Abstract
Of the estimated half a million people who develop multidrug resistant (MDR) tuberculosis each year, less than 7% are diagnosed and only 1 in 5 of these have access to eff ective treatment.1 To control this epidemic, dramatically increased efforts are required to scale up case detection and treatment provision. In The Lancet, Mercedes Becerra and colleagues2 report the yield of additional MDR tuberculosis diagnoses that are found by screening household contacts of index cases in Lima, Peru. This study—the largest of its kind to date—found that more than 2% of 4503 household contacts had active tuberculosis at the time the index case was diagnosed. Incident tuberculosis was also found at a rate of 1624 cases per 100 000 person-years over 4 years follow-up. These results support recommendations for active screening of household contacts of people with MDR tuberculosis,3 and provide valuable lessons for other programmes striving to improve case detection and to reduce community transmission of MDR tuberculosis.
