Prediction Tool to Identify Children at Highest Risk of Tuberculosis Disease Progression Among Those Exposed at Home

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Meredith B Brooks1, Leonid Lecca1,2, Carmen Contreras2

  • 1Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.

Open Forum Infectious Diseases
|November 22, 2021
PubMed

Insights

Identifying children at high risk for tuberculosis (TB) progression after household exposure is crucial. A positive tuberculin skin test (TST) significantly increases TB risk, especially in younger children not receiving preventive therapy.

Area of Science:

  • Epidemiology
  • Infectious Diseases
  • Pediatrics

Background:

  • Limited research exists on identifying children at highest risk of tuberculosis (TB) disease after household exposure.
  • Tailoring care requires understanding specific risk factors for TB progression in pediatric populations.

Purpose of the Study:

  • To identify predictors of TB disease progression in children exposed to infectious adults within a household setting.
  • To develop a tool for risk stratification among child contacts of TB patients.

Main Methods:

  • A prospective cohort study was conducted in Lima, Peru, involving 4545 children (0-14 years) exposed to pulmonary TB.
  • Classification and regression tree analysis identified TB disease predictors over 12 months.
  • Relative risks (RR) were calculated for key predictors across three age groups: 0-4, 5-9, and 10-14 years.

Main Results:

  • Of 4545 children, 156 (3.4%) developed TB within one year. Incidence was 3.4%, 2.3%, and 4.7% in the 0-4, 5-9, and 10-14 age groups, respectively.
  • A positive tuberculin skin test (TST) was the strongest predictor of TB, with RRs ranging from 5.2 to 6.6 across age groups.
  • In children aged 0-4 years with a positive TST, the absence of isoniazid preventive treatment increased TB risk (RR, 12.2).

Conclusions:

  • A tool utilizing contact tracing data can identify child household contacts at high risk for TB disease progression.
  • While TB preventive therapy is recommended for all exposed children, those identified as high-risk may benefit from intensified follow-up.
  • This approach aids in targeted interventions and resource allocation for pediatric TB prevention.
Abstract

Keywords:
CART analysisdecision treespediatricstuberculosis

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