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Objectives
Overview global epidemiology Review available surveillance data
and epidemiologic studies Review TB and HIV association Assess data limitations Provide recommendations for future data collection and research
Background
Tuberculosis (TB) is increasing
among adults in many areas TB is major cause of childhood morbidity and mortality worldwide Limited information on epidemiology of TB in children
Childhood TB
Why neglected?
Not considered important in global program or contributing to immediate transmission Not regarded as public health risk Difficult to diagnose
Why is it important?
Health problem in children May later contribute to epidemic
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TB in Children
WHO estimate of TB in children
1.3 million annual cases 450,000 deaths 15% of TB in low-income countries children vs. 6% in United States
700
Male Female
Effect of HIV?
45-49
Host factors
Effect of HIV?
Tuberculous Infection Among Children by Type of Contact and Bacteriologic Status of Index Case, British Columbia and Saskatchewan, 1966-1971
40 35 30
Close
Percent infected
25 20 15 10 5 0 Smear +
Casual
Smear -
Close Casual
Childhood TB in Malawi
Retrospective study of 43 hospitals using
National TB Data from 1998 2739 cases in children (11.9%) 1.3% smear-positive, 21.3% smearnegative, 15.9% extrapulmonary Poor outcomes 45% completed treatment 17% died 13% default 21% unknown
Harries AD et al.
Extrapulmonary TB in Children
Efficacy for adult pulmonary TB 080% in randomized clinical trials Best efficacy against serious childhood disease
400 400
200 200
0.1
0.2
0.3
0.4
Treatment questions
Difficult to evaluate true cure Recommended same length of treatment as
adults
Conclusions
Data on trends in childhood TB are
limited Consensus needed on common definitions Few epidemiologic studies in children worldwide Additional studies are needed Childhood TB needs to become a priority