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Morris SK, Giroux RJP, Consunji-Araneta R, Stewart K, Baikie M, Kakkar F, Zielinski D, Tse-Chang A, Cook VJ, Fisher DA, Salvadori MI, Pernica JM, Sauve LJ, Hui C, Miners A, Alvarez GG, Al-Azem A, Gallant V, Grueger B, Lam R, Langley JM, Radziminski N, Rea E, Wong S, Kitai I. Epidemiology, clinical features and outcomes of incident tuberculosis in children in Canada in 2013-2016: results of a national surveillance study. Arch Dis Child 2021; 106:1165-1170. [PMID: 34417191 DOI: 10.1136/archdischild-2021-322092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/05/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Childhood tuberculosis disease is difficult to diagnose and manage and is an under-recognised cause of morbidity and mortality. Reported data from Canada do not focus on childhood tuberculosis or capture key epidemiologic, clinical and microbiologic details. The purpose of this study was to assess demographics, presentation and clinical features of childhood tuberculosis in Canada. METHODS We conducted prospective surveillance from 2013 to 2016 of over 2700 paediatricians plus vertical tuberculosis programmes for incident tuberculosis disease in children younger than 15 years in Canada using the Canadian Paediatric Surveillance Program (CPSP). RESULTS In total, 200 cases are included in this study. Tuberculosis was intrathoracic in 183 patients of whom 86% had exclusively intrathoracic involvement. Central nervous system tuberculosis occurred in 16 cases (8%). Fifty-one per cent of cases were hospitalised and 11 (5.5%) admitted to an intensive care unit. Adverse drug reactions were reported in 9% of cases. The source case, most often a first-degree relative, was known in 73% of cases. Fifty-eight per cent of reported cases were Canadian-born Indigenous children. Estimated study rates of reported cases (per 100 000 children per year) were 1.2 overall, 8.6 for all Indigenous children and 54.3 for Inuit children. CONCLUSION Childhood tuberculosis may cause significant morbidity and resource utilisation. Key geographies and groups have very high incidence rates. Elimination of childhood tuberculosis in Canada will require well-resourced community-based efforts that focus on these highest risk groups.
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Affiliation(s)
- Shaun K Morris
- Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada .,University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ryan J P Giroux
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Kristoffor Stewart
- Saskatchewan Infectious Disease Care Network, Saskatoon, Saskatchewan, Canada
| | | | - Fatima Kakkar
- Pediatric Infectious Diseases, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - David Zielinski
- Division of Respiratory Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alena Tse-Chang
- University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Victoria J Cook
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Marina I Salvadori
- London Health Sciences Centre Children's Hospital, London, Ontario, Canada.,Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jeffrey M Pernica
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Laura J Sauve
- The University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Charles Hui
- Childrens Hosp Eastern Ontario, Ottawa, Ontario, Canada
| | - Amber Miners
- Qikiqtani General Hospital, Iqaluit, Nunavut, Canada
| | - Gonzalo G Alvarez
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Assaad Al-Azem
- Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada.,University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Ray Lam
- Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Joanne M Langley
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Nicole Radziminski
- Stanton Territorial Hospital, Yellowknife, Northwest Territories, Canada
| | | | - Sam Wong
- University of Alberta, Edmonton, Alberta, Canada.,Stanton Territorial Hospital, Yellowknife, Northwest Territories, Canada
| | - Ian Kitai
- Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Kobayashi S, Yoshiyama T, Uchimura K, Hamaguchi Y, Kato S. Epidemiology of childhood tuberculosis after ceasing universal Bacillus Calmette-Guérin vaccination. Sci Rep 2021; 11:15902. [PMID: 34354146 PMCID: PMC8342465 DOI: 10.1038/s41598-021-95294-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 07/21/2021] [Indexed: 11/18/2022] Open
Abstract
Universal Bacillus Calmette-Guérin (BCG) vaccination is recommended in countries with high tuberculosis (TB) burden. Nevertheless, several countries have ceased universal BCG vaccination over the past 40 years, with scarce comparative epidemiological analyses regarding childhood TB after the policy change. We analysed data on childhood TB in countries that ceased universal BCG vaccination. Data sources included national/international databases, published papers, annual TB reports, and public health authority websites. Childhood TB notification rate increased in one of seven countries with available data. Pulmonary TB and TB lymphadenitis were the main causes of increasing childhood cases, while changes in severe forms of TB cases were minor. Maintaining high vaccine coverage for the target group was a common challenge after shifting selective vaccination. In some countries showing no increase in childhood TB after a BCG policy change, the majority of childhood TB cases were patients from abroad or those with overseas parents; these countries had changed immigration policies during the same period. Heterogeneity in childhood TB epidemiology was observed after ceasing universal BCG vaccination; several factors might obscure the influence of vaccination policy change. Lessons learned from these countries may aid in the development of better BCG vaccination strategies.
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Affiliation(s)
- Sayori Kobayashi
- The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA), 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan.
| | - Takashi Yoshiyama
- The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA), 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Kazuhiro Uchimura
- The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA), 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Yuko Hamaguchi
- The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA), 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Seiya Kato
- The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA), 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
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Fritschi N, Schmidt AJ, Hammer J, Ritz N. Pediatric Tuberculosis Disease during Years of High Refugee Arrivals: A 6-Year National Prospective Surveillance Study. RESPIRATION; INTERNATIONAL REVIEW OF THORACIC DISEASES 2021; 100:1050-1059. [PMID: 34325426 DOI: 10.1159/000517029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In Europe, surveillance and monitoring of pediatric tuberculosis (TB) remains important, particularly in the light of migration in recent years. The aim of the study was to evaluate incidence rates of childhood TB and detailed diagnostic pathways and treatment. METHODS Data were collected through the Swiss Pediatric Surveillance Unit (SPSU) from December 2013 to November 2019. Monthly -notifications are obtained from the 33 pediatric hospitals in the SPSU, and a detailed questionnaire was sent out upon notification. Inclusion criteria were children and adolescents aged up to 15 years with culture- or molecular-confirmed TB disease or for whom a treatment with ≥3 antimycobacterial drugs had been initiated. Data were compared with age-matched notification data from the Swiss Federal Office of Public Health (FOPH). RESULTS Of the 172 cases notified to SPSU, a detailed questionnaire was returned for 161 (93%) children, of which 139 met the inclusion criteria. Reasons for exclusion were age >15 years, double reporting, and not fulfilling the criteria for TB disease. During the same time period, 172 pediatric TB cases were reported to the FOPH, resulting in an incidence of 2.1 per 100,000, ranging from 1.4 to 2.8 per year, without a clear trend over time. In the 64 (46.0%) foreign-born children, incidence rates were higher and peaked in 2016, with 13.7 per 100,000 (p = 0.018). The median interval between arrival in Switzerland and TB diagnosis was 5 (IQR 1-21) months, and 80% were diagnosed within 24 months of arrival. In 58% of the cases, TB disease was confirmed by culture or molecular assays. Age >10 years, presence of fever, or weight loss were independent factors associated with confirmed TB. CONCLUSION The annual pediatric TB incidence rate only varied among foreign-born children and was highest in 2016 when refugee influx peaked in Europe. Importantly, most foreign-born children with TB were diagnosed within 2 years after arrival in Switzerland. Thus, the early period after arrival in Switzerland is associated with a higher risk of TB disease in children, and this should be considered for screening guidance in refugees.
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Affiliation(s)
- Nora Fritschi
- Department of Clinical Research, Mycobacterial and Migrant Health Research Group, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Axel J Schmidt
- Infectious Diseases Division, Swiss Federal Office of Public Health, Bern, Switzerland
| | - Jürg Hammer
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicole Ritz
- Department of Clinical Research, Mycobacterial and Migrant Health Research Group, University Children's Hospital Basel, University of Basel, Basel, Switzerland.,Infectious Disease and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Parkville, Victoria, Australia
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Kontturi A, Kekomäki S, Soini H, Ollgren J, Salo E. Paediatric tuberculosis during universal and selective Bacillus Calmette-Guérin vaccination policy: a nationwide population-based retrospective study, Finland, 1995-2015. ACTA ACUST UNITED AC 2021; 26. [PMID: 33739257 PMCID: PMC7976386 DOI: 10.2807/1560-7917.es.2021.26.11.1900711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction In 2006, the Bacillus Calmette–Guérin (BCG) vaccination policy in Finland changed from universal to selective. Aim We assessed the impact of the policy change on tuberculosis (TB) morbidity in children under 5 years and epidemiological trends of paediatric TB in Finland. Methods We conducted a nationwide, population-based, retrospective registry study of all newly diagnosed active TB cases younger than 15 years in Finland from 1995 to 2015 by linking data from the National Infectious Diseases Register, Finnish Care Register for Health Care, medical patient records and Finnish Population Information System. We compared the TB incidence rate ratio of under 5 year-olds with universal and selective BCG vaccinations with a Poisson log-linear model and analysed incidence trends among those younger than 15 years with a negative binomial model. Results We identified 139 paediatric TB cases: 50 native (including 24 second-generation migrants) and 89 foreign-born children. The TB rate of under 5 year-olds remained stable after changing to selective BCG vaccination (incidence rate ratio (IRR): 1.3; 95% confidence interval (CI): 0.7–2.3). TB rate in the native population under 15 years increased slightly (IRR = 1.06; 95% CI: 1.01–1.11). Discussion Paediatric TB cases in Finland were concentrated in families with migrant background from high-TB incidence countries. The native TB morbidity in under 5-year-olds did not increase after the BCG policy revision, suggesting that selective vaccinations can prevent TB in the most vulnerable age group in low-incidence settings. Second-generation migrants under 15 years in Finland with high TB risk are probably increasing.
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Affiliation(s)
- Antti Kontturi
- Doctoral Programme in Population Health, University of Helsinki, Helsinki, Finland
| | - Satu Kekomäki
- Department of Pediatrics, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Soini
- Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
| | - Eeva Salo
- Department of Pediatrics, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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