Abstract
SummaryBackgroundTuberculosis is recognised as a major cause of morbidity and mortality in children, with most cases in children going undiagnosed and resulting in poor outcomes. Household contact management, which aims to identify children with active tuberculosis and to provide preventive therapy for those with HIV or those younger than 5 years, has long been recommended but has very poor coverage globally. New guidelines include widespread provision of preventive therapy to children with a positive tuberculin skin test (TST) who are older than 5 years.MethodsIn this mathematical modelling study, we provide the first global and national estimates of the impact of moving from zero to full coverage of household contact management (with and without preventive therapy for TST-positive children older than 5 years). We assembled data on tuberculosis notifications, household structure, household contact co-prevalence of tuberculosis disease and infection, the efficacy of preventive therapy, and the natural history of childhood tuberculosis. We used a model to estimate households visited, children screened, and treatment courses given for active and latent tuberculosis. We calculated the numbers of tuberculosis cases, deaths, and life-years lost because of tuberculosis for each intervention scenario and country.FindingsWe estimated that full implementation of household contact management would prevent 159 500 (75% uncertainty interval [UI] 147 000–170 900) cases of tuberculosis and 108 400 (75% UI 98 800–116 700) deaths in children younger than 15 years (representing the loss of 7 305 000 [75% UI 6 663 000–7 874 000] life-years). We estimated that preventing one child death from tuberculosis would require visiting 48 households, screening 77 children, giving 48 preventive therapy courses, and giving two tuberculosis treatments versus no household contact management.InterpretationHousehold contact management could substantially reduce childhood disease and death caused by tuberculosis globally. Funding and research to optimise its implementation should be prioritised.FundingUK Medical Research Council, US National Institutes of Health, Fulbright Commission, Janssen Global Public Health.
Highlights
Tuberculosis is the leading infectious cause of mortality worldwide, affecting an estimated 1 million children in 2016, of whom an estimated 253 000 died in 2016.1 Tuberculosis is a top ten cause of global under-5 mortality,[2] with most deaths each year occurring among the roughly half a million children who are never diagnosed or treated.[2,3] Younger children are more likely to develop severe forms of tuberculosis, such as tuberculous meningitis, that are often fatal or have long-term sequelae.[4]
One of the most effective ways of identifying children with both tuberculosis infection and disease is through household contact investigations, because children living in the homes of adults with tuberculosis are at high risk of both infection and disease.[5]
Assessing child household contacts can ensure that children with tuberculosis disease are diagnosed and treated early, and that children with tuberculosis infection or exposure are given preventive therapy to prevent them from becoming sick in the future
Summary
Tuberculosis is the leading infectious cause of mortality worldwide, affecting an estimated 1 million children in 2016, of whom an estimated 253 000 died in 2016.1 Tuberculosis is a top ten cause of global under-5 mortality,[2] with most deaths each year occurring among the roughly half a million children who are never diagnosed or treated.[2,3] Younger children are more likely to develop severe forms of tuberculosis, such as tuberculous meningitis, that are often fatal or have long-term sequelae (eg, neurological deficits).[4]. One of the most effective ways of identifying children with both tuberculosis infection and disease is through household contact investigations, because children living in the homes of adults with tuberculosis are at high risk of both infection and disease.[5] Systematically assessing child household contacts can ensure that children with tuberculosis disease are diagnosed and treated early, and that children with tuberculosis infection or exposure are given preventive therapy to prevent them from becoming sick in the future. Despite the fact that many national policies incorporate these recommendations,[8,9] major gaps exist in the implementation of household contact management (HCM).[10,11] Worldwide, only 13% of eligible children younger than 5 years are estimated to receive
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