Abstract
BackgroundOf the 9.2 million new TB cases occurring each year, about 10% are in children. Because childhood TB is usually non-infectious and non-fatal, national programs do not prioritize childhood TB diagnosis and treatment. We reviewed data from a demonstration project to learn more about the epidemiology of childhood TB in Thailand.MethodsIn four Thai provinces and one national hospital, we contacted healthcare facilities monthly to record data about persons diagnosed with TB, assist with patient care, provide HIV counseling and testing, and obtain sputum for culture and susceptibility testing. We analyzed clinical and treatment outcome data for patients age < 15 years old registered in 2005 and 2006.ResultsOnly 279 (2%) of 14,487 total cases occurred in children. The median age of children was 8 years (range: 4 months, 14 years). Of 197 children with pulmonary TB, 63 (32%) were bacteriologically-confirmed: 56 (28%) were smear-positive and 7 (4%) were smear-negative, but culture-positive. One was diagnosed with multi-drug resistant TB. HIV infection was documented in 75 (27%). Thirteen (17%) of 75 HIV-infected children died during TB treatment compared with 4 (2%) of 204 not known to be HIV-infected (p < 0.01).ConclusionChildhood TB is infrequently diagnosed in Thailand. Understanding whether this is due to absence of disease or diagnostic effort requires further research. HIV contributes substantially to the childhood TB burden in Thailand and is associated with high mortality.
Highlights
Of the 9.2 million new TB cases occurring each year, about 10% are in children
TB diagnosis Thai national guidelines recommend that childhood pulmonary TB (PTB) be diagnosed using a combination of factors, including: history of contact with a PTB patient known to be sputum smear-positive for acid-fast bacilli (AFB); suspected TB symptoms and signs; an abnormal chest radiograph, including pulmonary infiltrates and/or hilar or mediastinal lymphadenopathy; sputum or gastric aspirates that are smear-positive; and tuberculin skin testing
Because this project relied on data collected as part of routine TB control and most cases occurred in adults, limited information was collected about diagnostic tests other than chest radiography, sputum microscopy, and sputum culture
Summary
Because childhood TB is usually non-infectious and non-fatal, national programs do not prioritize childhood TB diagnosis and treatment. About 10% of these TB cases occur in children, i.e., persons less than 15 years old [2,3,4]. National TB programs (NTPs) focus case finding and treatment on pulmonary, acid-fast bacilli (AFB) smear-positive cases, which can be rapidly and reliably diagnosed and contribute greatest to community TB transmission [5]. Because most childhood TB cases are not smear-positive, children are given lower priority in NTPs. Historically, TB surveillance systems in high-burden countries only recorded age categories for smear-positive cases; as a result, few NTPs have been able to report reliably the total number of childhood TB cases diagnosed and treated annually [3]. The World Health Organization (WHO) recommends TB disease screening in children who live in the household of a smear-positive case, but few NTPs perform this routinely [6]
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