Tuberculosis in children and adolescents: California, 1985 to 1995

Lobato, Mark N.; Cummings, Kate; Will, D; Royce, Sarah

doi:10.1097/00006454-199805000-00012

Cited by 47 publications

(29 citation statements)

References 17 publications

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“…Reports about TB prevalence being higher in younger children are confl icting. [9][10][11][12][13][14] Although younger children are at greater risk of progressing to active TB once infected with M. tuberculosis, they were underrepresented in our study, possibly due to misdiagnosis. [15][16][17][18] For example, TB in younger children presenting with acute pneumonia or malnutrition may be missed due to clinical overlap with other common child illnesses, and die due to TB.…”

Section: Discussionmentioning

confidence: 99%

The burden and outcomes of childhood tuberculosis in Cotonou, Benin

Adè

Harries

Trébucq

et al. 2013

public health action

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(grouped together into the 0-14 year age group) are specifi cally identifi ed in the NTP's quarterly reports. At the General Hospital (GH) in Cotonou, the economic capital, children are diagnosed and treated on the basis of information recorded in their personal medical fi les, but are never notifi ed to the NTP, for a variety of reasons. NTP data on children are therefore incomplete and cannot be used to estimate the true burden of childhood disease in Benin.The aim of the present study was to describe the burden of TB and characteristics and outcomes along children treated in Cotonou, Benin. Specifi c objectives were to determine: 1) the total number of TB cases recorded in the NTP TB registers, and of these, the number of children aged <15 years; 2) the incidence rate of notifi ed TB cases among children aged <15 years; 3) the number of children notifi ed with TB in the NTP TB register and the number of children recorded in the GH medical fi les (who are not notifi ed in the NTP TB register) and, in each of these groups, stratifi cation by sex, age, type of TB and human immunodefi ciency virus (HIV) status; and 4) the treatment outcomes among these children stratifi ed by place of treatment, sex, age, type of TB and HIV status, from 2009 to 2011. STUDY POPULATION, DESIGN AND METHODS Study designThis was a cross-sectional, retrospective cohort study of children with TB in Cotonou based on reviews of NTP TB registers and the medical fi les of the GH. SettingBenin is a small country in West Africa with a population of 9 million and a gross national income of US$780 per capita (http://data.worldbank.org/about/countryclassifi cations). The NTP notifi es about 3500 TB cases each year. The national incidence rate of notifi ed new TB cases has been stable over the last 10 years, at 41-46 per 100 000 population. The NTP follows the DOTS strategy and uses internationally recognised criteria for diagnosing and treating patients with TB. 6,7 The NTP has a central unit responsible for policy and strategy, while diagnosis, registration and care are decentralised to 57 public or private basic management units (BMUs) in the country.The present study was conducted in Cotonou and its suburbs, which has a population of about 1 million. There are fi ve BMUs in Cotonou, all of which have a TB register and use TB treatment cards. The GH has a Interna onal Union Against Tuberculosis and Lung DiseaseHealth solu ons for the poor by the NTP and 29 (16%) by the GH; the latter were not notified to the NTP. The incidence rate of notified TB cases was between 8 and 13 per 100 000 population, and was higher in children aged >5 years. Of 167 children tested, 29% were HIV-positive. Treatment success was 72% overall, with success rates of 86%, 62% and 74%, respectively, among sputum smear-positive, sputum smear-negative and extra-pulmonary patients. Treatment success rates were lower in children with sputum smear-negative TB (62%) and those with HIV infection (58%). Conclusion:The number of children being treated for TB is low, and younger ch...

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Section: Discussionmentioning

confidence: 99%

The burden and outcomes of childhood tuberculosis in Cotonou, Benin

Adè

Harries

Trébucq

et al. 2013

public health action

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“…6 Incident TB cases in children Ͻ5 years of age increased 39% from 205 in 1985 to 285 in 1994, although cases have subsequently decreased. 7 The case rate in California children Ͻ5 years of age was 9.6/100 000 in 1994 and 5.9/100 000 in 1998, nearly twice the national average of 5.2/100 000 and 3.4/100 000, respectively, for this age group. 6,8 The high rate of childhood TB suggests that opportunities for preventing TB are being missed.…”

Section: Abstract Objectives Childhood Tuberculosis (Tb)mentioning

confidence: 95%

Missed Opportunities for Preventing Tuberculosis Among Children Younger Than Five Years of Age

2000

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ABSTRACT. Objectives. Childhood tuberculosis (TB)is an important indicator of public health success in interrupting and preventing TB transmission. To determine the frequency and types of missed opportunities for preventing TB among children <5 years of age.Methods. We collected data from the public health records of child TB cases and their adult source cases. These children were from health jurisdictions where TB case rates in children were higher than the California average for this age group.Results. We reviewed the records for 165 children reported with TB (20% confirmed by culture). These children were evaluated for TB because of signs or symptoms of illness (32%), a contact investigation (26%), screening (22%), a source case investigation (4%), and unknown reasons (16%). Excluding 4 children infected by Mycobacterium bovis, only 59 of 161 children (37%) had a source case found. Children found in a contact investigation, born in the United States, <1 year of age, or who were black were more likely to have a source case found than children who did not have one of these characteristics. Of 43 children found in a contact investigation, improvements in contact investigations may have prevented TB in 17 of these children (40%). Among the 43 adult source cases, factors that may have facilitated transmission include delayed reporting in 23%, a delayed contact investigation in 21%, and delayed or nondocumented bacteriologic sputum conversion in 42% of culture-positive cases.Conclusions. Important missed opportunities to prevent TB in children include the failure to find and appropriately manage adult source cases and failure to completely evaluate and properly treat children exposed to TB. Improvements in case detection, case management, and contact investigations are necessary to eliminate TB in children. Pediatrics 2000;106(6). URL: http://www. pediatrics.org/cgi/content/full/106/6/e75; tuberculosis, children, prevention, missed opportunities.ABBREVIATIONS. TB, tuberculosis; TST, tuberculin skin test; RR, relative risk; CI, confidence interval; INH, isoniazid. D espite recent declines in the incidence of tuberculosis (TB) in the United States, TB continues to be an important health problem in specific social and racial groups. As public health agencies increasingly focus on strategies to eliminate TB in the United States, 1 childhood TB becomes an important indicator of program success in interrupting and preventing recent TB transmission. TB cases among children indicate recent transmission of Mycobacterium tuberculosis usually from an infectious adult, often a family or household member, 2,3 and are a sensitive indicator of deficiencies in efforts to prevent TB transmission. The mainstays of TB prevention in children are the timely diagnosis, reporting, and curative treatment of adults with TB disease so that the transmission of M tuberculosis is interrupted. 4,5 In addition, children exposed to infectious cases need a thorough medical evaluation and, if TB disease is excluded, prompt initiation of treatment f...

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“…We found that children aged 15-18 had the highest incidence, placing the 5-14 year-olds on the second. However, in most studies, the ages 5-14 has been described as safe age for tuberculosis and most cases are reported in younger adults and children under 5 (2)(3)(4). This may be due to under diagnosed of tuberculosis in young children because getting a specimen like sputum for laboratory is difficult in this age group.…”

Section: Discussionmentioning

confidence: 99%

“…For the purpose of this study we retrospectively reviewed all medical files of patients aged 0-18 years old with diagnosis of tuberculosis. Tuberculosis was diagnosed according to WHO criteria by using clinical manifestation, history of close contact with tuberculosis patients, sputum smear/culture,Tuberculin skin test, and Pathological finding (1)(2)(3)(4)(5). We included all smears positive and smear negative and extra pulmonary cases for the purpose of this study.…”

Section: Methodsmentioning

confidence: 99%

“…During 1985-1995, the United States experienced a tuberculosis increase at the rate of 22% among children under 4, with the number of patients aged 5-14 growing by 66%, witnessing the highest number of victims among the former group. The figure for tuberculosis in children rose from the mid-1980s until early 1990s (4,5). Young children are most likely to be infected when exposed to active pulmonary tuberculosis, at a rate estimated of 20-40% for children aged 0-5.…”

Section: Introductionmentioning

confidence: 99%

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Childhood Tuberculosis in Kermanshah, Iran, During 10 Years

Ghadiri

Najafi

Solimani

et al. 2013

Arch Pediatr Infect Dis

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Background: Tuberculosis in children still remains as one of the main causes of morbidity and mortality throughout the world. Objectives: The aim of this study was to evaluate the epidemiological aspects of childhood tuberculosis in Kermanshah, Iran. Patients and Methods: Medical records of all 150 patients aged 0-18 in Kermanshah district who were diagnosed according to WHO criteria for 10 years were retrospectively reviewed. As well as presenting demographic and clinical aspects of patients, we calculated notification rate. Results: 35% of cases were male and 65% were female. Of total 150 tuberculosis cases, 56% were pulmonary and 44% were extra pulmonary. The most common symptoms were fever and cough. About 16% were asymptomatic. About 17% of patients had adult pulmonary tuberculosis in their families. The mean of the number of people living in a family (5.5) was similar in both pulmonary and extra pulmonary types. Except for year 2002, for all years the notification rate in girls was higher than that in boys. Over 10 years of study, the notification rate was 3.75/100,000 with no significant trend. Conclusions: Based on our results, rate of diagnosis seemed under the expected range, in particular in children under 5. Therefore, we recommend that authorities come up with programs that aim at raising awareness about the importance of diagnosis of pediatric tuberculosis.

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Tuberculosis in children and adolescents: California, 1985 to 1995

Cited by 47 publications

References 17 publications

The burden and outcomes of childhood tuberculosis in Cotonou, Benin

The burden and outcomes of childhood tuberculosis in Cotonou, Benin

Missed Opportunities for Preventing Tuberculosis Among Children Younger Than Five Years of Age

Childhood Tuberculosis in Kermanshah, Iran, During 10 Years

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