended periods during the day with the index patient.
  4. Household contact: is a person who shared the same enclosed living space with the index patient for one or more nights or for frequent or extended periods.
  5. Contact investigation: is a systematic process for identifying previously undiagnosed people with TB disease and TB infection among the contacts of an index TB patient and/or other comparable settings where transmission occurs. Contact investigation consists of identification, clinical evaluation and/or testing and provision of appropriate anti-TB therapy (for people with confirmed TB) or TB preventive treatment (for those without TB disease).
  6. TB preventive treatment (TPT): Treatment is offered to individuals who are considered to be at risk of developing TB disease, in order to reduce that risk. It is also referred to as treatment of TB infection or LTBI treatment.
  7. Active case finding (ACF): Health workers, NGO staff, and/or community volunteers screen individuals for TB by asking a series of standard questionnaire related to signs, symptoms and contact history of TB. When the verbal symptom screening is positive, the presumptive TB cases are evaluated by investigation. If the laboratory test confirms a diagnosis of TB, the patient is put on appropriate treatment and their contacts are in turn screened and tested for TB.