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High tuberculosis prevalence in children exposed at home to drug-resistant tuberculosis
F Amanullah1, M Ashfaq2, S Khowaja2
1Indus Hospital Research Center, Korangi Crossing, Karachi, Pakistan.
Insights
Contact investigation identified a high prevalence of tuberculosis (TB) in children living with drug-resistant TB (DR-TB) patients. Children exposed to DR-TB are a key group for TB case detection.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Drug-resistant tuberculosis (DR-TB) poses a significant global health challenge.
- Children in close contact with DR-TB patients are at increased risk of infection and disease.
- Effective strategies are needed to identify TB cases within these vulnerable populations.
Purpose of the Study:
- To evaluate the yield of a contact investigation protocol for detecting TB in children exposed to DR-TB patients.
- To describe the characteristics of TB cases identified in child contacts of DR-TB patients.
Main Methods:
- A contact investigation protocol was implemented in urban Karachi, Pakistan, for children living with DR-TB patients.
- Evaluations included medical history, physical examination, tuberculin skin testing, chest radiography, and microbiological testing (smear microscopy, culture, drug susceptibility testing).
- Child contacts were assessed at baseline and monthly intervals.
Main Results:
- Out of 133 children, 7.5% were diagnosed with TB disease.
- Prevalence of TB was similar across age groups (<5 years and 5-14 years).
- A significant proportion of children were underweight, indicating potential malnutrition.
Conclusions:
- A high prevalence of TB was found in children living with DR-TB patients.
- Child contacts of DR-TB patients represent a high-yield population for TB case finding.
- Targeted investigations are crucial for early detection and management of TB in children exposed to DR-TB.
Setting:
Urban Karachi, Pakistan.
Objective:
To describe the yield of a contact investigation protocol implemented among children living with drug-resistant tuberculosis (DR-TB) patients.
Design:
We implemented a contact investigation protocol in households of DR-TB patients treated at the Indus Hospital, Karachi, between January 2008 and April 2011. This included a detailed history and physical examination, tuberculin skin test, chest radiograph, smear microscopy and culture of sputum or gastric aspirate specimens, and drug susceptibility testing. Treatment supporters who visited DR-TB patients at home referred all child contacts for baseline evaluation and performed monthly assessments. We evaluated two age groups: 1) children aged <5 years, and 2) those aged 5-14 years.
Results:
Among 133 children aged <15 years in 40 households, 40.4% (51/125) were moderately to severely underweight (weight-for-age Z-score <-2). Overall, 7.5% (10/133) had TB disease. This proportion was 6.5% (2/31) in those aged <5 years and 7.8% (8/102) in those aged 5-14 years. Seven (7/10) were smear-positive, and 4/10 had culture-confirmed multidrug-resistant Mycobacterium tuberculosis
Conclusion:
We detected a high prevalence of TB in children who live with DR-TB patients, regardless of the age of the child. Child contacts of DR-TB patients are a high-yield population for detecting TB cases.
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