Pediatric Tuberculosis Disease during Years of High Refugee Arrivals: A 6-Year National Prospective Surveillance Study

Abstract

<b><i>Background:</i></b> In Europe, surveillance and monitoring of pediatric tuberculosis (TB) remains important, particularly in the light of migration in recent years. The aim of the study was to evaluate incidence rates of childhood TB and detailed diagnostic pathways and treatment. <b><i>Methods:</i></b> Data were collected through the Swiss Pediatric Surveillance Unit (SPSU) from December 2013 to November 2019. Monthly ­notifications are obtained from the 33 pediatric hospitals in the SPSU, and a detailed questionnaire was sent out upon notification. Inclusion criteria were children and adolescents aged up to 15 years with culture- or molecular-confirmed TB disease or for whom a treatment with ≥3 antimycobacterial drugs had been initiated. Data were compared with age-matched notification data from the Swiss Federal Office of Public Health (FOPH). <b><i>Results:</i></b> Of the 172 cases notified to SPSU, a detailed questionnaire was returned for 161 (93%) children, of which 139 met the inclusion criteria. Reasons for exclusion were age >15 years, double reporting, and not fulfilling the criteria for TB disease. During the same time period, 172 pediatric TB cases were reported to the FOPH, resulting in an incidence of 2.1 per 100,000, ranging from 1.4 to 2.8 per year, without a clear trend over time. In the 64 (46.0%) foreign-born children, incidence rates were higher and peaked in 2016, with 13.7 per 100,000 (<i>p</i> = 0.018). The median interval between arrival in Switzerland and TB diagnosis was 5 (IQR 1–21) months, and 80% were diagnosed within 24 months of arrival. In 58% of the cases, TB disease was confirmed by culture or molecular assays. Age >10 years, presence of fever, or weight loss were independent factors associated with confirmed TB. <b><i>Conclusion:</i></b> The annual pediatric TB incidence rate only varied among foreign-born children and was highest in 2016 when refugee influx peaked in Europe. Importantly, most foreign-born children with TB were diagnosed within 2 years after arrival in Switzerland. Thus, the early period after arrival in Switzerland is associated with a higher risk of TB disease in children, and this should be considered for screening guidance in refugees.

Challenges in the Medical and Psychosocial Care of the Paediatric Refugee—A Systematic Review

“…A positive correlation was observed between the incidence of tuberculosis and the percentage of immigrants living in the region [ 17 ].…”

Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings

“…For example, in Switzerland, annual TB incidence ranged from 1.4 to 2.8 per 100,000 child population between 2013 and 2019, which was comparable to earlier years [11]. In foreign-born children, incidence rates were considerably higher, up to 13.7 per 100,000, and peaked in 2016 [12].…”

“…Extrapulmonary disease is common in symptomatic older children and adolescents in low-burden settings [9,31]; physician perception of TB as a pulmonary disease may delay diagnosis. In addition, children with evidence of infection and abnormal radiographs may be asymptomatic, as has been reported in one-third and up to half of younger children in studies from Switzerland, Austria, and Belgium [12]. Furthermore, TB may mimic more common conditions, including inflammatory bowel disease [32] and oligoarticular juvenile arthritis [33].…”

Towards Accurate Point-of-Care Tests for Tuberculosis in Children

“…Chest radiographs play a key role in screening for and diagnosis of childhood TB [ 52 , 53 , 54 ]. Findings on a chest radiograph may support the clinical suspicion of TB in children by demonstrating hilar or mediastinal lymphadenopathy and parenchymal changes [ 55 ]. However, the findings are often non-specific and considerable inter-observer variability demonstrates the difficulties in radiological interpretation, even by trained experts [ 56 ].…”