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Michael N. Bates, PhD; Asheena Khalakdina, PhD; Madhukar Pai, MD, PhD; Kirk R. Smith, PhD

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In reply

We thank Jay for providing additional detail on the history of the association between tobacco smoking and tuberculosis. In citing one 1956 article¹ in support of our statement on the long-standing nature of this issue, we had not intended to imply that this was the earliest occasion on which the possibility of such an association had been raised.

We also appreciate the useful comments of Leung and colleagues. The result in the silicotic cohort is interesting. However, the presence of silicosis may have increased the risk of tuberculosis in smokers. For our meta-analysis we excluded studies in populations prone to high levels of TB (including those with silicosis) or high levels of smoking.² Whether active smoking has a boosting effect on the TST should be investigated in a population without silicosis. We agree . . . [Full Text of this Article]

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Risk of Tuberculosis From Exposure to Tobacco Smoke: A Systematic Review and Meta-analysis
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