High Prevalence of Active and Latent Tuberculosis in Children and Adolescents in Tibetan Schools in India: The Zero TB Kids Initiative in Tibetan Refugee Children

Abstract

Background Tuberculosis (TB) prevalence is high among Tibetan refugees in India, with almost half of cases occurring in congregate facilities, including schools. A comprehensive program of TB case finding and treatment of TB infection (TBI) was undertaken in schools for Tibetan refugee children. Methods Schoolchildren and staff in Tibetan schools in Himachal Pradesh, India, were screened for TB with an algorithm using symptoms, chest radiography, molecular diagnostics, and tuberculin skin testing. Individuals with active TB were treated and those with TBI were offered isoniazid-rifampicin preventive therapy for 3 months. Results From April 2017 to March 2018, we screened 5391 schoolchildren (median age, 13 years) and 786 staff in 11 Tibetan schools. Forty-six TB cases, including 1 with multidrug resistance, were found in schoolchildren, for a prevalence of 853 per 100 000. Extensively drug-resistant TB was diagnosed in 1 staff member. The majority of cases (66%) were subclinical. TBI was detected in 930 of 5234 (18%) schoolchildren and 334 of 634 (53%) staff who completed testing. Children in boarding schools had a higher prevalence of TBI than children in day schools (915/5020 [18%] vs 15/371 [4%]; P < .01). Preventive therapy was provided to 799 of 888 (90%) schoolchildren and 101 of 332 (30%) staff with TBI; 857 (95%) people successfully completed therapy. Conclusions TB prevalence is extremely high among Tibetan schoolchildren. Effective active case finding and a high uptake and completion of preventive therapy for children were achieved. With leadership and community mobilization, TB control is implementable on a population level.

Paediatric tuberculosis transmission outside the household: challenging historical paradigms to inform future public health strategies

“…Despite the complexity in quantifying where M tuberculosis transmission occurs in children at the population level, understanding this key question is essential to design appropriate and effective public health programmes to detect, diagnose, and treat children with tuberculosis. 13 studies [14][15][16][17][18][19][20][21][22][23][24][25][26] published between 2003 and 2018 that made use of diverse methodologies and designs shed light on this topic. This description is specific to the type of study, and is thus described for each study type in later sections.…”

“…Five similar studies that were not included in this review 18 also found similar results (table 1). [19][20][21][22][23] A community-based survey of 3170 children from Malawi was done. 19 Using mixture analysis of tuberculin data, the authors found that 1•1% of all children were infected.…”

“…In a large study in several Tibetan schools, 5234 children were screened with tuberculin skin tests. 22 Only 156 (3%) of these students were exposed to a household tuberculosis case in the previous 2 years, indicating that the most new infections were community driven. Lastly, 9810 children between ages 6 years and 13 years were administered QFTs in Mongolia.…”

“…Lastly, given predominance of community-driven M tuberculosis transmission, certain social settings have been identified as drivers of M tuberculosis transmission in children. 16,22,26 Studies have implicated church attendance, mini-bus transportation, and schools as key locations for paediatric conversion events. 16,22,26 Intuitively, these locations might be ideal locations to focus health programmes that provide screening for children.…”

Tuberculosis among School Age (6 - 18 Years) Children Seen in University of Port Harcourt Teaching Hospital: A Need for Effective School Health Services

“…Dorjee et al, reported a latent TB infection prevalence of 18% and 54% among secondary school children and staff respec-B. A. Alex-Hart et al These researchers equally found 46 cases of TB disease and one case of extensive drug resistant TB amongst the children[8]. Though these studies were done outside Nigeria, they however showed the magnitude of the global childhood TB burden among school children and the need to include the school communities in the active TB case finding.…”