Tuberculosis infection in children visiting friends and relatives in countries with high incidence of tuberculosis

Abstract

Introduction: Tuberculosis (TB) is a global infectious disease. In low-incidence countries, paediatric TB affects mostly immigrant children and children of immigrants. We hypothesize that these children are at risk of exposure to Mycobacterium tuberculosis when they travel to the country of origin of their parents to visit friends and relatives (VFR). In this study, we aim to estimate the incidence rate and risk factors associated to latent tuberculosis infection (LTBI) and TB in VFR children. Methods and analysis: A prospective study will be carried out in collaboration with 21 primary health care centres (PCC) and 5 hospitals in Catalonia, Spain. The study participants are children under 15 years of age, either immigrant themselves or born to immigrant parents, who travel to countries with high incidence of TB (≥ 40 cases/100,000 inhabitants). A sample size of 492 children was calculated. Participants will be recruited before traveling, either during a visit to a travel clinic or to their PCC, where a questionnaire including sociodemographic, epidemiological and clinical data will be completed, and a tuberculin skin test (TST) will be performed and read after 48 to 72 hours; patients with a positive TST at baseline will be excluded. A visit will be scheduled eight to twelve-weeks after their return to perform a TST and a QuantiFERON-TB Gold Plus test. The incidence rate of LTBI will be estimated per individual/month and person/year per country visited, and also by age-group. Ethics and dissemination: The study protocol was approved by the Clinical Research Ethics Committee of the Hospital Universitari Mútua Terrassa (code 02/16) and the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (code P16/094). Articles will be published in indexed scientific journals. Trial registration: Clinical-Trials.gov: NCT04236765

Situación epidemiológica de la Tuberculosis infantil en el departamento de Caldas 2016-2018

“…La sensibilidad de Xpert puede ser mucho mayor en niños mayores con baciloscopia positiva (similar a los adultos) y es más baja en niños pequeños con baciloscopia negativa 30 . Esta situación también se ve reflejada en el diagnóstico de Tuberculosis latente, pues la falta de estándar de oro para el diagnóstico responde a su naturaleza paucibacilar, el estado inactivo de M. tuberculosis y la localización en los ganglios linfáticos mediastínicos 31 .…”

Research of childhood tuberculosis in suspected populations by molecular methods: A multicenter study in China

“…However, children aged 5~10 have the lowest infection rate, then the incidence increases during adolescence. ( Reyes et al., 2020 ; Soriano-Arandes et al., 2020 ) According to China National Tuberculosis Programme (2010-2017), of 40,561 children with tuberculosis, 77.7% (n = 31,529) were aged 10-14 years but only 19.6% (n = 7931) were bacteriologically confirmed, ( Li et al., 2020 ) far from the rates needed for the goal of ending tuberculosis. We found here that among all 851 suspected childhood cases, only 81 (9.5%) cases tested positive ( Table 2 ).…”

“…The higher rates were probably due to increased interaction with adults when children get in middle school, which raises the risk of exposure to patients with open tuberculosis, and their samples are easy to obtain and contain more bacteria. ( Soriano-Arandes et al., 2020 ) Living conditions including poor housing, poverty, and urban environments are also associated with higher tuberculosis prevalence and transmission. ( Stosic et al., 2019 ; Bekken et al., 2020 ; Boukamel et al., 2020 ; Martinez et al., 2020 ) Unlike adult tuberculosis, there is no gender difference in childhood tuberculosis, ( Marais et al., 2004 ; Nelson and Wells, 2004 ; Swaminathan and Rekha, 2010 ) and in this study we did not find gender differences in either PTB or EPTB.…”

Tuberculosis among children visiting friends & relatives

“…A detailed description of the study protocol was published previously. 15 Trial registration: Clinical-Trials.gov : NCT04236765.…”

“…Based on the previously calculated sample size, 15 we aimed to enrol 492 children to detect at least an increase from 0 to 2% in the proportion of incident LTBI cases.…”