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Published on: March 15, 2014
[GENERAL PROBLEMS OF ANTITUBERCULOSIS CARE TO CHILDREN IN MOSCOW]
Insights
Pediatric tuberculosis vaccination coverage in Moscow is declining, with high parental refusal rates. Increased focus on infection hotspots and evidence-based prevention is crucial for child health.
Area of Science:
- Public Health
- Pediatrics
- Epidemiology
Background:
- Antituberculosis care delivery challenges in Moscow's pediatric population analyzed.
- Declining vaccination coverage and increasing parental refusal rates for tuberculosis vaccination noted in neonates and children.
Purpose of the Study:
- To analyze problems in antituberculosis care for children in Moscow.
- To identify reasons for low vaccination coverage and propose solutions.
Main Methods:
- Analysis of statutory forms from tuberculosis dispensaries and additional data from pediatric institutions.
- Examination of vaccination coverage rates, parental refusal statistics, and contact tracing data.
Main Results:
- Significant reduction in neonatal vaccination coverage from 2005 to 2008.
- Alarmingly high parental refusal rates (60.5%) in children's polyclinics.
- Inadequate work in tuberculosis infection foci and uncontrolled infection reservoirs among migrants and socially disadapted individuals.
Conclusions:
- Propose active involvement of general practitioners, pediatricians, and public organizations in prophylaxis.
- Emphasize directing resources to tuberculosis infection foci and differentiating preventive chemotherapy based on evidence-based medicine.
Abstract:
Problems in the delivery of antituberculosis care to the pediatric population of Moscow are analyzed. Databases are set up by the statutory forms available in the city's tuberculosis dispensaries and by additional analytical tables from pediatric therapeutic-and-prophylactic institutions, such as children's local polyclinics. In Moscow, there was a reduction in the vaccination coverage of healthy neonatal infants at their discharge from maternity hospitals and departments over a number of years (88.0% in 2008 and 90.3% in 2005). The proportion of non-vaccinated neonates due to their parents' refusal was as high as 3.2% of the annual cohort to be vaccinated at maternal hospital discharge. A more alarming situation is established in children's polyclinics where the share of parents' refusal of tuberculosis vaccination was 60.5% (44.5% in 2005) of all the children who were registered in the children's polyclinics and remained unvaccinated at the end of the year. The low number of contacts per bacteria-excreting person registered in the Moscow dispensaries (2.7% in.2008, 2.5% in 2007, and 2.0% in 2004) suggests that phthisiatricians and epidemiologists did inadequately active work in the foci of tuberculosis infection. Migrants with tuberculosis and socially disadapted persons living in the megapolis are an uncontrolled reservoir of infection. In 2008, there was a surge in the number of tuberculosis children who had been non-vaccinated with BCG vaccine for various reasons--the annual growth rate was +2.96. The possible ways out of the established situation are considered. The authors propose to actively involve not only general practitioners and local pediatricians, but also public organizations into prophylactic work with children. Major attention and resources should be directed to work in the foci of tuberculosis infection; it is necessary to differentiate the use of preventive chemotherapy in children, by taking into account the results of evidence-based medicine to identify the most likely risk factors for the development of the disease.
