{ "abstract": "As tuberculosis (TB) incidence declines, transmission becomes increasingly concentrated in vulnerable populations and neighbourhoods. There is an urgent need for affordable surveillance strategies to monitor trends, identify high-risk groups and target interventions. TB disease prevalence surveys are no longer cost-effective in monitoring epidemiological trends as countries target TB elimination, while passive surveillance methodologies such as case-notification rates (CNRs) are biased by healthcare access disparities. Mycobacterium tuberculosis (Mtb) immunoreactivity surveys indirectly measure transmission and therefore undiagnosed infectious TB, and may provide valuable information to TB programmes globally. We conducted a pragmatic hybrid clinic- and household-based cross-sectional interferon-gamma release assay (IGRA) survey in healthy children aged 1–4 years in 33 high-burden neighbourhoods Blantyre, Malawi. Participants were recruited using novel convenience sampling in health facilities, alongside random household sampling guided by satellite imagery, and tested for Mtb immunoreactivity using QFT-Plus IGRA. We constructed hierarchical Bayesian logistic regression models for IGRA positivity, with neighbourhood-level random effects. Of 1,545 participants, 102 (6.6%) had a positive IGRA: an annual risk of Mtb infection (ARTI) of 2.7% (95% CrI 2.2-3.2%). Immunoreactivity was higher in the poorest third of households (8.7% vs 4.9%; adjusted odds ratio: 1.88, 95% CrI 1.08-3.01) compared to the richest, but was not associated with HIV exposure, malnutrition or reported household TB exposure. There was substantial between-neighbourhood heterogeneity (ARTI range 1.1-4.1%). There was no association between neighbourhood-level TB case notifications and ARTI. Measuring Mtb immunoreactivity in young children, using innovative recruitment strategies, revealed a high burden of immunoreactivity suggestive of recent TB transmission. Children in the poorest households were at highest risk, highlighting the importance of social and economic inequity in driving the TB epidemic. Case notification rates may not reflect the areas with the highest transmission, and Mtb immunoreactivity surveillance may support identification of high-risk populations, monitoring of trends and targeting of public health interventions.", "abstract_shown": true, "affiliations": [ "Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom", "Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi", "Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom", "Helse Nord TB Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi", "School of Medicine, University of St Andrews, St Andrews, United Kingdom", "Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi", "Department of Infectious Disease, Imperial College London, London, United Kingdom", "Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa", "Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom", "Malawi National Tuberculosis and Leprosy Elimination Programme, Lilongwe, Malawi", "School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom" ], "article_type": "Research Article", "arxiv": null, "author_total": 15, "authors": [ { "affs": [ 0 ], "name": "Hannah M. Rickman" }, { "affs": [ 1 ], "name": "Mphatso D. Phiri" }, { "affs": [ 2 ], "name": "Hannah Mbale" }, { "affs": [ 3 ], "name": "Helena R. A. Feasey" }, { "affs": [ 4 ], "name": "Marriott Nliwasa" }, { "affs": [ 5 ], "name": "George Chagaluka" }, { "affs": [ 6 ], "name": "James A. Seddon" }, { "affs": [ 7 ], "name": "Henry C. Mwandumba" }, { "affs": [ 8 ], "name": "Katherine C. Horton" }, { "affs": [ 9 ], "name": "Marc Y. R. Henrion" }, { "affs": [ 10 ], "name": "Tisungane Mwenyenkulu" }, { "name": "Kuzani N. Mbendera" }, { "name": "Emily S. Nightingale" }, { "name": "Elizabeth L. Corbett" }, { "name": "Peter MacPherson" } ], "bibtex": "https://research.draconitic.com/paper/5q1wk6xbnjqpk.bib", "cited_by": 0, "doi": "10.1371/journal.pgph.0007269", "fulltext_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007269", "id": "5q1wk6xbnjqpk", "issns": [ "2767-3375" ], "landing_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007269", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2725|Tuberculosis Research and Epidemiology" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Bacteria/Actinobacteria/Mycobacterium tuberculosis" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/RNA viruses/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Earth sciences/Geography/Human geography/Social geography/Neighborhoods" ], [ "plos", "/Medicine and health sciences/Epidemiology/HIV epidemiology" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Health care/Socioeconomic aspects of health" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Bacterial diseases/Tuberculosis" ], [ "plos", "/Medicine and health sciences/Medical conditions/Tropical diseases/Tuberculosis" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Socioeconomic aspects of health" ], [ "plos", "/People and places/Geographical locations/Africa/Malawi" ], [ "plos", "/Social sciences/Human geography/Social geography/Neighborhoods" ] ], "openalex": "W7221168980", "pdf_url": "https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0007269&type=printable", "pmcid": null, "pmid": null, "published": "2026-10-09", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/5q1wk6xbnjqpk.ris", "sources": [ { "first_seen": "2026-10-30T12:17:30Z", "native_id": "10.1371/journal.pgph.0007269", "source": "plos", "url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007269" } ], "subjects": [ { "field": "biology", "origin": "plos:microbiology", "subfield": "microbiology" }, { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" } ], "title": "Heterogeneity in Mycobacterium tuberculosis immunoreactivity in young children in Blantyre, Malawi: A community-based survey", "title_text": "Heterogeneity in Mycobacterium tuberculosis immunoreactivity in young children in Blantyre, Malawi: A community-based survey", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:30Z", "url": "https://research.draconitic.com/paper/5q1wk6xbnjqpk", "venue": "PLOS Global Public Health", "versions": [] }