TB in Children Exposed at Home to Multidrug-resistant TB
TB in Children Exposed at Home to Multidrug-resistant TB
Background: The tuberculosis burden in children exposed at home to multidrug-resistant tuberculosis (MDR-TB) is unquantified. With limited access to MDR-TB treatment, likely millions of children share the experience of chronic exposure to an infectious patient.
Methods: We conducted a retrospective cohort study of child and adult household contacts of patients treated for MDR-TB in Lima, Peru, in 1996 to 2003. The primary outcome was TB disease. We estimated prevalence of TB disease when the index case began MDR-TB treatment and incidence of TB disease over the subsequent 4 years.
Results: Among 1299 child contacts, 67 were treated for TB. TB prevalence was 1771 (confidence interval [CI]: 1052–2489) per 100,000 children. In 4362 child-years of follow-up, TB incidence rates per 100,000 child-years were: 2079 (CI: 1302–2855) in year 1; 315 (CI: 6–624) in year 2; 634 (CI: 195–1072) in year 3; and 530 (CI: 66–994) in year 4. TB disease rates in children aged >1 year were not significantly different from those observed in adults. Children accounted for 20% of TB cases. Seven (87.5%) of 8 children tested had MDR-TB. Child contacts had TB disease rates approximately 30 times higher than children in the general population.
Conclusions: Children were at high risk for TB disease when the index case started MDR-TB treatment and during the following year. These results highlight the need for implementing contact investigations and establishing systems for prompt referral and treatment of pediatric household contacts of MDR-TB patients, regardless of the age of the child.
Globally, the epidemic of tuberculosis (TB) in children is largely invisible. Furthermore, there are no valid estimates of how many children are sick with drug-resistant TB (DR-TB). One readily identifiable population of children in whom a disease burden may be quantified is the population of children who were exposed at home to a patient with pulmonary drug-resistant disease. With effective treatment still available to only very few DR-TB patients globally, millions of child contacts across high TB burden settings likely share the experience of chronic exposure to DR-TB at home.
We previously reported the prevalence and incidence of TB disease in the households of patients who were treated for multidrug-resistant TB (MDR-TB). Here, we examine the disease burden specifically in children in those households and compare this with that observed in adults.
Abstract and Introduction
Abstract
Background: The tuberculosis burden in children exposed at home to multidrug-resistant tuberculosis (MDR-TB) is unquantified. With limited access to MDR-TB treatment, likely millions of children share the experience of chronic exposure to an infectious patient.
Methods: We conducted a retrospective cohort study of child and adult household contacts of patients treated for MDR-TB in Lima, Peru, in 1996 to 2003. The primary outcome was TB disease. We estimated prevalence of TB disease when the index case began MDR-TB treatment and incidence of TB disease over the subsequent 4 years.
Results: Among 1299 child contacts, 67 were treated for TB. TB prevalence was 1771 (confidence interval [CI]: 1052–2489) per 100,000 children. In 4362 child-years of follow-up, TB incidence rates per 100,000 child-years were: 2079 (CI: 1302–2855) in year 1; 315 (CI: 6–624) in year 2; 634 (CI: 195–1072) in year 3; and 530 (CI: 66–994) in year 4. TB disease rates in children aged >1 year were not significantly different from those observed in adults. Children accounted for 20% of TB cases. Seven (87.5%) of 8 children tested had MDR-TB. Child contacts had TB disease rates approximately 30 times higher than children in the general population.
Conclusions: Children were at high risk for TB disease when the index case started MDR-TB treatment and during the following year. These results highlight the need for implementing contact investigations and establishing systems for prompt referral and treatment of pediatric household contacts of MDR-TB patients, regardless of the age of the child.
Introduction
Globally, the epidemic of tuberculosis (TB) in children is largely invisible. Furthermore, there are no valid estimates of how many children are sick with drug-resistant TB (DR-TB). One readily identifiable population of children in whom a disease burden may be quantified is the population of children who were exposed at home to a patient with pulmonary drug-resistant disease. With effective treatment still available to only very few DR-TB patients globally, millions of child contacts across high TB burden settings likely share the experience of chronic exposure to DR-TB at home.
We previously reported the prevalence and incidence of TB disease in the households of patients who were treated for multidrug-resistant TB (MDR-TB). Here, we examine the disease burden specifically in children in those households and compare this with that observed in adults.