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[Analysis of children with tuberculosis in the past 20 years]
Insights
Childhood tuberculosis is most common in children under three, with many cases linked to family infections. Early BCG vaccination, prompt diagnosis of adult tuberculosis, and family contact tracing are crucial for prevention.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Context:
- Childhood tuberculosis (TB) presents unique clinical challenges.
- Understanding TB epidemiology in pediatric populations is vital for control efforts.
- This study examines clinical features and risk factors in children with TB.
Purpose:
- To characterize the clinical features, including symptoms, signs, and laboratory findings, of childhood tuberculosis.
- To identify risk factors and transmission patterns in pediatric TB cases.
- To inform strategies for the prevention and control of childhood TB.
Summary:
- Analysis of 89 children with TB revealed that 56.2% were under three years old, with primary complex and serious TB (tuberculous meningitis, miliary TB) being common.
- A significant majority (86.0%) of young children had not received BCG vaccination.
- Family members were the primary source of infection (83.6%), and only 16.9% of cases were smear-positive.
Impact:
- Highlights the importance of early BCG vaccination in infancy for preventing severe childhood TB.
- Emphasizes the need for early diagnosis of adult TB cases to reduce pediatric exposure.
- Underscores the critical role of family contact examinations in controlling childhood TB transmission.
Abstract:
To characterize the clinical features of childhood tuberculosis, we analyzed the symptoms, signs, and laboratory findings of the 89 children with tuberculosis admitted to the Yokohama City University Hospital from 1975 to 1994. Compared with the numbers of patients admitted from 1975 to 1979, those of patients of the past 5 years (from 1990 to 1994) were reduced by half. Of the 89 subjects, 56.2% were below 3 years of age and 24.7% were under 1 year of age. 51.7% had primary complex and 20.2% had serious tuberculosis (tuberculous meningitis 14.6%, miliary tuberculosis 3.4%, and bone and joint tuberculosis 2.2%). Tuberculous children below 3 years of age consisted of primary complex (60.0%) and serious tuberculosis (32.0%). The majority (86.0%) of tuberculous children below 3 years of age had not received BCG vaccination. In 55 (61.8%) of 89 subjects, the sources of tuberculosis were clarified. Of these subjects, 83.6% were infected in the family. The rate of BCG inocluation tended to decrease with decreasing age, especially that of children below 3 years of age was 14.0%. Of the 89 subjects, only 16.9% proved to be smear-positive. Taken together, in order to eliminate tuberculous children below 3 years of age, the following is necessary; (1) BCG inoculation in early infancy, (2) early diagnosis of index cases with adult tuberculosis, and (3) prompt and appropriate family contact examination.