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Tuberculosis Epidemiologic Studies Consortium (TBESC)
Task Order 3: Zero tolerance for pediatric TB
Task Order 3 looks at missed opportunities for preventing
pediatric TB. The purpose of the project is to help TB programs
improve performance in detecting children exposed to infectious TB
cases. The project will define the missed opportunities for making
appropriate interventions to prevent pediatric tuberculosis and to
improve the timely identification of young children exposed to
infectious TB cases. As part of this process, the project will
evaluate implementation of existing guidelines and methodologies for
pediatric related contact investigations, source case
investigations, and screenings. By assessing these activities in
areas with a high concentration of pediatric TB, new recommendations
can be made to improve or enhance already existing methods.
Sites
Alameda County Health Department, San Diego County Department of
Health, University of North Texas Health Science Center at Fort
Worth, Columbia University, New York.
Study Objectives
Identify missed opportunities for the prevention of TB in
children, specifically:
- missed opportunities for preventing exposure to M. Tb
- missed opportunities for reducing the period of exposure to
M. Tb
- missed opportunities for preventing the progression of M. Tb
infection to disease.
Study Design
Phase I of the study involved retrospective collection of
consecutive pediatric TB disease cases identified and/or closed on
or between January 1, 2002 and the start date of prospective data
collection at each site. Phase II of the study, completed
prospectively, involved pediatric TB disease cases identified and/or
closed within 12 months of the prospective data collection start
date. The study population is children younger than five years of
age who have active TB disease, latent TB infection, or have been
exposed to infectious TB. Data from the medical records of the
source cases or potential source cases of children with TB disease
and children with LTBI will also be abstracted. Recommendations for
standard practices for investigating children who have been exposed
to or infected with TB were established by the American Academy of
Pediatrics (AAP) (2000) and CDC (1999). The investigators will
compare data obtained from current medical evaluations, contact
investigations, source case investigations, and screenings to the
AAP and CDC recommendations and the policies of the project sites.
Using this comparison and a descriptive examination of the data,
recommendations will be made for improved control of TB in children.
TB control practices will be examined individually and compared to
current national and local TB prevention and control recommendations
in order to determine missed opportunities for the prevention of TB
in children. Missed opportunities will be categorized as to whether
they relate primarily to symptoms, screening, contact
investigations, source case investigations, or failed treatment
regimens.
Study Progress
The study has been completed. It enrolled 428 cases. The study
found that delays and missed opportunities for the diagnosis of TB
in children and their source cases occur at the patient, provider,
and health department level. A manuscript was recently accepted for
publication in the American Journal of Pediatrics and Adolescent
Medicine. The next step is to learn how these findings can be
translated into practice by local health departments.
Last Modified: 07/25/2007
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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