CONTACT TRACING
MDR WORKSHOP : EThekwini District
Coastlands Hotel : Durban
18.09. 2015
Z.V Radebe – KZN TBCP
Outline
• Why contact tracing
• How
• Surveillance results
• Conclusion
MMWR – March 2005
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• The main purpose is to prevent the spread of
DRTB in the community.
Household surveillance of MDR/XDR
• 1st visit is conducted immediately after diagnosis of
index case
• Initially piloted in COSH and contacts were followed
twice over 2 years(Results available)
• Rolled out to the whole district in 2007 according to
WHO guidelines with the support of Italian
Cooperation.
METHOD
• After diagnosis of MDR/XDR case Household file with all contacts is opened by the tracer / injection team.
• Each index case household is mapped.
• Contacts are screened for the first time.
• Sputa for AFB and culture is taken from contacts.
• Suspected cases who cannot produce sputum with signs and symptoms are referred to hospital for X-ray.
• All contacts are offered VCT at a household level.
• Data for the household is documented ( health, social, etc.).
METHOD continued…
• Monteux test is done in children 5 yrs. and under.
• All children with positive Monteux , signs and symptoms of TB are sent for chest x-ray and VCT at hospital.
• The information is captured at the decentralized site.
• The list of households due for follow up at a specific Quarter is
sent out to sub-districts by the decentralized site as reminder.
• Sub districts follow up contacts and record findings on
household files every six months for 2 years
• Data is analyzed and report is compiled Quarterly/yearly.
What else is done during household
visit• Education on TB/HIV
• Education on IPC(Ventilation, cough hygiene, use of
mask etc.)
• What to do if there is anyone with signs and
symptoms of TB
• Referral to other departments e.g SASSA, Home
affairs
MDR Surveillance
2008 2009 2010
No HH visited 49 139 110
Contacts
Screened
296 895 609
Sputa collected 148 257 94
Monteux Test
done
26 44 15
AFB Positive 2 1 2
Culture Positive 2 2 2
MDR Diagnosed 1 0 0
XDR Diagnosed 0 0 0
Results of contact tracing from Q1/09 to Q3/09.
1st visit 2nd visit 3rd visit 4th visit
Contacts
screened
1846 1334 930 127
TB 9 = 0.5% 8 =0.6% 0 0
MDR 12 = 0.7% 0 0 0
XDR 16 = 0.9% 1= 0.07% 0 0
Total Pos 37 = 2% 9(0.67) =1% 0 0
Conclusion• Early tracing of household contacts is essential and
leads to:
• Decrease in transmission of MDR
• Decrease in death rate (MDR survival rate)
• Community awareness on importance of IPC in the
household(one to one education is given on IPC –
KAP study)
• Study conducted by MRC- KZN shows decrease in
XDR incidence at UMzinyathi but other districts
show increase!
Change in incidence of XDR-TB in KwaZulu-Natal
province, South Africa, 2007 to 2010–
122007(MRC)
Change in incidence of XDR-TB in KwaZulu-Natal
province, South Africa, 2007 to 2010–12
The end
• Siyabonga
•Thank you
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