Khadija Said1,2,3, Jerry Hella1,2,3, Mwajabu Ruzegea1, Rajesh Solanki4, Magreth Chiryamkubi5, Francis Mhimbira1,2,3, Nicole Ritz3,6, Christian Schindler2,3, Anna M Mandalakas7, Karim Manji8, Marcel Tanner2,3, Jürg Utzinger2,3, Lukas Fenner9. 1. From the Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, Tanzania. 2. Swiss Tropical and Public Health Institute, Basel, Switzerland. 3. University of Basel, Basel, Switzerland. 4. Temeke Municipal Council Hospital, Dar es Salaam, Tanzania. 5. National Tuberculosis and Leprosy Control Program, Dar es Salaam, Tanzania. 6. Basel University Children's Hospital, Basel, Switzerland. 7. The Global Tuberculosis Program, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas. 8. Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. 9. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Abstract
BACKGROUND: Childhood tuberculosis (TB) is acquired after exposure to an infectious TB case, often within the household. We prospectively screened children 6-59 months of age, exposed and unexposed to an infectious TB case within the same household, for latent tuberculosis infection (LTBI), in Dar es Salaam, Tanzania. METHODS: We collected medical data and clinical specimens (to evaluate for helminths, TB and HIV coinfections) and performed physical examinations at enrollment and at 3-month and 6-month follow-up surveys. LTBI was assessed using QuantiFERON-TB Gold (QFT) at enrollment and at 3 months. RESULTS: In total, 301 children had complete data records (186 with TB exposure and 115 without known TB exposure). The median age of children was 26 months (range: 6-58); 52% were females, and 4 were HIV positive. Eight children (3%) developed TB during the 6-month follow-up. We found equal proportions of children with LTBI among those with and without exposure: 20% (38/186) versus 20% (23/115) QFT-positive, and 2% (4/186) versus 4% (5/115) indeterminate QFT. QFT conversion rate was 7% (22 children) and reversion 8% (25 children). Of the TB-exposed children, 72% initiated isoniazid preventive therapy, but 61% of parents/caregivers of children with unknown TB exposure and positive QFT refused isoniazid preventive therapy. CONCLUSIONS: In this high burden TB setting, TB exposure from sources other than the household was equally important as household exposure. Nearly one third of eligible children did not receive isoniazid preventive therapy. Evaluation for LTBI in children remains an important strategy for controlling TB but should not be limited to children with documented TB exposure.
BACKGROUND: Childhood tuberculosis (TB) is acquired after exposure to an infectious TB case, often within the household. We prospectively screened children 6-59 months of age, exposed and unexposed to an infectious TB case within the same household, for latent tuberculosis infection (LTBI), in Dar es Salaam, Tanzania. METHODS: We collected medical data and clinical specimens (to evaluate for helminths, TB and HIV coinfections) and performed physical examinations at enrollment and at 3-month and 6-month follow-up surveys. LTBI was assessed using QuantiFERON-TB Gold (QFT) at enrollment and at 3 months. RESULTS: In total, 301 children had complete data records (186 with TB exposure and 115 without known TB exposure). The median age of children was 26 months (range: 6-58); 52% were females, and 4 were HIV positive. Eight children (3%) developed TB during the 6-month follow-up. We found equal proportions of children with LTBI among those with and without exposure: 20% (38/186) versus 20% (23/115) QFT-positive, and 2% (4/186) versus 4% (5/115) indeterminate QFT. QFT conversion rate was 7% (22 children) and reversion 8% (25 children). Of the TB-exposed children, 72% initiated isoniazid preventive therapy, but 61% of parents/caregivers of children with unknown TB exposure and positive QFT refused isoniazid preventive therapy. CONCLUSIONS: In this high burden TB setting, TB exposure from sources other than the household was equally important as household exposure. Nearly one third of eligible children did not receive isoniazid preventive therapy. Evaluation for LTBI in children remains an important strategy for controlling TB but should not be limited to children with documented TB exposure.
Authors: Noëmi R Meier; Thomas Volken; Marc Geiger; Ulrich Heininger; Marc Tebruegge; Nicole Ritz Journal: Front Pediatr Date: 2019-05-29 Impact factor: 3.418
Authors: Micaela Sandoval; Padma Swamy; Alexander W Kay; Pilar Ustero Alonso; Gloria Sisi Dube; Hypertia Hlophe-Dlamini; Anna M Mandalakas Journal: Am J Trop Med Hyg Date: 2020-09-24 Impact factor: 3.707