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Perez-Porcuna TM, Noguera-Julian A, Riera-Bosch MT, Macià-Rieradevall E, Santos-Santiago J, Rifà Pujol MÀ, Eril M, Aulet-Molist L, Padilla-Esteba E, Tórtola MT, Gómez i Prat J, Vilamala Bastarras A, Rebull-Fatsini JS, Papaleo A, Rius-Gordillo N, Gonçalves AQ, Naranjo-Orihuela À, Urgelles M, García-Lerín MG, Jimenez-Lladser G, Lorenzo-Pino B, Giuliano-Cuello MA, Pascual-Sánchez MT, Marco-García M, Abellana R, Espiau M, Altet-Gómez MN, Orcau-Palau A, Caylà JA, Soriano-Arandes A. Tuberculosis among children visiting friends & relatives. J Travel Med 2024; 31:taae037. [PMID: 38438137 PMCID: PMC11298048 DOI: 10.1093/jtm/taae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/15/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Most paediatric tuberculosis (TB) cases in low-TB-incidence countries involve children born to migrant families. This may be partially explained by trips to their countries of origin for visiting friends and relatives (VFR). We aimed to estimate the risk of latent TB infection (LTBI) and TB in children VFR. METHODS We conducted a prospective multicentric observational study in Catalonia (Spain) from June 2017 to December 2019. We enrolled children aged < 15 years with a negative tuberculin skin test (TST) at baseline and at least one parent from a high-TB-incidence country, and who had travelled to their parent's birth country for ≥21 days. TST and QuantiFERON-TB Gold Plus (QFT-Plus) were performed within 8-12 weeks post-return. LTBI was defined as a TST ≥5 mm and/or a positive QFT-Plus. RESULTS Five hundred children completed the study, equivalent to 78.2 person-years of follow-up (PYFU). Thirteen children (2.6%) were diagnosed with LTBI (16.6/per100 PYFU, 95%CI = 8.8-28.5), including two cases (0.4%) of TB (2.5/per100 PYFU, 95%CI = 0.3-9.3). LTBI incidence rates remained high after excluding BCG-vaccinated children (9.7/per100 PYFU, 95%CI = 3.9-20.0). Household tobacco smoke exposure was associated with LTBI (aOR = 3.9, 95%CI = 1.1-13.3). CONCLUSIONS The risk of LTBI in children VFR in high-TB-incidence countries may equal, or perhaps even exceed, the infection risk of the native population. The primary associated risk factor was the presence of smokers in the household. Furthermore, the incidence rate of active TB largely surpassed that of the countries visited. Children VFR in high-TB-incidence countries should be targeted for diagnostic and preventive interventions.
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Affiliation(s)
- Tomas M Perez-Porcuna
- TB Pediatric Unit, Research Foundation of Primary Health and Mútua Terassa University Hospital, Mútua Terrassa, Terrassa, Catalunya 08221, Spain
| | - Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Servei de Malalties Infeccioses, Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona 08950, Spain
| | | | | | - José Santos-Santiago
- Salut International i Malalties Transmisibles Drassanes, Institut Català de la Salut, Barcelona 08001, Spain
| | | | - Maria Eril
- EAP La Vall del Ges, Institut Català de la Salut, Barcelona 08007, Spain
| | | | | | - Maria Teresa Tórtola
- Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona 08035, Barcelona
| | - Jordi Gómez i Prat
- Public Health and Community Team (eSPiC), Unit of Tropical Medicine and International Health Drassanes-Vall d'Hebron (UTMIHD-VH), PROSICS, Barcelona 08028, Spain
| | - Anna Vilamala Bastarras
- Hospital Universitari de Vic, Multidisciplinary Inflammation Research group (MIRG), Barcelona 08500, Spain
| | | | - Andrea Papaleo
- CAP Magoria, Institut Català de la Salut, Barcelona 08014, Spain
| | - Neus Rius-Gordillo
- Servei de Pediatria, Hospital Universitari Sant Joan de Reus, Reus 43204, Spain
| | - Alessandra Q Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa 08007, Spain
| | | | - Marta Urgelles
- CAP Terrassa Sud, Fundació Assistencial Mútua Terrassa, Terrassa 08221, Spain
| | | | | | - Beatriz Lorenzo-Pino
- CAP Rubí Mútua Terrassa, Fundació Assistencial Mútua Terrassa, Terrassa 08221, Spain
| | | | | | | | - Rosa Abellana
- Departament de Fonaments Clínics. Unitat de Bioestadística. Universitat de Barcelona, Barcelona 08007, Spain
| | - Maria Espiau
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Children's Hospital Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia 08035, Spain
| | | | | | - Joan A Caylà
- Barcelona Tuberculosis Research Unit Foundation, Barcelona 08036, Spain
| | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Children's Hospital Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia 08035, Spain
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Li C, Wang S, Yu H, Wang J, Deng J, Wang H, Hua C, Zhuo Z, Chen L, Hao J, Gao W, Zhang H, Zhang T, Xu H, Wang C. Research of childhood tuberculosis in suspected populations by molecular methods: A multicenter study in China. Front Cell Infect Microbiol 2022; 12:1018699. [PMID: 36339333 PMCID: PMC9626968 DOI: 10.3389/fcimb.2022.1018699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/27/2022] [Indexed: 10/16/2023] Open
Abstract
The research of childhood tuberculosis is inadequate in china. The cross-priming amplification (CPA) of specific DNA in clinical samples is increasingly adopted for the diagnosis of childhood tuberculosis. In this study, a multicenter research was performed to investigate the incidence and characteristics of childhood tuberculosis in suspected populations mainly by CPA method. 851 children suspected of tuberculosis were enrolled in seven centers across China. All samples were tested by a CPA method and 159 subjects were tested by Xpert MTB/RIF and liquid culture method in parallel to assess the reliability of the CPA method. A positive result in any one of the three methods provided a definitive diagnosis of Mycobacterium tuberculosis complex (MTBC) infection. The MTBC-positive rate was 9.5% (81/851) by the combined methods; 93.8% of the cases were detected by CPA technology (76/81). The rate of pulmonary infection was significantly higher than that of extrapulmonary infection (7.1%, 60/851 vs 2.5%, 21/851; P < 0.001). Scrofula was the predominant type of extrapulmonary tuberculosis. The MTBC positive rates in 12-18-year-old group (middle school), was 28.4% (23/81), higher than in those under-six-year-old (preschool; 39/525) and the 6~11-year-old (primary school; 18/235) groups combined (P < 0.001). The MTBC positive rate in patients with a clear history of tuberculosis exposure was significantly higher than in cases in which there was no history of tuberculosis contact(35.3%, 18/51 vs 7.8%, 61/782; P < 0.001). In conclusion, this multicenter investigation showed that pulmonary tuberculosis and extrapulmonary tuberculosis are not uncommon in children in China, with teenagers being particularly susceptible to infection. The incidence of pulmonary tuberculosis in children is higher than that of extrapulmonary tuberculosis. History of exposure to tuberculosis is a high risk factor for childhood tuberculosis.
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Affiliation(s)
- Chunling Li
- Clinical Microbiology Laboratory, Children’s Hospital of Fudan University, Children’s National Medical Center, Shanghai, China
| | - Shifu Wang
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Children’s Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Hui Yu
- Division of Infectious Diseases, Children’s Hospital of Fudan University, Children’s National Medical Center, Shanghai, China
| | - Jiangxia Wang
- Department of Infection Diseases Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jikui Deng
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Hongmei Wang
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Chunzhen Hua
- Division of Infectious Diseases, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Zhiqiang Zhuo
- Department of Infectious Diseases, Xiamen Children’s Hospital (Children’s Hospital of Fudan University Xiamen Branch), Xiamen, Fujian Province, China
| | - Lei Chen
- Department of Medical Laboratory Diagnosis Center, Xiamen Children’s Hospital (Children's Hospital of Fudan University Xiamen Branch), Xiamen, Fujian Province, China
| | - Jianhua Hao
- Department of Medical Laboratory Diagnosis Center, Children’s Hospital of Kaifeng City, Kaifeng, Henan Province, China
| | - Wei Gao
- Department of Infectious Diseases, Children’s Hospital of Kaifeng City, Kaifeng, Henan Province, China
| | - Hong Zhang
- Department of Medical Laboratory Diagnosis Center, Children’s Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting Zhang
- Institue of Pediatric Infection, Immunity and Critical Care Medicine, Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongmei Xu
- Department of Infection Diseases Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chuanqing Wang
- Clinical Microbiology Laboratory, Children’s Hospital of Fudan University, Children’s National Medical Center, Shanghai, China
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