Contact Investigation: A Practical Approach to Tuberculosis Eradication

Hsu, Katharine H. K.

doi:10.2105/ajph.53.11.1761

Cited by 44 publications

(11 citation statements)

References 9 publications

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“…In the United States, the major method of preventing tuberculosis in children is interrupting transmission through a community-based contact investigation with appropriate chemotherapy, and the treatment of tuberculosis infection to prevent the development of disease. [109][110][111] The contact investigation is the most important activity in the United States for preventing tuberculosis in children because the yield is high for finding infection and it finds the most recent infections, which are most likely to develop soon into cases of tuberculosis disease in children. Several investigations have shown that when contact investigations are not conducted well or completely, preventable cases of tuberculosis in children inevitably occur.…”

Section: Preventionmentioning

confidence: 99%

Tuberculosis in Children

Starke

2004

Seminars in Respiratory and Critical Care Medicine

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The natural history and clinical expression of infection due to Mycobacterium tuberculosis differ substantially in children compared with adults. The natural history depends upon the age at infection and the host immune status. Children infected prior to age 4 have a very high rate of developing immediate clinical or radiographic manifestations or both, but are unlikely to develop reactivation disease in adulthood. In contrast, children infected in preadolescence or adolescence are more prone to developing more severe adult-type pulmonary tuberculosis soon after infection or in adulthood. It is difficult to confirm the diagnosis of tuberculosis by current microbiological methods. Even in industrialized countries, the triad of a positive tuberculin skin test, radiographic and/or clinical manifestations consistent with tuberculosis, and establishing a recent link to a known infectious case of tuberculosis is the "gold standard" for diagnosis. Children with tuberculosis respond well to and tolerate the same basic treatment regimens as used for adults. Some prevention of childhood tuberculosis can be achieved by the use of the bacille Calmette-Guérin (BCG) vaccines, but the use of chemotherapy to treat recent tuberculosis infection, discovered via contact tracing, is of paramount importance even when BCG vaccines are used.

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Section: Preventionmentioning

confidence: 99%

Tuberculosis in Children

Starke

2004

Seminars in Respiratory and Critical Care Medicine

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“…As public health agencies increasingly focus on strategies to eliminate TB in the United States, 1 childhood TB becomes an important indicator of program success in interrupting and preventing recent TB transmission. TB cases among children indicate recent transmission of Mycobacterium tuberculosis usually from an infectious adult, often a family or household member, 2,3 and are a sensitive indicator of deficiencies in efforts to prevent TB transmission. The mainstays of TB prevention in children are the timely diagnosis, reporting, and curative treatment of adults with TB disease so that the transmission of M tuberculosis is interrupted.…”

mentioning

confidence: 99%

Missed Opportunities for Preventing Tuberculosis Among Children Younger Than Five Years of Age

2000

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ABSTRACT. Objectives. Childhood tuberculosis (TB)is an important indicator of public health success in interrupting and preventing TB transmission. To determine the frequency and types of missed opportunities for preventing TB among children <5 years of age.Methods. We collected data from the public health records of child TB cases and their adult source cases. These children were from health jurisdictions where TB case rates in children were higher than the California average for this age group.Results. We reviewed the records for 165 children reported with TB (20% confirmed by culture). These children were evaluated for TB because of signs or symptoms of illness (32%), a contact investigation (26%), screening (22%), a source case investigation (4%), and unknown reasons (16%). Excluding 4 children infected by Mycobacterium bovis, only 59 of 161 children (37%) had a source case found. Children found in a contact investigation, born in the United States, <1 year of age, or who were black were more likely to have a source case found than children who did not have one of these characteristics. Of 43 children found in a contact investigation, improvements in contact investigations may have prevented TB in 17 of these children (40%). Among the 43 adult source cases, factors that may have facilitated transmission include delayed reporting in 23%, a delayed contact investigation in 21%, and delayed or nondocumented bacteriologic sputum conversion in 42% of culture-positive cases.Conclusions. Important missed opportunities to prevent TB in children include the failure to find and appropriately manage adult source cases and failure to completely evaluate and properly treat children exposed to TB. Improvements in case detection, case management, and contact investigations are necessary to eliminate TB in children. Pediatrics 2000;106(6). URL: http://www. pediatrics.org/cgi/content/full/106/6/e75; tuberculosis, children, prevention, missed opportunities.ABBREVIATIONS. TB, tuberculosis; TST, tuberculin skin test; RR, relative risk; CI, confidence interval; INH, isoniazid. D espite recent declines in the incidence of tuberculosis (TB) in the United States, TB continues to be an important health problem in specific social and racial groups. As public health agencies increasingly focus on strategies to eliminate TB in the United States, 1 childhood TB becomes an important indicator of program success in interrupting and preventing recent TB transmission. TB cases among children indicate recent transmission of Mycobacterium tuberculosis usually from an infectious adult, often a family or household member, 2,3 and are a sensitive indicator of deficiencies in efforts to prevent TB transmission. The mainstays of TB prevention in children are the timely diagnosis, reporting, and curative treatment of adults with TB disease so that the transmission of M tuberculosis is interrupted. 4,5 In addition, children exposed to infectious cases need a thorough medical evaluation and, if TB disease is excluded, prompt initiation of treatment f...

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“…1,66 Although no controlled trials have examined preventive therapy for persons exposed to MDR-TB, 67 experts who have reviewed observational data suggest management of close contacts include preventive therapy regimens for MDR-TB. [68][69][70][71][72][73] Contact investigation has, for half a century, 74 been the best way to find children newly infected with TB and those with early disease. It remains so today.…”

Section: Why Are Children With Drug-resistant Tb Invisible?mentioning

confidence: 99%

“…86 In the United States, for example, pediatric TB rates reflected the late 1980s' upsurge in adult rates, 87,88 and were slow to drop even after adult rates declined. 89 Many TB workers have talked of 'sentinel events', 37,38,47 'Geiger counters', 74 and 'litmus tests' 90 when referring to children sick with TB.…”

Section: Children As Sentinels Of Transmission and Policy Responsementioning

confidence: 99%

Commentary: A targets framework: Dismantling the invisibility trap for children with drug-resistant tuberculosis

Becerra

Swaminathan

2014

J Public Health Pol

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Tuberculosis (TB) is an airborne infectious disease that is both preventable and curable, yet it kills more than a million people every year. Children are highly vulnerable, but often invisible casualties. Drug-resistant forms of TB are on the rise globally, and children are as vulnerable as adults but less likely to be counted as cases of drug-resistant disease if they become sick. Four factors make children with drug-resistant TB 'invisible': first, the nature of the disease in children; second, deficiencies in existing diagnostic tools; third, overreliance on these tools; and fourth, our collective failure to deploy one effective tool for finding and treating children -contact investigation. We describe a nascent science-advocacy network -the Sentinel Project on Pediatric Drug-Resistant Tuberculosis -whose goal is to end child deaths from this disease. Provisional annual targets, focused on children exposed at home to multidrug-resistant TB, to be updated every year, constitute a framework to focus attention and collective actions at the community, national, and global levels. The targets in two age groups, under 5 and 5-14 years old, tell us the number of: (i) children who require complete evaluation for TB disease and infection; (ii) children who require treatment for TB disease; and (iii) children who would benefit from preventive therapy.

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Contact Investigation: A Practical Approach to Tuberculosis Eradication

Cited by 44 publications

References 9 publications

Tuberculosis in Children

Tuberculosis in Children

Missed Opportunities for Preventing Tuberculosis Among Children Younger Than Five Years of Age

Commentary: A targets framework: Dismantling the invisibility trap for children with drug-resistant tuberculosis

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