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Tuberculosis Case Detection and Guideline Adherence among Child Contacts in Switzerland: A Retrospective
Nathalie Gasser1, Nora Fritschi2,3, Jean-Marie Egger1
1TB Competence Center, Swiss Lung Association, Bern, Switzerland.
Insights
Tuberculosis (TB) contact investigations in children found a significant number with TB infection or disease. However, management often deviated from national guidelines, indicating a need for better implementation to protect child contacts.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Children in contact with tuberculosis (TB) index cases face a substantial risk of TB infection and subsequent disease.
- Effective contact investigation is crucial for early detection and prevention of TB transmission in pediatric populations.
Purpose of the Study:
- To determine the proportion of child contacts developing TB infection or disease.
- To evaluate diagnostic pathways and adherence to current TB management guidelines in children exposed to TB.
- To identify areas for improvement in pediatric TB contact investigation protocols.
Main Methods:
- A retrospective observational study was conducted on children aged 16 years or younger exposed to a TB index case between January 2019 and July 2021.
- Data from 380 (95%) of 401 exposed children were analyzed, stratified by age groups: 0-4, 5-11, and 12-16 years.
Main Results:
- Of the 380 children analyzed, 7 (2%) were diagnosed with active TB disease and 35 (9%) with TB infection.
- Significant deviations from national Swiss guidelines were observed, including delayed diagnostic testing and suboptimal prescription of prophylactic treatment, particularly in younger children (0-4 years).
- Adherence to recommended testing schedules and prophylactic measures varied, with only 82% of young children receiving timely diagnostic evaluation and 66% being prescribed recommended prophylactic treatment.
Conclusions:
- Pediatric contact investigations for tuberculosis are effective in identifying infected children and those with active disease, even in low-incidence settings.
- Current practices show notable deviations from established guidelines, highlighting a critical need for improved implementation and adherence to ensure optimal care for child TB contacts.
- Strengthening the application of national guidelines in TB contact investigations is essential to mitigate the risk of TB infection and disease progression in exposed children.
Background:
Children exposed to a tuberculosis (TB) index case are at risk of TB infection and disease.
Objectives:
The aim of this study was to describe the proportion of child contacts who developed TB infection or disease after exposure and to assess the diagnostic pathways and adherence to current guidelines.
Methods:
Retrospective observational study including children ≤16 years of age who had contact to a TB index case between January 2019 and July 2021. Analysis was stratified by age groups 0-4, 5-11, and 12-16 years.
Results:
Of 401 TB-exposed children, data were available for 380 (95%). Of those, 7 (2%) were diagnosed with TB disease and 35 (9%) with TB infection. We identified several deviations in the management compared to recommendations in national Swiss guidelines: In the children aged 0-4 years, only 82% were examined with an immunodiagnostic test or a chest radiography within 2 weeks after last contact. Recommended prophylactic treatment was prescribed in 66% of the children only. In the children aged 5-11 years, 64% were tested with an immunodiagnostic test in a first examination and 75% in a second examination, 2 weeks and 2 months after last contact, respectively.
Conclusions:
Contact investigations of children exposed to a TB index case identified a significant proportion of children with TB infection and disease in a low TB incidence setting. We observed significant deviations from the guidelines in the contact investigations suggesting the need for improved implementation.
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