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Management implications of latent TB among under-five children at risk: Insights from a community study in Mumbai,
Suchitra Surve1, Vikrant Bhor2, Venkateshwaran Gounder1
1Department of Child Health Research, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health (ICMR-NIRRCH), Mumbai, India.
Insights
Latent tuberculosis infection (LTBI) is prevalent in Indian children, with household contacts and drug-resistant TB increasing risk. Findings suggest revising India
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Latent tuberculosis infection (LTBI) management is vital for the WHO's End TB Strategy.
- Indian guidelines advocate for treating children under five with household TB contacts, irrespective of LTBI testing.
- The exact LTBI burden in children in high-burden settings like India remains undetermined.
Purpose of the Study:
- To determine the epidemiology of LTBI in under-five children at risk in urban Indian slums.
- To inform TB control interventions by understanding LTBI prevalence and risk factors in this demographic.
Main Methods:
- A community-based study enrolled 369 eligible children under five.
- LTBI screening utilized Tuberculin skin test (TST) and Interferon gamma release assay (IGRA).
- Active TB was excluded before initiating TB preventive therapy (TPT); statistical analyses included chi-square and logistic regression.
Main Results:
- LTBI prevalence was 12.4% by IGRA and 21.4% by TST.
- Lower IGRA positivity was observed in undernourished children (p=0.027).
- Household TB contacts, longer exposure, and drug-resistant TB (DR-TB) were associated with higher IGRA positivity (p<0.001).
Conclusions:
- LTBI prevalence in under-five children is lower than in adults.
- Key risk factors for LTBI in children include household TB contacts (HHC), DR-TB exposure, and prolonged contact.
- The study recommends revising the TPT framework for Indian children, potentially adopting a test-and-treat approach.
Background:
Latent tuberculosis infection (LTBI) management is crucial to WHO's End TB Strategy. Indian guidelines recommend treating under-five children with household TB contacts after ruling out active TB, regardless of TBI testing. However, the precise LTBI burden among children in high TB burden settings like India is unknown. A community-based study in Mumbai's urban slums screened and managed under-five children at LTBI risk to understand its epidemiology and inform TB control interventions.
Methods:
Total 369 eligible under-five children were enrolled for the study. LTBI screening was done using Tuberculin skin test and Interferon gamma release assay. Active TB was ruled out before initiation of TB preventive therapy among LTBI positives. Statistical tests like chi-square, logistic regression analysis and Hosmer-Lemeshow test were used.
Results:
Overall, LTBI prevalence among under-five children was 12.4% by IGRA and 21.4% by TST. Undernourished children had significantly lower LTBI positivity by IGRA (p = 0.027), while those with household contacts, longer contact duration and drug-resistant tuberculosis (DR-TB) exhibited proportionally greater IGRA positivity (p = <0.001).
Conclusion:
The study found a lower LTBI prevalence among under-five children compared to adults, with key risk factors being HHC, DR-TB contact, and prolonged exposure. These findings suggest the need to revise or revisit the TPT framework for this age group in India, particularly by implementing a test-and-treat approach.
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