High Prevalence of Tuberculosis Infection and Disease in Child Household Contacts of Adults With Rifampin-resistant Tuberculosis

Abstract

Background: Household contact (HHC) investigation is an important strategy to identify individuals with tuberculosis (TB) exposure, infection and disease, including those who may benefit from tuberculosis preventive therapy (TPT). Data in children exposed to rifampin-resistant TB are limited. Methods: In preparation for and to inform the feasibility of an interventional trial, HHC of adults with pulmonary rifampin-resistant TB from high TBburden countries were evaluated in a cross-sectional study. Using interferongamma release assay and study-specific and 2015 international consensus definitions of intrathoracic TB in children, we evaluated the prevalence and predictors of TB infection and disease in child (<15 years) HHCs. Results: Of 303 child HHCs, median age (range) 7 years (0−14), 57%[95% confidence interval (CI): 50%-64%] had a positive interferongamma release assay result (TB infected). TB infection was associated with the index case smoking (P = 0.034), being the parent or sleeping in the same room (P = 0.002) and the child HHC being age ≥5 years and having attended school (P = 0.013). Four had study-defined confirmed TB and 9 had probable TB, a prevalence of 4.3% (95% CI: 2.6%−7.1%). Using the international consensus definitions, 4 had confirmed TB and 49 had unconfirmed TB, a prevalence of 17.2% (95% CI: 12.9%-22.4%). Twenty (7%) children had received TPT. Conclusions: The prevalence of TB infection and disease was high in child HHC exposed to rifampin-resistant TB. Few children had routinely received TPT. High-quality evidence is needed to inform strong recommendations for and access to TPT in children exposed to TB resistant to rifampin.

What's new in childhood tuberculosis

“…Despite the high prevalence of TB infection and disease in household contacts of adults with drug-resistant-TB [21 ▪ ], the WHO recommends the provision of drug-resistant-TPT based on clinical judgement of risk of progression to disease and not to all household contacts. This is due to the lack of current evidence around the provision of TPT for children exposed to drug-resistant TB [10].…”

Factors associated with prevalent Mycobacterium tuberculosis infection and disease among adolescents and adults exposed to rifampin-resistant tuberculosis in the household

“…HHCs had to be enrolled within 30 days of their index participant. Although HHCs of all ages were eligible to enroll in the study, for this report we restricted our analysis population to HHCs �15 years of age, since data on exposures, and the criteria used for diagnosing TB disease differed for those <15 years (results for HHCs <15 years of age have been reported separately [4]).…”

Tuberculosis Infection in Pregnant People: Current Practices and Research Priorities

“…A meta-analysis reported 47% of DR-TB household contacts developed TBI [75]. The risk is higher in young children and may be higher during pregnancy [76]. Prevention of DR-TB is especially important in pregnant people because there are no internationally accepted regimens for DR-TB treatment in pregnancy [77].…”