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Abstract

Background

Confirming tuberculosis (TB) in children and obtaining information on drug susceptibility is essential to ensure adequate treatment. We assessed whether there are gaps in diagnosis and treatment of multidrug-resistant (MDR) TB in children in the European Union and European Economic Area (EU/EEA), quantified the burden of MDR TB in children and characterised cases. : We analysed surveillance data from 2007 to 2015 for paediatric cases younger than 15 years. : In that period, 26 EU/EEA countries reported 18,826 paediatric TB cases of whom 4,129 (21.9%) were laboratory-confirmed. Drug susceptibility testing results were available for 3,378 (17.9%), representing 81.8% of the confirmed cases. The majority (n = 2,967; 87.8%) had drug-sensitive TB, 249 (7.4%) mono-resistant TB, 64 (1.9%) poly-resistant TB, 90 (2.7%) MDR TB and eight (0.2%) had extensively drug-resistant (XDR) TB. MDR TB was more frequently reported among paediatric cases with foreign background (adjusted odds ratio (aOR) = 1.73; 95% confidence interval (95% CI): 1.12–2.67) or previous TB treatment (aOR: 6.42; 95% CI: 3.24–12.75). Successful treatment outcome was reported for 58 of 74 paediatric MDR TB cases with outcome reported from 2007 to 2013; only the group of 5–9 years-olds was significantly associated with unsuccessful treatment outcome (crude odds ratio (cOR) = 11.45; 95% CI: 1.24–106.04). : The burden of MDR TB in children in the EU/EEA appears low, but may be underestimated owing to challenges in laboratory confirmation. Diagnostic improvements are needed for early detection and adequate treatment of MDR TB. Children previously treated for TB or of foreign origin may warrant higher attention.

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/content/10.2807/1560-7917.ES.2017.22.47.17-00103
2017-11-23
2017-12-11
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2017.22.47.17-00103
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References

  1. World Health Organization (WHO). The end TB strategy: Global strategy and targets for tuberculosis prevention, care and control after 2015. Geneva: WHO; 2014. Available from: http://www.who.int/tb/strategy/End_TB_Strategy.pdf?ua=1
  2. World Health Organization (WHO). Global tuberculosis report 2016. Geneva: WHO; 2016. Available from: http://apps.who.int/iris/bitstream/10665/250441/1/9789241565394-eng.pdf?ua=1
  3. Dodd PJ, Sismanidis C, Seddon JA. Global burden of drug-resistant tuberculosis in children: a mathematical modelling study. Lancet Infect Dis. 2016;16(10):1193-201.  https://doi.org/10.1016/S1473-3099(16)30132-3  PMID: 27342768 
  4. European Centre for Disease prevention and Control (ECDC)/World Health Organization Regional Office for Europe (WHO/Europe). Tuberculosis surveillance and monitoring in Europe 2017. Stockholm: ECDC; 2017. Available from: https://ecdc.europa.eu/sites/portal/files/documents/ecdc-tuberculosis-surveillance-monitoring-Europe-2017-WEB.pdf
  5. Cuevas LE, Browning R, Bossuyt P, Casenghi M, Cotton MF, Cruz AT, et al. Evaluation of tuberculosis diagnostics in children: 2. Methodological issues for conducting and reporting research evaluations of tuberculosis diagnostics for intrathoracic tuberculosis in children. Consensus from an expert panel. J Infect Dis. 2012;205(Suppl 2):S209-15.  https://doi.org/10.1093/infdis/jir879  PMID: 22476719 
  6. Dunn JJ, Starke JR, Revell PA. Laboratory Diagnosis of Mycobacterium tuberculosis Infection and Disease in Children. J Clin Microbiol. 2016;54(6):1434-41.  https://doi.org/10.1128/JCM.03043-15  PMID: 26984977 
  7. Jenkins HE, Tolman AW, Yuen CM, Parr JB, Keshavjee S, Pérez-Vélez CM, et al. Incidence of multidrug-resistant tuberculosis disease in children: systematic review and global estimates. Lancet. 2014;383(9928):1572-9.  https://doi.org/10.1016/S0140-6736(14)60195-1  PMID: 24671080 
  8. Chiang SS, Swanson DS, Starke JR. New Diagnostics for Childhood Tuberculosis. Infect Dis Clin North Am. 2015;29(3):477-502.  https://doi.org/10.1016/j.idc.2015.05.011  PMID: 26188605 
  9. Lopez Avalos GG, Prado Montes de Oca E. Classic and new diagnostic approaches to childhood tuberculosis. J Trop Med. 2012;2012:818219.
  10. Clinical and Laboratory Standards Institute (CLSI). Laboratory detection and identification of mycobacteria. 1st ed. CLSI document M48-A. Wayne, PA: CLSI; 2008.
  11. Horsburgh CR Jr, Barry CE 3rd, Lange C. Treatment of Tuberculosis. N Engl J Med. 2015;373(22):2149-60.  https://doi.org/10.1056/NEJMra1413919  PMID: 26605929 
  12. World Health Organization (WHO). Treatment of tuberculosis. Guidelines. 4th ed. Geneva: WHO; 2010. Available from: http://apps.who.int/iris/bitstream/10665/44165/1/9789241547833_eng.pdf?ua=1&ua=1
  13. World Health Organization (WHO). Guidance for national tuberculosis programmes on the management of tuberculosis in children. 2nd ed. Geneva: WHO; 2014. Available from: http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf?ua=1
  14. Piccini P, Chiappini E, Tortoli E, de Martino M, Galli L. Clinical peculiarities of tuberculosis. BMC Infect Dis. 2014;14(Suppl 1):S4.  https://doi.org/10.1186/1471-2334-14-S1-S4  PMID: 24564419 
  15. Morris SK, Demers AM, Lam R, Pell LG, Giroux RJ, Kitai I. Epidemiology and clinical management of tuberculosis in children in Canada. Paediatr Child Health. 2015;20(2):83-8.  https://doi.org/10.1093/pch/20.2.83  PMID: 25838781 
  16. Yuen CM, Rodriguez CA, Keshavjee S, Becerra MC. Map the gap: missing children with drug-resistant tuberculosis. Public Health Action. 2015;5(1):45-58.  https://doi.org/10.5588/pha.14.0100  PMID: 26400601 
  17. Mukherjee JS, Joseph JK, Rich ML, Shin SS, Furin JJ, Seung KJ, et al. Clinical and programmatic considerations in the treatment of MDR-TB in children: a series of 16 patients from Lima, Peru. Int J Tuberc Lung Dis. 2003;7(7):637-44. PMID: 12870684 
  18. Padayatchi N, Bamber S, Dawood H, Bobat R. Multidrug-resistant tuberculous meningitis in children in Durban, South Africa. Pediatr Infect Dis J. 2006;25(2):147-50.  https://doi.org/10.1097/01.inf.0000199314.88063.4c  PMID: 16462292 
  19. Seddon JA, Donald PR, Vlok GJ, Schaaf HS. Multidrug-resistant tuberculosis of the spine in children--characteristics from a high burden setting. J Trop Pediatr. 2012;58(5):341-7.  https://doi.org/10.1093/tropej/fmr104  PMID: 22170512 
  20. Shah I. Multidrug-resistant tuberculosis in children from 2003 to 2005: a brief report. Indian J Med Microbiol. 2012;30(2):208-11.  https://doi.org/10.4103/0255-0857.96694  PMID: 22664439 
  21. Mignone F, Codecasa LR, Scolfaro C, Raffaldi I, Lancella L, Ferrarese M, et al. The spread of drug-resistant tuberculosis in children: an Italian case series. Epidemiol Infect. 2014;142(10):2049-56.  https://doi.org/10.1017/S0950268813003191  PMID: 24480079 
  22. Achar J, Berry C, Herboczek K, Parpieva N, Tillyashaykhov MN, Tigay ZN, et al. Multidrug-Resistant Tuberculosis in Child Successfully Treated with 9-Month Drug Regimen. Emerg Infect Dis. 2015;21(11):2105-6.  https://doi.org/10.3201/eid2111.151119  PMID: 26488556 
  23. European Commission. Commission Implementing Decision of 8 August 2012 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. Luxembourg: Publications Office of the European Union. Official Journal. L262 2012. Available from: http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=OJ%3AL%3A2012%3A262%3ATOC
  24. Abubakar I, Laundy MT, French CE, Shingadia D. Epidemiology and treatment outcome of childhood tuberculosis in England and Wales: 1999-2006. Arch Dis Child. 2008;93(12):1017-21.  https://doi.org/10.1136/adc.2008.139543  PMID: 18562450 
  25. Pang J, Teeter LD, Katz DJ, Davidow AL, Miranda W, Wall K, et al. Epidemiology of tuberculosis in young children in the United States. Pediatrics. 2014;133(3):e494-504.  https://doi.org/10.1542/peds.2013-2570  PMID: 24515517 
  26. Menzies HJ, Winston CA, Holtz TH, Cain KP, Mac Kenzie WR. Epidemiology of tuberculosis among US- and foreign-born children and adolescents in the United States, 1994-2007. Am J Public Health. 2010;100(9):1724-9.  https://doi.org/10.2105/AJPH.2009.181289  PMID: 20634457 
  27. Teo SS, Tay EL, Douglas P, Krause VL, Graham SM. The epidemiology of tuberculosis in children in Australia, 2003-2012. Med J Aust. 2015;203(11):440.  https://doi.org/10.5694/mja15.00717  PMID: 26654612 
  28. Ritz N, Curtis N. Novel concepts in the epidemiology, diagnosis and prevention of childhood tuberculosis. Swiss Med Wkly. 2014;144:w14000. PMID: 25207918 
  29. Faddoul D. Childhood tuberculosis: an overview. Adv Pediatr. 2015;62(1):59-90.  https://doi.org/10.1016/j.yapd.2015.04.001  PMID: 26205109 
  30. Hamzaoui A, Yaalaoui S, Tritar Cherif F, Slim Saidi L, Berraies A. Childhood tuberculosis: a concern of the modern world. Eur Respir Rev. 2014;23(133):278-91.  https://doi.org/10.1183/09059180.00005314  PMID: 25176964 
  31. Maltezou HC, Spyridis P, Kafetzis DA. Extra-pulmonary tuberculosis in children. Arch Dis Child. 2000;83(4):342-6.  https://doi.org/10.1136/adc.83.4.342  PMID: 10999874 
  32. Zumla A, Raviglione M, Hafner R, von Reyn CF. Tuberculosis. N Engl J Med. 2013;368(8):745-55.  https://doi.org/10.1056/NEJMra1200894  PMID: 23425167 
  33. World Health Organization (WHO). Roadmap for childhood tuberculosis. Geneva: WHO; 2013. Available from: http://apps.who.int/iris/bitstream/10665/89506/1/9789241506137_eng.pdf
  34. Shah NS, Yuen CM, Heo M, Tolman AW, Becerra MC. Yield of contact investigations in households of patients with drug-resistant tuberculosis: systematic review and meta-analysis. Clin Infect Dis. 2014;58(3):381-91.  https://doi.org/10.1093/cid/cit643  PMID: 24065336 
  35. Seddon JA, Hesseling AC, Willemse M, Donald PR, Schaaf HS. Culture-confirmed multidrug-resistant tuberculosis in children: clinical features, treatment, and outcome. Clin Infect Dis. 2012;54(2):157-66.  https://doi.org/10.1093/cid/cir772  PMID: 22052896 
  36. Seddon JA, Hesseling AC, Godfrey-Faussett P, Schaaf HS. High treatment success in children treated for multidrug-resistant tuberculosis: an observational cohort study. Thorax. 2014;69(5):458-64.  https://doi.org/10.1136/thoraxjnl-2013-203900  PMID: 24064441 
  37. Mor Z, Cedar N, Pinsker G, Bibi H, Grotto I. Childhood tuberculosis in Israel: epidemiological trends and treatment outcomes, 1999-2010. Eur Respir J. 2013;41(5):1157-62.  https://doi.org/10.1183/09031936.00033912  PMID: 23018912 
  38. Frydenberg AR, Graham SM. Toxicity of first-line drugs for treatment of tuberculosis in children: review. Trop Med Int Health. 2009;14(11):1329-37.  https://doi.org/10.1111/j.1365-3156.2009.02375.x  PMID: 19735381 
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