The epidemiology of childhood tuberculosis in the Netherlands: still room for prevention

Abstract

BackgroundThe occurrence of tuberculosis (TB) among children has long been neglected as a public health concern. However, any child with TB is a sentinel event indicating recent transmission. Vaccination, early case finding and treatment of those latently infected with TB can prevent cases, severe morbidity and unnecessary death.MethodThe objective of the study was to describe the occurrence of TB events among children in the Netherlands which may be avoided through preventive measures. For this purpose we performed a trend analysis of routine Dutch TB and LTBI (surveillance data in 1993–2012 and a descriptive analysis of children with TB and with LTBI diagnosed in 2005–2012).ResultsOverall childhood TB incidence has declined over the last two decades from 3.6 in 1993 to 1.9 per 100,000 children in 2012. The decline was stronger among Dutch-born children compared to foreign-born children. In 2005–2012 64% of childhood TB cases were detected through active case finding. Foreign-born children with TB were less likely to be detected through active case finding, when not detected through post-entry TB screening. Childhood TB diagnosis was culture confirmed in 68% of passively detected cases and 12% of actively detected cases. Of 1,049 children with LTBI started on preventive treatment in 2005–2012, 90% completed treatment. In 37% of all childhood TB cases there was at least one ‘missed opportunity’ for prevention. Thirty nine percent of child TB patients eligible for BCG were not vaccinated.ConclusionChildren with TB in the Netherlands are generally detected at an early stage and treatment completion rates are high. However, more TB cases among children can be prevented through enhancing TB case finding and screening and preventive treatment of latent TB infection among migrant children, and improving the coverage of BCG vaccination among eligible risk groups.

The epidemiology of tuberculosis in children in Australia, 2003–2012

“…This study provides original, comprehensive and recent data on the epidemiological and clinical characteristics of TB in children in Australia. Paediatric cases of TB accounted for 5% of the total national TB case load, a finding similar to those of recent reports from other low‐incidence settings 15 . ‐ 17 National rates of TB in children in Australia have not changed markedly over the past 10 years, consistent with the stable rate for the overall population 18…”

“…In most cases (56%), the reported country of birth was outside Australia, and this proportion was higher than the corresponding figures for New Zealand, the United States and western Europe, where 26%–31% of patients with TB were born outside the respective country 16 , 17 , 19 . The notification rate of 9.57 per 100 000 overseas‐born children per year is lower than the rate of 35–37 per 100 000 overseas‐born children reported for the United Kingdom (1999–2006) and the Netherlands (1993–2012) 15 , 20 . This difference may reflect the fact that there was no pre‐migration screening in those countries during the reported periods, so that all cases were detected and notified after arrival.…”

Mortality in children diagnosed with tuberculosis: a systematic review and meta-analysis

“…12,15,25 In the USA surveillance dataset, which provided the vast majority of the HIV-stratified data, CFRs were higher for HIV-infected children than HIV-uninfected children (Table 3). We were unable to extract data about HIV-infected children’s immune status or whether they were receiving antiretroviral therapy, but stratifying the USA surveillance data into time periods before and after the widespread availability of highly active antiretroviral therapy suggests a protective effect 15 (Table 3).…”

Evaluation of Treatment Indications, Tuberculin Skin Test, and Bacillus Calmette-Guerin Vaccination Scars in the Cases of Latent Tuberculosis Infection Treatment

“…A prospective study showed that only 53% of patients completed the therapy [26]. Erkens et al [27] showed that of 1,049 children with LTBI started on LTBI treatment in 2005-2012, and 90% completed the treatment. In our study, the LTBI treatment completion rate was 95%.…”