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No. 1, 2006
TB EPIDEMIOLOGIC STUDIES CONSORTIUM UPDATE
TBESC Task Order #3: Zero Tolerance for Pediatric
Tuberculosis
Background and Methods. Tuberculosis (TB) in
young children represents a sentinel event and may indicate an undetected
case of infectious TB in the community. The incidence of TB in young
children is also an important indicator that defines insufficiencies
in TB program interventions to prevent TB transmission. We conducted
this study to learn more about the problems encountered by TB programs
in identifying, evaluating, and treating children <5 years of
age with TB and latent TB infection (LTBI). We also sought to define
missed opportunities to prevent TB and LTBI in children and improve
outcomes related to their evaluation and treatment. The study took
place in three areas of the country with diverse populations: Harlem
and Washington Heights in New York City, Alameda and San Diego counties
in California, and Tarrant County, Texas.
Results. In this study, 428 children were enrolled
(67% in California). Of these children, 124 were diagnosed with
TB and 304 had LTBI. The children had the following characteristics:
65% were Hispanic, 51% were born in the United States, and 19% were
born in Mexico. Treatment was by directly observed therapy for 87%
of TB cases, but for only 7% of LTBI cases. Children with active
TB were primarily identified when they sought medical care for symptoms
(45%) or were detected through contact investigations (20%). Children
with LTBI were most often found through screening (44%). Three children
had a prolonged symptomatic period before diagnosis (112–144
days). About 10% of children had a ≥14 day delay from TST
to chest radiograph. The mean time from the chest radiograph to
the start of treatment was 5 days for children with TB and 19 days
for children with LTBI. In addition, 10% of children with TB and
18% of children with LTBI had a ≥14 day delay from radiograph
to the start of therapy. Adherence to appointments was measured.
Missing three or more appointments was experienced by 8% of children
with TB and 14% of children with LTBI. Completion of therapy was
greater for children with TB compared with those who had LTBI, 82%
(11% on treatment at the end of the study) and 58%, respectively.
Conclusion. We detected important missed opportunities
and delays in the diagnosis and evaluation of children with TB and
LTBI. An in-depth review of each case of pediatric TB and of child
contacts allows health departments to evaluate their success in
preventing TB and LTBI in young children. As case rates among children
continue to decline, the possibility of eliminating TB in children
becomes real.
—Reported by Mark Lobato, MD
Div of TB Elimination
for the Pediatric TB Working Group, TO #3, TBESC
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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