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Tuberculosis in Children Exposed at Home to Multidrug-resistant Tuberculosis

Becerra, Mercedes C. ScD*†‡; Franke, Molly F. ScD*†; Appleton, Sasha C. ScM*†; Joseph, J. Keith MD*†‡; Bayona, Jaime MD*†; Atwood, Sidney S. BA; Mitnick, Carole D. ScD*†‡

Pediatric Infectious Disease Journal: February 2013 - Volume 32 - Issue 2 - p 115–119
doi: 10.1097/INF.0b013e31826f6063
Original Studies

Background: The tuberculosis burden in children exposed at home to multidrug-resistant tuberculosis (MDR-TB) is unquantified. With limited access to MDR-TB treatment, likely millions of children share the experience of chronic exposure to an infectious patient.

Methods: We conducted a retrospective cohort study of child and adult household contacts of patients treated for MDR-TB in Lima, Peru, in 1996 to 2003. The primary outcome was TB disease. We estimated prevalence of TB disease when the index case began MDR-TB treatment and incidence of TB disease over the subsequent 4 years.

Results: Among 1299 child contacts, 67 were treated for TB. TB prevalence was 1771 (confidence interval [CI]: 1052–2489) per 100,000 children. In 4362 child-years of follow-up, TB incidence rates per 100,000 child-years were: 2079 (CI: 1302–2855) in year 1; 315 (CI: 6–624) in year 2; 634 (CI: 195–1072) in year 3; and 530 (CI: 66–994) in year 4. TB disease rates in children aged >1 year were not significantly different from those observed in adults. Children accounted for 20% of TB cases. Seven (87.5%) of 8 children tested had MDR-TB. Child contacts had TB disease rates approximately 30 times higher than children in the general population.

Conclusions: Children were at high risk for TB disease when the index case started MDR-TB treatment and during the following year. These results highlight the need for implementing contact investigations and establishing systems for prompt referral and treatment of pediatric household contacts of MDR-TB patients, regardless of the age of the child.

From the *Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Partners In Health, Boston, MA and Lima, Peru; and Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA.

Accepted for publication August 15, 2012.

MCB, SCA, JB and CDM designed the study. MCB, SCA, MFF, JKJ and CDM participated in data collection. MCB, MFF and SSA performed the data analysis. All authors participated in data interpretation. MCB wrote the manuscript draft, had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors participated in manuscript revisions.

The authors are grateful for financial support for this study from: the Charles H. Hood Foundation, the David Rockefeller Center for Latin American Studies at Harvard University, and Thomas J. White. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have no other funding or conflicts of interest to disclose.

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Address for correspondence: Mercedes C. Becerra, ScD, Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.