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Tuberculosis Epidemiologic Studies Consortium (TBESC)

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Task Order 3: Zero tolerance for pediatric TB

Task Order 3 looks at missed opportunities for preventing pediatric TB. The purpose of the project is to help TB programs improve performance in detecting children exposed to infectious TB cases. The project will define the missed opportunities for making appropriate interventions to prevent pediatric tuberculosis and to improve the timely identification of young children exposed to infectious TB cases. As part of this process, the project will evaluate implementation of existing guidelines and methodologies for pediatric related contact investigations, source case investigations, and screenings. By assessing these activities in areas with a high concentration of pediatric TB, new recommendations can be made to improve or enhance already existing methods.

Sites

Alameda County Health Department, San Diego County Department of Health, University of North Texas Health Science Center at Fort Worth, Columbia University, New York.

Study Objectives

Identify missed opportunities for the prevention of TB in children, specifically:

  1. missed opportunities for preventing exposure to M. Tb
  2. missed opportunities for reducing the period of exposure to M. Tb
  3. missed opportunities for preventing the progression of M. Tb infection to disease.

Study Design

Phase I of the study involved retrospective collection of consecutive pediatric TB disease cases identified and/or closed on or between January 1, 2002 and the start date of prospective data collection at each site. Phase II of the study, completed prospectively, involved pediatric TB disease cases identified and/or closed within 12 months of the prospective data collection start date. The study population is children younger than five years of age who have active TB disease, latent TB infection, or have been exposed to infectious TB. Data from the medical records of the source cases or potential source cases of children with TB disease and children with LTBI will also be abstracted. Recommendations for standard practices for investigating children who have been exposed to or infected with TB were established by the American Academy of Pediatrics (AAP) (2000) and CDC (1999). The investigators will compare data obtained from current medical evaluations, contact investigations, source case investigations, and screenings to the AAP and CDC recommendations and the policies of the project sites. Using this comparison and a descriptive examination of the data, recommendations will be made for improved control of TB in children. TB control practices will be examined individually and compared to current national and local TB prevention and control recommendations in order to determine missed opportunities for the prevention of TB in children. Missed opportunities will be categorized as to whether they relate primarily to symptoms, screening, contact investigations, source case investigations, or failed treatment regimens.

Study Progress

The study has been completed. It enrolled 428 cases. The study found that delays and missed opportunities for the diagnosis of TB in children and their source cases occur at the patient, provider, and health department level. A manuscript was recently accepted for publication in the American Journal of Pediatrics and Adolescent Medicine. The next step is to learn how these findings can be translated into practice by local health departments.

 
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