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Children exposed to multidrug-resistant tuberculosis at a home-based day care centre: a contact investigation

A J Garcia-Prats1, K Zimri1, Z Mramba1

  • 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease
|October 10, 2014
PubMed

Insights

Day care centers can be a source of tuberculosis (TB) exposure for young children. Preventive therapy averted drug-resistant TB cases in children exposed at a South African day care center.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Pediatrics

Background:

  • High tuberculosis (TB) burden settings may underestimate day care centers as sources of exposure for children to both drug-susceptible (DS) and drug-resistant (DR) TB.
  • Children attending day care centers are vulnerable to infectious TB cases.

Purpose of the Study:

  • To investigate the outcomes of contact tracing among children exposed to an adult with drug-resistant TB (DR-TB) at a South African home-based day care center.

Main Methods:

  • Retrospective, descriptive, community-based cohort study.
  • Contact investigation of children (<15 years) exposed to an adult DR-TB case.
  • Tuberculin skin testing and initiation of DR-TB preventive therapy.

Main Results:

  • An adult index case with DR-TB (resistant to isoniazid, rifampicin, and amikacin) was identified at a home-based day care center.
  • Of 34 children (<15 years) investigated, 8 had a reactive tuberculin skin test; none had active TB.
  • 24 children received 6 months of DR-TB preventive therapy, and none developed TB during 12 months of follow-up.

Conclusions:

  • Day care center TB exposures can lead to numerous young children with high TB contact scores, comparable to household contacts.
  • Proactive identification and prompt initiation of preventive treatment are crucial to prevent DR-TB cases in exposed children.
Abstract

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