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Close contact with tuberculosis in childhood
Insights
Children exposed to tuberculosis (TB) require careful monitoring. Those in contact with smear-positive TB cases face a higher risk of infection, underscoring the need for targeted screening.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) remains a significant global health concern, necessitating effective contact tracing and management strategies.
- BCG vaccination is a common preventive measure for TB, but its efficacy in preventing infection in close contacts requires ongoing evaluation.
- Identifying high-risk pediatric populations for TB infection is crucial for timely diagnosis and treatment.
Purpose of the Study:
- To assess the risk of tuberculosis infection in children who have had close contact with adult TB patients.
- To evaluate the effectiveness of the Mantoux test in identifying infected children within this cohort.
- To determine the necessity and impact of INH (isoniazid) prophylaxis in exposed children.
Main Methods:
- A 1-year prospective study involving 83 children in close contact with 52 adults diagnosed with tuberculosis.
- Utilized the Mantoux test to assess tuberculin skin reactivity (PPD) in all child contacts.
- Administered INH therapy to children based on age, Mantoux test results, or conversion of test results.
Main Results:
- 49% of BCG-vaccinated children tested PPD negative.
- One 14-year-old boy was diagnosed with primary tuberculosis and received treatment.
- Nine children received INH therapy due to positive Mantoux tests or conversion; seven had contact with smear-positive index cases.
Conclusions:
- Routine examination of children in contact with TB patients is feasible as TB incidence declines.
- Children exposed to smear-positive TB index cases are at a significantly higher risk of contracting tuberculosis.
- Targeted screening and preventive therapy are essential for high-risk pediatric TB contacts.
Abstract:
In a 1-year prospective study 83 children, who had been in close contact with 52 adults who had tuberculosis, were examined. Thirty-six of the index cases had culture positive tuberculosis and 16 of these had smear positive tuberculosis. All the children had been BCG-vaccinated at birth. Forty-one (49%) of the children were PPD negative on examination with the Mantoux test. Of these 83 children, one 14-year-old boy was diagnosed as having primary tuberculosis and was treated. Twenty-one children received INH therapy, 12 because of their age (under 2 years of age or at puberty), nine because of a strong positive reaction to the first Mantoux test or because of the conversion of a negative test result to positive during the follow-up period. Seven of the latter nine children had been in contact with persons whose disease was culture- and smear-positive. It is concluded that as the frequency of tuberculosis declines, the practice of examining all children who have been in close contact with tuberculous adults is possible. The children who have been in contact with smear-positive index cases are at special risk of contracting tuberculosis.