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Pediatric tuberculosis in Mexico and the COVID-19 phenomenon: Past and present
Liliana Rivera-Espinosa1, Chaak Castellanos-Carrizal2, Sergio Montes2
11Laboratorio de Farmacología, Instituto Nacional de Pediatría, Ave Iman No.1, Insurgentes Cuicuilco, Coyoacán, CDMX, Ciudad de México, 04530, México.
Insights
Pediatric tuberculosis, often neglected, poses a significant risk for children in endemic areas. The COVID-19 pandemic has worsened the situation in Mexico, impacting diagnosis and treatment success for this vulnerable population.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Pediatric tuberculosis is a significant public health issue in endemic regions, often overlooked despite its high risk of dissemination in children.
- Diagnosing tuberculosis in children is challenging due to difficulties in sample collection and low bacterial yield, compounded by inconsistent immunological tests in immunocompromised individuals.
- The COVID-19 pandemic has disrupted healthcare services, raising concerns about the current status of pediatric tuberculosis management.
Purpose of the Study:
- To highlight the historical neglect and unique challenges of pediatric tuberculosis.
- To analyze the impact of the COVID-19 pandemic on tuberculosis surveillance and treatment in Mexico.
- To emphasize the need for updated research and improved epidemiological surveillance for pediatric tuberculosis.
Main Methods:
- Review of existing literature on pediatric tuberculosis challenges.
- Analysis of national tuberculosis data from Mexico pre- and post-COVID-19 pandemic.
- Examination of trends in case reporting, mortality, treatment success, and vaccination rates.
Main Results:
- Tuberculosis disproportionately affects children in endemic regions, with a higher incidence compared to low-endemic areas.
- Mexican national data shows a decrease in reported tuberculosis cases and treatment success rates, alongside an increase in mortality and a significant drop in childhood vaccination rates post-pandemic.
- Immunological tests for Mycobacterium tuberculosis are inconsistent in endemic settings, particularly for immunocompromised children.
Conclusions:
- Pediatric tuberculosis requires dedicated attention and specialized strategies beyond those for adult tuberculosis.
- The COVID-19 pandemic has exacerbated existing challenges in managing pediatric tuberculosis in Mexico, necessitating urgent re-evaluation of public health interventions.
- Further research is crucial to understand the current epidemiology of pediatric tuberculosis and enhance surveillance systems in high-incidence regions.
Abstract:
In endemic regions, tuberculosis in children constitutes a bigger fraction of total cases as compared to those in low endemic regions, regardless of the implications, this phenomenon has been historically neglected. Pediatric tuberculosis has an insidious onset and quickly develops into disseminated disease and the young are at a special risk for dissemination. Some studies suggest that measures to contain adult tuberculosis are not enough to manage tuberculosis in children, meaning that pediatric tuberculosis needs dedicated attention. Children are harder to diagnose than adults, because collecting samples is difficult, and their bacterial yield is low. In endemic countries, such as Mexico, where contact with Mycobacterium tuberculosis is common, immunological tests are inconsistent, especially in immunocompromised children. With the disruption of Mexican healthcare services by the COVID-19 pandemic, there is an uncertainty of how the situation has evolved, current data about tuberculosis indicates a drop in the national report of cases: 15.4 per 100,000 persons in 2021, compared with pre-COVID 2019 17.7 per 100,000 persons, a small increase in mortality: 1.7 per 100,000 in 2021 compared with 2019 1.6 per 100,000, a drop in treatment success: 80.4% in 2021 compared with 85.4% in 2019, and a decrease in national vaccination rates: an estimate of 86.6% children between 1 and 2 years-old were vaccinated in 2021 compared with 97.3% reported national rate in 2018-2019. There is a need for new research on regions with high tuberculosis incidence, to clarify the current situation of pediatric tuberculosis and improve epidemiological surveillance.
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