Adolescents and young adults: a neglected population group for tuberculosis surveillance

García‐Basteiro, Alberto L.; Schaaf, H. Simon; Diel, Roland; Migliori, Giovanni Battista

doi:10.1183/13993003.00176-2018

Cited by 18 publications

(10 citation statements)

References 26 publications

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“…Additionally, although our results indicate that young children have the highest risk of developing tuberculosis, adolescents (aged 10-18 years) face a greater risk following lower risks between the ages of 5-9 years. 23,24 We believe these findings have several important clinical and public health implications. First, we found marked protection of preventive therapy against incident tuberculosis.…”

Section: Discussionmentioning

confidence: 84%

The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis

et al. 2020

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Background Tens of millions of children are exposed to Mycobacterium tuberculosis globally every year; however, there are no contemporary estimates of the risk of developing tuberculosis in exposed children. The effectiveness of contact investigations and preventive therapy remains poorly understood.Methods In this systematic review and meta-analysis, we investigated the development of tuberculosis in children closely exposed to a tuberculosis case and followed for incident disease. We restricted our search to cohort studies published between Jan 1, 1998, and April 6, 2018, in MEDLINE, Web of Science, BIOSIS, and Embase electronic databases. Individual-participant data and a pre-specified list of variables were requested from authors of all eligible studies. These included characteristics of the exposed child, the index case, and environmental characteristics. To be eligible for inclusion in the final analysis, a dataset needed to include: (1) individuals below 19 years of age; (2) followup for tuberculosis for a minimum of 6 months; (3) individuals with household or close exposure to an individual with tuberculosis; (4) information on the age and sex of the child; and (5) start and end follow-up dates. Studies assessing incident tuberculosis but without dates or time of follow-up were excluded. Our analysis had two primary aims:(1) estimating the risk of developing tuberculosis by time-period of follow-up, demographics (age, region), and clinical attributes (HIV, tuberculosis infection status, previous tuberculosis); and (2) estimating the effectiveness of preventive therapy and BCG vaccination on the risk of developing tuberculosis. We estimated the odds of prevalent tuberculosis with mixed-effects logistic models and estimated adjusted hazard ratios (HRs) for incident tuberculosis with mixedeffects Poisson regression models. The effectiveness of preventive therapy against incident tuberculosis was estimated through propensity score matching. The study protocol is registered with PROSPERO (CRD42018087022).Findings In total, study groups from 46 cohort studies in 34 countries-29 (63%) prospective studies and 17 (37%) retrospective-agreed to share their data and were included in the final analysis. 137 647 tuberculosis-exposed children were evaluated at baseline and 130 512 children were followed for 429 538 person-years, during which 1299 prevalent and 999 incident tuberculosis cases were diagnosed. Children not receiving preventive therapy with a positive result for tuberculosis infection had significantly higher 2-year cumulative tuberculosis incidence than children with a negative result for tuberculosis infection, and this incidence was greatest among children below 5 years of age (19•0% [95% CI 8•4-37•4]). The effectiveness of preventive therapy was 63% (adjusted HR 0•37 [95% CI 0•30-0•47]) among all exposed children, and 91% (adjusted HR 0•09 [0•05-0•15]) among those with a positive result for tuberculosis infection. Among all children <5 years of age who developed tuberculosis, 83% were diagnosed within 9...

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Section: Discussionmentioning

confidence: 84%

The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis

et al. 2020

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“…6,12 Even in countries with high tuberculosis burden, healthcare providers might often perceive tuberculosis as a disease that seldom affects young people. 13 Approximately nine in ten young people live in low income and middleincome countries, many of which are also countries with high tuberculosis burden. 13,14 Brazil, an uppermiddleincome country, is among the 30 countries with the highest burden of tuberculosis globally.…”

Section: Introductionmentioning

confidence: 99%

“…13 Approximately nine in ten young people live in low income and middleincome countries, many of which are also countries with high tuberculosis burden. 13,14 Brazil, an uppermiddleincome country, is among the 30 countries with the highest burden of tuberculosis globally. 4 In Brazil, between 2015 and 2018, 67 360 (19%) of the 357 155 total tuberculosis cases were among young people.…”

Section: Introductionmentioning

confidence: 99%

Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study

Chenciner

Annerstedt

Pescarini

et al. 2021

The Lancet Global Health

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Background Tuberculosis elimination strategies in Brazil might neglect adolescents and young adults aged 10-24 years, hampering tuberculosis control. However, little is known about factors associated with tuberculosis treatment outcomes in this underserved group. In this study, we aimed to investigate social and health factors associated with unfavourable treatment outcomes in young people with tuberculosis in Brazil.Methods A national retrospective cohort study was done using data from Sistema de Informação de Agravos de Notificação (SINAN), the national tuberculosis registry in Brazil. People aged 10-24 years (young people) with tuberculosis registered in SINAN between Jan 1, 2015, and Dec 31, 2018, were included. Unfavourable outcomes were defined as loss to follow-up, treatment failure, and death. Favourable outcome was defined as treatment success. Multiple logistic regression models estimated the association between social and health factors and tuberculosis treatment outcomes. Findings 67 360 young people with tuberculosis were notified to SINAN, and we included 41 870 young people in our study. 7024 (17%) of the 41 870 included individuals had unfavourable treatment outcomes. Young people who received government cash transfers were less likely to have an unfavourable outcome (adjusted odds ratio 0•83, 95% CI 0•70-0•99). Homelessness (3•03, 2•07-4•42), HIV (2•89, 2•45-3•40), and illicit drug use (2•22, 1•93-2•55) were the main factors associated with unfavourable treatment outcome. Interpretation In this national cohort of young people with tuberculosis in Brazil, tuberculosis treatment success rates were lower than WHO End TB Strategy targets, with almost a fifth of participants experiencing unfavourable treatment outcomes. Homelessness, HIV, and illicit drug use were the main factors associated with unfavourable outcome. In Brazil, strategies are required to support this underserved group to ensure favourable tuberculosis treatment outcomes.

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“…3 The paucity of data on the burden of disease in this overlooked population has also been exacerbated by the nature of programmatic reporting, which splits the group between children (age 0-14 years) and adults (age 15 years). 4 Due to the demographic structure of many high-burden settings, 5 adolescents and young adults represent a significant proportion of patients who initiate anti-tuberculosis treatment, 6 and thus improving the treatment outcomes in this demographic group is of great importance to global tuberculosis control. 7 However, assessment of the quality of tuberculosis care provided to patients has received very little attention, apart from a few exceptions, 8 with national tuberculosis programmes more focused on improving 'coverage', such as increasing the availability of free tuberculosis diagnostic and treatment services.…”

Section: Editorialmentioning

confidence: 99%

The adolescent tuberculosis care cascade: an urgent need to address high rates of loss to follow-up from diagnosis to cure

Khan

2018

public health action

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Adolescents and young adults: a neglected population group for tuberculosis surveillance

Cited by 18 publications

References 26 publications

The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis

The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis

Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study

The adolescent tuberculosis care cascade: an urgent need to address high rates of loss to follow-up from diagnosis to cure

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