Towards elimination of childhood and adolescent tuberculosis in the Netherlands: an epidemiological time-series analysis of national surveillance data

Gafar, Fajri; Ochi, Taichi; Boveneind-Vrubleuskaya, Natasha van’t; Akkerman, Onno W.; Erkens, Connie; Hof, Susan van den; Werf, Tjip S van der; Alffenaar, Jan‐Willem C.; Wilffert, Bob

doi:10.1183/13993003.01086-2020

Cited by 4 publications

(2 citation statements)

References 38 publications

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“…Similarly, several countries, such as Nigeria, China, and Brazil, showed an increasing trend during the same study period (Daniel et al 2015;Alves et al 2020;Wang et al 2020). While a decreasing trend was observed in most of the developed countries (Mor et al 2013), the trend was often stable among foreignborn immigrant children in these countries (Cowger et al 2019;Gafar et al 2020). As mentioned above, we assume that regional differences in TB estimates may be due to the differences in population densities, number of contacts with TB, air pollution levels, and/or economic status.…”

Section: Accepted Manuscriptmentioning

confidence: 80%

Childhood Tuberculosis in Mongolia: Trends and Estimates, 2010-2030

Zanaa

Paramita

Erdenee

et al. 2022

Tohoku J. Exp. Med.

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Mongolia was listed among the 30 countries with a high tuberculosis burden in 2021.Approximately 10 -11% of the tuberculosis cases are of children, which is higher than the global average (6.0%). As children are a vulnerable population, it is important to understand the current situation and prioritize the development of tuberculosis prevention strategies. However, only few studies have addressed childhood tuberculosis in Mongolia. Therefore, we aimed to describe the characteristics of childhood tuberculosis and to show its trends and estimates in Mongolia. We performed descriptive and trend analyses on secondary data from the National Center for Communicable Diseases from 2010 to 2020. A total of 4,242 childhood tuberculosis cases, compiled from nine districts of the capital city and 21 provinces, were analyzed. We found that tuberculosis occurred more frequently in school-age children, and 71.8% of the all cases were an extrapulmonary tuberculosis. Trend analysis revealed that childhood tuberculosis continuously increased with fluctuations from 2018 onwards. The central region, including the capital city of Ulaanbaatar, is the most tuberculosis-burdened. Childhood tuberculosis is estimated to increase in the central region and decrease in the others from 2021 to 2030. Our findings showed that the national childhood tuberculosis trend is increasing, although there are differences in the pattern between regions. Further studies are needed to identify the determinant factors of regional differences, and age-specific public health interventions, such as scale-up screening and preventive treatment, are in demand in high-prevalence areas.

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Section: Accepted Manuscriptmentioning

confidence: 80%

Childhood Tuberculosis in Mongolia: Trends and Estimates, 2010-2030

Zanaa

Paramita

Erdenee

et al. 2022

Tohoku J. Exp. Med.

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“…In adults in Germany, this proportion was only 4% in 2019. For every child detected with TB disease in the Netherlands, 2.5 child contacts were started on TB-preventive treatment [13,14].…”

Section: Western Europementioning

confidence: 99%

Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings

et al. 2022

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In low tuberculosis-burden countries, children and adolescents with the highest incidence of tuberculosis (TB) infection or disease are usually those who have immigrated from high-burden countries. It is, therefore, essential that low-burden countries provide healthcare services to immigrant and refugee families, to assure that their children can receive proper testing, evaluation, and treatment for TB. Active case-finding through contact tracing is a critical element of TB prevention in children and in finding TB disease at an early, easily treated stage. Passive case-finding by evaluating an ill child is often delayed, as other, more common infections and conditions are suspected initially. While high-quality laboratory services to detect Mycobacterium tuberculosis are generally available, they are often underutilized in the diagnosis of childhood TB, further delaying diagnosis in some cases. Performing research on TB disease is difficult because of the low number of cases that are spread over many locales, but critical research on the evaluation and treatment of TB infection has been an important legacy of low-burden countries. The continued education of medical providers and the involvement of educational, professional, and non-governmental organizations is a key element of maintaining awareness of the presence of TB. This article provides the perspective from North America and Western Europe but is relevant to many low-endemic settings. TB in children and adolescents will persist in low-burden countries as long as it persists throughout the rest of the world, and these wealthy countries must increase their financial commitment to end TB everywhere.

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Clinical Features, Adverse Events and Treatment Outcomes of Multidrug/Rifampicin-resistant Tuberculosis in Children and Adolescents: An Eight-year Retrospective Cohort Study in Bandung, Indonesia

Nataprawira,

Gafar,

Sari

et al. 2024

Pediatric Infectious Disease Journal

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Background: Data on childhood and adolescent multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) in Indonesia are lacking. We aimed to assess clinical features, adverse events (AEs) and treatment outcomes of childhood and adolescent MDR/RR-TB. Methods: A retrospective cohort study was performed in children and adolescents aged <18 years treated for MDR/RR-TB at Hasan Sadikin General Hospital in Bandung, Indonesia, between June 2016 and March 2024. Multivariable logistic regression analyses were used to calculate adjusted odds ratios (aOR) for predictors of all-cause mortality. Results: Among 84 included patients, 69 (82%) were adolescents aged 10–17 years, 54 (64%) were female, 54 (64%) were malnourished and 55 (65%) had culture-confirmed disease. Among 69 (82%) patients with known outcomes, 48 (70%) were successfully treated, 14 (20%) died (including 5 pretreatment deaths) and 7 (10%) were lost to follow-up (LTFU) (including 5 pretreatment LTFU). Predictors of all-cause mortality included shortness of breath on admission [aOR: 6.4, 95% confidence interval (CI): 1.3–49.1], high bacillary burden on Xpert MTB/RIF assay (aOR: 17.0, 95% CI: 1.6–260.5) and the presence of lung cavities on chest radiograph (aOR: 4.8, 95% CI: 1.1–23.3). Among 74 patients who initiated treatment, 39 (53%) had at least one grade 1–2 AE, and 4 (5%) had one grade 3–4 AE each, including hepatotoxicity, QT prolongation, hearing loss and rash/hyperpigmentation. Conclusion: Younger children were underrepresented among those treated for MDR/RR-TB, indicating reduced access to care. Severe AEs were uncommon during MDR/RR-TB treatment. Baseline indicators of extensive disease were associated with all-cause mortality. The high proportion of pre-treatment mortality and LTFU may reflect complex patient pathways limiting access to care.

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Towards elimination of childhood and adolescent tuberculosis in the Netherlands: an epidemiological time-series analysis of national surveillance data

Cited by 4 publications

References 38 publications

Childhood Tuberculosis in Mongolia: Trends and Estimates, 2010-2030

Childhood Tuberculosis in Mongolia: Trends and Estimates, 2010-2030

Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings

Clinical Features, Adverse Events and Treatment Outcomes of Multidrug/Rifampicin-resistant Tuberculosis in Children and Adolescents: An Eight-year Retrospective Cohort Study in Bandung, Indonesia

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