Current status of new tuberculosis vaccine in children

Li²,

Zhu³

et al. 2020

Preprint

Background : Sichuan is a province located in southwestern China, which have a higher incidence of tuberculosis (TB).This study aimed to analyze the epidemiological and clinical characteristics, as well as drug resistance in culture-confirmed children with Tuberculosis meningitis (TBM) in Southwest of China. Materials and Methods: We performed a retrospective study on children (<14 years old) with cerebrospinal fluid (CSF) culture-confirmed TBM between January 2013 and December 2018 at Public Health Clinical Center of Chengdu (PHCCC). Mycobacterium tuberculosis (MTB) drug sensitivity testing (DST) was performed using the MicroDST TM method. The age, gender, family history of tuberculosis, status of Bacillus Calmette–Guérin (BCG) vaccination, residential areas information, clinical, laboratory, and radiological features were recorded. Data were analyzed using SPSS Statistics Client 25.0, and the change in drug resistance rate was examined using the Cruskal-Wallis test. Results: Among 319 patients clinically diagnosed with TBM, 42 cases were Mycobacterial culture-positive, with a positive rate of 13.2 per 100 patients. Their median age was nine years, and the distribution was equal among female and male patients. Among 42 patients who were enrolled in the study, 1/42 (2.38%) passed away. Children with TBM were concentrated in the minority areas of western Sichuan, where 34/42 (81.0%) patients with TBM were ethnic minorities, and only 2/42 (4.76%) received BCG vaccination in the past. Chest X-rays changes were observed in all patients. Fever and headache were the most common presenting symptom. Thirty-five (83.3%) patients suffered from neck stiffness, and 30/42 (71.4%) had high CSF pressure. DST results showed that the resistance rate was high; resistance to any anti-tuberculosis drug (ATD) was observed in 13 (31.0%) patient isolates, while multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) were found in 2 (4.8%) and 1 (2.4%) patients, respectively. Conclusions : TBM among children in Southwest China was mainly concentrated in the minority areas of western Sichuan. The most common symptoms were fever, headache, and neck stiffness and all patients had positive chest X-ray findings. In addition, high rates of drug resistance were found; and more than 95% of patients did not receive BCG vaccination at birth.ΦΦΦ

Section: Discussionmentioning

confidence: 99%

Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

Li²,

Zhu³

et al. 2020

Preprint

“…Although the Chinese government has strengthened TB control in minority areas over recent years with modest success, infantile TBM still remains a neglected field [4][5]. WHO and numerous studies have reported that BCG vaccination can protect children from the severe types of TB, such as TB meningitis and miliary TB [6][7].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

Li²,

Zhu³

et al. 2019

Preprint

Background : Sichuan is a province located in southwestern China, which have a higher incidence of tuberculosis (TB).This study aimed to analyze the epidemiological, clinical characteristics, and drug resistance in culture-confirmed children with Tuberculosis meningitis (TBM) in Southwest of China. Materials and Methods: We performed a retrospective study of children with cerebrospinal fluid (CSF) culture-confirmed TBM who were <14 years of age between January 2013 and December 2018 at Public Health Clinical Center of Chengdu (PHCCC). Mycobacterium tuberculosis (MTB) drug sensitivity testing (DST) was performed using the MicroDST TM method. The age, gender, family history of tuberculosis, status of Bacillus Calmette–Guérin (BCG) vaccination, residential areas information, clinical, laboratory and radiological features were recorded. Data were analyzed using SPSS Statistics Client 25.0, and the change in drug resistance rate was analyzed using the Cruskal-Wallis test. Results: From 319 TBM initially recruited patients,42 cases were Mycobacterialculture-positive, with the positive rate of 13.2 per 100 patients. Theirmedian age was nine years, sex distribution was equal. Among 42 patients who were enrolled in the study, 1/42 (2.38%) died. Children with TBM in the southwest of China were mainly concentrated in the minority areas of western Sichuan. In fact, 34/42 (81.0%) patients with TBM belonged to ethnic minorities, and only 2/42 (4.76%) had BCG vaccination histories.All the 42 patients had varying degrees of chest X-rays changes and 18/42 (42.9%) merger of extracranial TB. Fever and headache were the most common presenting symptom. Thirty-five (83.3%) patients suffered from neck stiffness and 30/42 (71.4%) had high CSF pressure. DST results showed that the resistance rate was high; resistance to any anti-tuberculosis drug (ATD) was 13 (31.0%), and to multidrug-resistant tuberculosis (MDR-TB) and XDR it was 2 (4.8%) and 1 (2.4%), respectively. Conclusions : TBM in children in Southwest China was mainly concentrated in the minority areas of western Sichuan. The most common symptoms were fever, headache and neck stiffness and all patients had positive chest X-ray findings. High rates of drug resistance were founded. In addition, more than 95% of patients did not receive BCG vaccination at birth.

“…Although the Chinese government has strengthened TB control in minority areas in recent years and achieved some success, childhood TBM still remains a neglected field [3][4]. WHO and numerous studies have been reported that BCG vaccination can protect children from the severe types of TB such as TB meningitis and miliary TB [5][6]. In many ethnic minority areas in southwest China, most residents live a nomadic lifestyle due to regional reasons, which makes the government's TB prevention and control work more difficult.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

Liao

Li³

et al. 2019

Preprint

Background: There are little data on the disease in children. This study aimed to analyze the epidemiological, clinical characteristics and drug resistance situation of culture-confirmed children TBM in Southwest of China and hope this study will provide some recommendations to readers in clinical or related fields. Methods: We performed a retrospective study including children <14 years of age with cerebrospinal fluid (CSF) culture-confirmed TBM between January 2013 and December 2018 at Public Health Clinical Center of Chengdu (PHCCC). Nontuberculosis Mycobacteria (NTM) were excluded. Mycobacterium tuberculosis (MTB) drug sensitivity testing (DST) was performed using the MicroDSTTM method. The age, gender, family history of tuberculosis, status of Bacillus Calmette-Guérin (BCG) vaccination, residential areas information, clinical, laboratory and radiological features were recorded. Data were analyzed using SPSS Statistics Client 19.0, and the change in drug resistance rate was analyzed using the chi-square ( 2) test. Results: From 3467 probable TBM patients recruited, 295 cases were Mycobacterial culture-positive, the positive rate of 8.5 per 100 patients, included 253 adults and 42 children. We included all the 42 children <14 years of age for this study, the median age was 9 years, sex distribution was equal, of which 1/42 (2.38%) died. The geographical distribution of children's TBM in southwest of China is mainly concentrated in the minority areas of western Sichuan. Thirty-four (81.0%) children TBM patients is the population ofChina's ethnic minorities, only 2/42 (4.76%) had BCG vaccination histories. All the 42 patients had varying degrees of Chest X-rays changes and 18/42(42.9%) merger of extracranial TB. Fever and headache are the most common presenting symptom. Thirty-five (83.3%) with neck stiffness and 30/42(71.4%) with high CSF pressure. DST results showed that the resistance rate was high, to any anti-tuberculosis drug (ATD) resistance was 18 (42.9%), to multidrug-resistant tuberculosis (MDR-TB) and pre-XDR rate were 1 (2.4%) respectively. Conclusions: TBM in Children in Southwest China were mainly concentrated in the minority areas of western Sichuan, presents with nonspecific clinical features and all with positive chest X-ray findings. High rates of drug resistance were founded. More than 95% of patients were lack of BCG vaccination at birth.