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No. 1, 2006


TBESC Task Order #3: Zero Tolerance for Pediatric Tuberculosis

Background and Methods. Tuberculosis (TB) in young children represents a sentinel event and may indicate an undetected case of infectious TB in the community. The incidence of TB in young children is also an important indicator that defines insufficiencies in TB program interventions to prevent TB transmission. We conducted this study to learn more about the problems encountered by TB programs in identifying, evaluating, and treating children <5 years of age with TB and latent TB infection (LTBI). We also sought to define missed opportunities to prevent TB and LTBI in children and improve outcomes related to their evaluation and treatment. The study took place in three areas of the country with diverse populations: Harlem and Washington Heights in New York City, Alameda and San Diego counties in California, and Tarrant County, Texas.

Results. In this study, 428 children were enrolled (67% in California). Of these children, 124 were diagnosed with TB and 304 had LTBI. The children had the following characteristics: 65% were Hispanic, 51% were born in the United States, and 19% were born in Mexico. Treatment was by directly observed therapy for 87% of TB cases, but for only 7% of LTBI cases. Children with active TB were primarily identified when they sought medical care for symptoms (45%) or were detected through contact investigations (20%). Children with LTBI were most often found through screening (44%). Three children had a prolonged symptomatic period before diagnosis (112–144 days). About 10% of children had a ≥14 day delay from TST to chest radiograph. The mean time from the chest radiograph to the start of treatment was 5 days for children with TB and 19 days for children with LTBI. In addition, 10% of children with TB and 18% of children with LTBI had a ≥14 day delay from radiograph to the start of therapy. Adherence to appointments was measured. Missing three or more appointments was experienced by 8% of children with TB and 14% of children with LTBI. Completion of therapy was greater for children with TB compared with those who had LTBI, 82% (11% on treatment at the end of the study) and 58%, respectively.

Conclusion. We detected important missed opportunities and delays in the diagnosis and evaluation of children with TB and LTBI. An in-depth review of each case of pediatric TB and of child contacts allows health departments to evaluate their success in preventing TB and LTBI in young children. As case rates among children continue to decline, the possibility of eliminating TB in children becomes real.

—Reported by Mark Lobato, MD
Div of TB Elimination
for the Pediatric TB Working Group, TO #3, TBESC



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