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Evaluation of transmission of Mycobacterium tuberculosis in a pediatric setting
M Moore1, J Schulte, S E Valway
1Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Insights
Limited transmission of Mycobacterium tuberculosis (TB) occurred in children exposed to an infectious pediatrician. Despite screening efforts, only 43% of exposed pediatric patients completed testing, indicating challenges in public health response.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Surveillance
- Mycobacterium tuberculosis Transmission
Background:
- Healthcare professionals can transmit infectious diseases, including tuberculosis (TB), to vulnerable patient populations.
- Pediatric patients are particularly susceptible to infections due to their developing immune systems.
Purpose of the Study:
- To assess the transmission rate of Mycobacterium tuberculosis from an infectious pediatrician to pediatric patients.
- To evaluate the effectiveness of screening protocols in identifying exposed children.
Main Methods:
- Identification of pediatric patients exposed to a pediatrician with active pulmonary tuberculosis using clinic and hospital records.
- Notification of exposed children and offering tuberculosis screening.
- Analysis of tuberculosis screening results, including skin test induration sizes.
Main Results:
- 1416 pediatric patients were identified as exposed; 606 completed screening.
- 2% of screened children had a positive tuberculosis skin test (≥10 mm), and 0.3% had an intermediate result (5-9 mm).
- No active tuberculosis cases were diagnosed; however, 7 children with positive skin tests had no other risk factors, suggesting potential transmission.
Conclusions:
- Evidence suggests limited Mycobacterium tuberculosis transmission in this pediatric outpatient setting.
- Low screening completion rates (43%) highlight challenges in resource allocation and public health priorities.
- Balancing patient protection with resource availability is crucial in managing similar exposure events.
Objective:
To determine the extent of transmission of Mycobacterium tuberculosis to pediatric patients exposed to a pediatrician with smear- and culture-positive pulmonary tuberculosis (TB).
Methods:
Clinic billing and hospital admission records were used to identify patients seen during the pediatrician's infectious period. Patients were notified of the potential exposure and were offered screening.
Results:
A total of 1416 pediatric patients were identified as exposed. Of the 606 who completed screening, 12 (2%) had a skin test result > or = 10 mm, 2 (0.3 had a result 5 to 9 mm, and 592 (98%) had a negative test result (0 to 4 mm). No active TB cases were identified. Of the 14 children with a skin test result > or = 5 mm, 7 were U.S.-born and had no other risk for a positive skin test. The remaining seven had either been exposed to another person with infections TB or were from countries with a high prevalence of TB.
Conclusion:
We found evidence of limited transmission of Mycobacterium tuberculosis in the outpatient pediatric setting. Despite extensive resources dedication, only 43% of exposed children completed screening. In similar situations decision should balance the responsibility to protect children exposed to Mycobacterium tuberculosis with other public health priorities and available resources.