PEDIATRICS Vol. 106 No. 1 July 2000, p. e1

ELECTRONIC ARTICLE:
Pediatric Tuberculosis: What Needs to be Done to Decrease Morbidity and Mortality

Received Aug 23, 1999; accepted Feb 2, 2000.

S. Jody Heymann^*, , Timothy F. Brewer^{, §}, Mary E. Wilson^*, , Graham A. Colditz^{, §}, and Harvey V. Fineberg

From ^* Harvard School of Public Health;  Harvard Medical School; ^§ Channing Laboratory, Brigham and Women's Hospital; and  Harvard University, Boston, Massachusetts.

Objective.  Tuberculosis (TB) control programs have been less successful among children than among adults in the United States. Between 1992 and 1997, the rate of decline of TB cases among 0- to 14-year-old children was less than the rate of decline among any other age group of US-born persons. Because of the higher prevalence of active TB among adults and their higher infectivity, most programs for TB in the United States have targeted adults. The inherent assumption has been that by targeting adults, from whom children may become infected, TB morbidity and mortality among children also will be reduced effectively.

Methods.  Using a semi-Markov model that divided the US population into age groups <15 years old and 15 years old and into 18 clinical states based on the risk for or presence of TB and human immunodeficiency virus infection, we developed a computer-based simulation model to examine the effect of a range of potential TB control strategies on projected TB cases and deaths in children. We compare the impact of interventions targeted at children with the impact of interventions targeted at adults on pediatric morbidity and mortality.

Results.  After 10 years, a 5% increase in the number of adults with TB who enter treatment would only lead to a .05% decline in TB cases among children, compared with predicted cases without this intervention. Improving treatment efficacy among those adults who are already receiving treatment for their TB leads to a smaller decline in cases among children of only .003%. In contrast, a 5% increase in the number of children who enter treatment leads to a 25% decline, after 10 years, in the number of TB cases among children and a 16% decline in the number of TB deaths. In the presence of immigration of tuberculin-positive children, the benefit of targeting programs directly at children is magnified.

Conclusions.  Marginal changes in programs targeted directly at children are significantly more effective at further reducing pediatric TB morbidity and mortality than the same changes in programs targeted at adults with the indirect goal of reducing spread to children. Marginal increases in the number of children who enter treatment are far more effective at decreasing morbidity and mortality than equivalent marginal increases in treatment effectiveness. Unfortunately, declining insurance coverage and increasing restrictions on services to immigrants have made it harder for those who are at greatest risk of TB to get medical care. Marginal increases in preventive therapy rates substantially reduce future pediatric TB cases and deaths among children with TB infection and human immunodeficiency virus.  Key words:  pediatric tuberculosis, tuberculosis control, tuberculosis prevention, computer simulation models.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. H. Rathore and A. Alvarez Is it Time to Revisit Short-Course Therapy for Latent TB Infection? AAP Grand Rounds, December 1, 2007; 18(6): 66 - 66. [Full Text] [PDF]