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Transmission of tuberculosis from adults to children in a Paris suburb
Fouad Madhi1, Claire Fuhrman, Isabelle Monnet
1Service de Pédiatrie, Centre Hospitalier Intercommunal, Créteil, France.
Insights
Tuberculosis infection in children is often from household contacts. Early examination and a second evaluation for exposed children are crucial to prevent latent infection and active disease progression.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) transmission in children frequently occurs within family or household settings.
- Identifying risk factors for latent TB infection and active TB disease in exposed children is critical for effective public health interventions.
Purpose of the Study:
- To evaluate the risk factors associated with latent tuberculosis infection and active disease in children exposed to infectious adult cases in a suburban Parisian setting.
- To assess the effectiveness of initial and follow-up evaluations in detecting infection and disease.
Main Methods:
- Retrospective review of medical records from 1997-2000 at six medical prevention centers.
- Inclusion of 39 adult patients with M. tuberculosis-positive sputum and 91 exposed children (3 months-17 years).
- Initial tuberculin skin test and chest radiography, with a mandatory second evaluation at 3 months for initially negative children.
Main Results:
- Overall, 22% (20/91) of exposed children were infected, with 4 identified only at the second evaluation.
- Active TB disease was diagnosed in 40% (8/20) of infected children, including 2 identified at the second evaluation.
- Childhood age did not influence infection risk, but adult case characteristics (age <40, cavitary lesions, high bacillary load) were significant risk factors.
Conclusions:
- Early and routine second evaluations for children exposed to tuberculosis are essential for timely diagnosis and management.
- Identifying specific characteristics of adult infectious cases can help target high-risk child populations for intensified screening.
- Prompt intervention can prevent the progression from latent infection to active tuberculosis disease in pediatric populations.
Abstract:
Tuberculosis in children is often acquired by contact with a family or household member. The aim of our study was to evaluate risk factors for latent infection and active disease in exposed children in a suburb of Paris. We examined medical records for the period 1997-2000 at six departmental centers for medical prevention in Val de Marne. Thirty-nine patients aged 18 years or more with M. tuberculosis-positive sputum samples, and living with children or adolescents, were identified. Ninety-one children, aged 3 months-17 years, were exposed to these index cases. All the children initially underwent a tuberculin skin test and chest radiography, and children with no criteria for latent infection or active disease at time of initial evaluation were asked to attend a second evaluation 3 months later. Overall, 20 of the 91 (22%) children were infected, including 4 children identified only at the second evaluation. Eight (40%) of the 20 infected children had active disease, including 2 of the 4 children identified at the second evaluation. The risk of infection was not influenced by the children's age, but was significantly associated with three characteristics of the adult cases, i.e., age younger than 40 years, presence of cavitary lesions, and smears with more than 100 bacilli per microscopic field. In conclusion, our results call for early examination of all exposed children, in order to prevent infection and progression to active disease, and for a routine second evaluation after the adult contact has ended.
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