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Pediatric tuberculosis pyramid and its fate with and without chemotherapy/chemoprophylaxis
1Department of Pediatrics, Bombay Hospital.
Insights
Preventive chemoprophylaxis with two bactericidal drugs is crucial for controlling pediatric tuberculosis primary infections. This strategy is vital due to increasing isoniazid-resistant bacilli and limited BCG vaccine efficacy in preventing complications, especially in high-risk children.
Area of Science:
- Public Health
- Pediatric Infectious Diseases
- Tuberculosis Control
Background:
- High annual detection of infectious tuberculosis cases, including sputum-positive individuals, fuels transmission to children.
- Primary tuberculosis infection in children, particularly those in infancy and early childhood, can lead to severe complications.
- BCG vaccination offers limited protection against lung bacilli lodgement and serious complications in malnourished children.
Purpose of the Study:
- To present current data on tuberculosis cases and highlight the challenges in controlling pediatric tuberculosis.
- To evaluate the effectiveness of chemoprophylaxis in preventing complications of primary tuberculosis infection in children.
- To advocate for a shift in strategy towards preventive chemoprophylaxis for high-risk pediatric populations.
Main Methods:
- Analysis of available national data on tuberculosis cases.
- Review of existing literature on pediatric tuberculosis, BCG vaccination, and chemoprophylaxis.
- Consideration of clinical patterns in vaccinated and partially treated children.
Main Results:
- Despite increased BCG vaccination coverage, intrathoracic tuberculosis cases, including mediastinal lymph node involvement, are rising.
- Complications of primary infection occur in 10-15% of children, even in developed countries.
- Increasing incidence of isoniazid-resistant bacilli necessitates multi-drug chemoprophylaxis.
Conclusions:
- Preventive chemoprophylaxis, ideally with two bactericidal drugs, should be the primary strategy for controlling pediatric tuberculosis primary infections.
- A large multicentric trial for chemoprophylaxis in high-risk children is recommended as part of primary healthcare.
- Addressing primary infection treatment is essential for effective tuberculosis control in children.
Abstract:
The latest available information on total and infectious cases of tuberculosis in the country and also large number of sputum positive cases being detected annually, particularly after the involvement of multipurpose workers in the primary health care programme for the control of tuberculosis, is presented. The consequences of the large pool of infectious cases in the population lead to spread of bacilli to children with development of primary infection in them. These children with primary infection, specially high risk group in infancy and early childhood, get serious complications of the disease. It may be emphasized that BCG vaccination cannot prevent the lodgement of tubercle bacilli in the lung but can only contain or restrict haematogenous spread. Inspite of increasing coverage of infants with BCG vaccination there are an increasing number of cases of intrathoracic tuberculosis, particularly various groups of mediastinal nodes. However, to a lesser extent haematogenous complications do occur in malnourished children, as BCG has a limited value in preventing serious complications in children with malnutrition. The clinical pattern of pediatric tuberculosis has also changed in vaccinated and partly or inadequately drug treated children. Hence, chemoprophylaxis/chemotherapy to prevent complications of primary infection has been tried. Even relatively privileged children in developed countries are reported to have complications of primary infection to an extent of 10 to 15%, as per the studies all over world. So preventive chemoprophylaxis, preferably with two bactericidal drugs, should be considered as the main strategy for controlling primary infection. Chemoprophylaxis with two drugs should be used as incidence of isoniazid resistant bacilli has increased. All concerned with child health should consider the strategy of treatment of primary infection in high risk children by chemoprophylaxis by starting a large multicentric trial both in urban and rural areas, as a part and parcel of primary health care intervention already in practice for cases of sputum positive pulmonary tuberculosis.