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Tuberculosis among children visiting friends & relatives
Tomas M Perez-Porcuna1, Antoni Noguera-Julian2, Maria Teresa Riera-Bosch3
1TB Pediatric Unit, Research Foundation of Primary Health and Mútua Terassa University Hospital, Mútua Terrassa, Terrassa, Catalunya 08221, Spain.
Insights
Children visiting family abroad face a significant risk of latent tuberculosis infection (LTBI) and active tuberculosis (TB). Household smoking increases this risk, highlighting the need for targeted screening and prevention in these pediatric populations.
Area of Science:
- Pediatric infectious diseases
- Public health
- Epidemiology
Background:
- Paediatric tuberculosis (TB) cases in low-incidence countries often involve children from migrant families.
- Visiting friends and relatives (VFR) travel to high-TB-incidence countries is a potential risk factor for TB transmission.
- Estimating the risk of latent TB infection (LTBI) and TB in children undertaking VFR travel is crucial for public health strategies.
Purpose of the Study:
- To estimate the risk of latent TB infection (LTBI) and active TB in children who travelled to their parents' birth country.
- To identify risk factors associated with LTBI in this pediatric population.
Main Methods:
- Prospective, multicentric observational study in Catalonia, Spain (June 2017-December 2019).
- Enrolled children (<15 years) with a parent from a high-TB-incidence country who travelled for ≥21 days.
- Tuberculin skin test (TST) and QuantiFERON-TB Gold Plus (QFT-Plus) performed 8-12 weeks post-return; LTBI defined as TST ≥5 mm and/or positive QFT-Plus.
Main Results:
- 13 out of 500 children (2.6%) were diagnosed with LTBI (16.6/100 person-years of follow-up).
- Two cases (0.4%) of active TB were diagnosed (2.5/100 person-years of follow-up).
- Household tobacco smoke exposure was significantly associated with LTBI (adjusted odds ratio = 3.9).
Conclusions:
- Children undertaking VFR travel to high-TB-incidence countries face a substantial risk of LTBI, potentially exceeding that of the native population.
- Household smoking is a primary risk factor for LTBI in children returning from VFR travel.
- Targeted diagnostic and preventive interventions are recommended for children VFR in high-TB-incidence settings.
Background:
Most paediatric tuberculosis (TB) cases in low-TB-incidence countries involve children born to migrant families. This may be partially explained by trips to their countries of origin for visiting friends and relatives (VFR). We aimed to estimate the risk of latent TB infection (LTBI) and TB in children VFR.
Methods:
We conducted a prospective multicentric observational study in Catalonia (Spain) from June 2017 to December 2019. We enrolled children aged < 15 years with a negative tuberculin skin test (TST) at baseline and at least one parent from a high-TB-incidence country, and who had travelled to their parent's birth country for ≥21 days. TST and QuantiFERON-TB Gold Plus (QFT-Plus) were performed within 8-12 weeks post-return. LTBI was defined as a TST ≥5 mm and/or a positive QFT-Plus.
Results:
Five hundred children completed the study, equivalent to 78.2 person-years of follow-up (PYFU). Thirteen children (2.6%) were diagnosed with LTBI (16.6/per100 PYFU, 95%CI = 8.8-28.5), including two cases (0.4%) of TB (2.5/per100 PYFU, 95%CI = 0.3-9.3). LTBI incidence rates remained high after excluding BCG-vaccinated children (9.7/per100 PYFU, 95%CI = 3.9-20.0). Household tobacco smoke exposure was associated with LTBI (aOR = 3.9, 95%CI = 1.1-13.3).
Conclusions:
The risk of LTBI in children VFR in high-TB-incidence countries may equal, or perhaps even exceed, the infection risk of the native population. The primary associated risk factor was the presence of smokers in the household. Furthermore, the incidence rate of active TB largely surpassed that of the countries visited. Children VFR in high-TB-incidence countries should be targeted for diagnostic and preventive interventions.
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