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Twenty years of pulmonary tuberculosis in children: what has changed?
Iciar Sánchez-Albisua1, Fernando Baquero-Artigao, Fernando Del Castillo
1Center of Research, Infectious Diseases Unit, Children's Hospital La Paz, Madrid, Spain. soekler.sanchez@tonline.de
Insights
The discontinuation of Calmette-Guérin bacillus (BCG) vaccination and the emergence of human immunodeficiency virus (HIV) infection had minimal impact on childhood tuberculosis trends. Childhood tuberculosis patterns, including hilar adenopathy, showed some changes, but overall influence from these factors was limited.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Epidemiology
- Tuberculosis Research
Background:
- Childhood tuberculosis (TB) epidemiology is influenced by vaccination status and co-infections.
- The discontinuation of Calmette-Guérin bacillus (BCG) vaccination in Spain in 1987 and the rise of human immunodeficiency virus (HIV) infection since 1985 are significant public health events.
- Understanding the impact of these events on pediatric TB is crucial for public health strategies.
Purpose of the Study:
- To compare the frequency, clinical, and radiologic manifestations of pulmonary tuberculosis in children over two decades.
- To evaluate the influence of BCG vaccination discontinuation and HIV emergence on childhood tuberculosis.
- To identify the sources of infection for pediatric TB cases.
Main Methods:
- Retrospective review of 324 children diagnosed with pulmonary tuberculosis between 1978 and 1997.
- Comparison of data from two distinct 10-year periods: 1978–1987 and 1988–1997.
- Analysis of clinical and radiological findings, extrapulmonary manifestations, source of infection, and HIV status in contacts and patients.
Main Results:
- A significant increase in single hilar adenopathy was observed in the second decade (43.4% vs. 32.2%, P < 0.05).
- Fewer cases presented with parenchymal involvement or mixed patterns in the second decade (45.7% vs. 62.4%).
- No significant changes in extrapulmonary manifestations, including tuberculous meningitis, were noted; HIV positivity was low in children (2.3%) and higher in adult contacts (10.8%).
Conclusions:
- The discontinuation of BCG vaccination and the emergence of HIV infection had a limited impact on the overall epidemiology of childhood tuberculosis in the studied area.
- Changes in radiologic patterns, specifically an increase in hilar adenopathy, were observed but not definitively linked to BCG or HIV.
- Continued surveillance for pediatric TB and its risk factors remains important.
Objectives:
To compare the frequency, clinical and radiologic manifestations and source of infection of pulmonary tuberculosis in children treated in our hospital during two decades (1978 through 1987 and 1988 through 1997) and to evaluate the influence of the emergence of HIV infection (since 1985) and the effect of the discontinuation of Calmette-Guérin bacillus (BCG) vaccination (since 1987) on childhood tuberculosis.
Methods:
We reviewed 324 children diagnosed with pulmonary tuberculosis in our hospital during the 20 years (1978 through 1997). The data from 2 decades, 1978 through 1987 and 1988 through 1997, were compared. BCG vaccination in Spain was discontinued in 1987, and HIV infection emerged significantly as a public health problem.
Results:
An increase in the number of children with single hilar adenopathy was observed (32.2% in 1978 through 1987 vs. 43.4%, in 1988 through 1997, P < 0.05) in comparison with those with parenchymal involvement or a mixed pattern (62.4% in 1978 through 1987 vs. 45.7% in 1988 to 1997). Frequency in extrapulmonary manifestations in both periods was similar, with a nonsignificant trend toward a lower rate of tuberculous meningitis in the latter decade (10.4 vs. 5.6%, P = 0.07). We were able to identify an adult source case for 67.1% of the children (100 of 149) in the first decade vs.58.3% (102 of 175) in the second (P = NS); 10.8% of adult contacts but only 2.3% of children (all of them in the second period) were HIV-positive.
Conclusions:
Discontinuation of BCG vaccination and emergence of HIV infection have had little influence on childhood tuberculosis in our area.