Children exposed to multidrug-resistant tuberculosis at a home-based day care centre: a contact investigation.

Abstract

In high tuberculosis (TB) burden settings, day care centres may be an underestimated source of exposure of children to infectious drug-susceptible (DS) and drug-resistant (DR) TB cases. To describe the results of a contact investigation of children exposed to an adult with DR-TB at a South African home-based day care centre. Retrospective descriptive community-based cohort study. Mycobacterium tuberculosis resistant to isoniazid (INH), rifampicin and amikacin was cultured from the sputum of an adult index case residing in a home-based day care centre. Of 38 children aged <15 years identified during routine contact investigation, consent was obtained for 34; the median age was 3.9 years (IQR 2.9-5.2); 23/34 were aged <5 years, none were human immunodeficiency virus infected. The median contact score was 4/10, 8 had a reactive tuberculin skin test (⩾10 mm) and none had TB. Of the 34 study children, 24 received 6 months of DR-TB preventive therapy comprising ofloxacin, ethambutol and high-dose INH; 21 completed 12 months' follow-up and none developed TB. TB at day care centres may result in many exposed young children with high TB contact scores, similar to household contact investigations. Active identification and initiation of preventive treatment may be able to avert DR-TB cases.