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Tuberculosis in 0-5-year-old children following TB contact investigations: a retrospective study in a low burden
Cassandre Pasqualini1, Laure Cohen1, Enora Le Roux2,3
1Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale et Maladies Infectieuses, Hôpital Robert Debré, Paris, France.
Insights
Tuberculosis (TB) risk is high in young children with close household contact in low-prevalence settings. Prophylaxis needs further study for intermediate or low-risk TB contacts.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) contact investigations are crucial for early detection in children.
- Understanding TB risk in young children in low-prevalence settings is essential for public health strategies.
Purpose of the Study:
- To assess the risk, management, and outcomes of children aged 0-5 years following TB contact investigations.
- To identify risk factors associated with TB in this pediatric population.
Main Methods:
- Retrospective study of 261 children (0-5 years) attending a TB clinic in Paris from June 2016 to December 2019.
- Univariate and multivariate analyses were used to determine risk factors for TB.
Main Results:
- 18% of children had TB (37 latent TB infections, 9 active TB diseases).
- High-risk contacts (household/close) had a 21% TB prevalence.
- Living with the index case, BCG vaccination, prolonged contact duration, and sleeping in the index case's room were associated with TB.
Conclusions:
- The risk of TB is significant in young children with household or close contact, even in low-prevalence areas.
- Further research is needed to refine prophylaxis recommendations for intermediate and low-risk TB contacts in children.
Introduction:
We assessed the risk of tuberculosis (TB), the management and the outcomes of 0-5-year-old children after TB contact investigations in a low-burden setting.
Method:
All 0-5-year-old children who attended the TB clinic of Robert Debre Hospital, Paris, France, for a TB contact investigation between June 2016 and December 2019 were included in this retrospective study. The risk factors for TB were assessed using univariate and multivariate analyses.
Results:
A total of 261 children were included. Forty-six (18%) had TB, including 37 latent tuberculosis infections (LTBIs) and 9 active TB diseases. The prevalence of TB was 21% among high-risk contacts, i.e., household or close contacts and regular or casual contacts. There was no TB among intermediate- or low-risk contacts (0/42). Living under the same roof with (OR: 19.8; 95% CI: 2.6-153), the BCG vaccine (OR: 3.2; 95% CI: 1.2-8.3), contact duration >40 h (OR: 7.6; 95% CI: 2.3-25.3) and sleeping in the room of the index case (OR: 3.9; 95% CI: 1.3-11.7) were independently associated with TB. The BCG vaccine was no longer associated when the analysis was restricted to interferon gamma release assay results. Among children without initial LTBI, antibiotic prophylaxis was not prescribed for 2-5-year-old children or for 32/36 (89%) of 0-2-year-old children who had intermediate- or low-risk contact. Overall, none of these children experienced TB.
Conclusion:
In our low prevalence setting, the risk of TB in 0-5-year-old children following a household or close contact was high. Further studies are needed to better assess prophylaxis recommendations in intermediate or low risk contact.
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