Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study
Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study
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DOI：
10.1016/s2214-109x(14)70245-1
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发表时间：
2014-08-01
影响因子：
34.3
通讯作者：
Seddon, James A.
中科院分区：
文献类型：
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作者：
Dodd, Peter J.;Gardiner, Elizabeth;Seddon, James A.
背景：确认儿童（年龄< 15岁）的结核病诊断具有挑战性；即使儿童到卫生服务机构就诊，也可能出现漏报现象。无法获得直接的发病率估计，世卫组织的估计基于儿科通报，并对监测不完全进行了调整，与成人通报的因素相同。我们的目的是估计22个疾病高负担国家的儿童感染和疾病发生率、感染流行率和家庭暴露情况。方法在一个机械数学模型中，我们将2010年成人结核病患病率的估计值与儿科结核病的自然史相结合。在家庭模型中，我们估计了家庭暴露和感染。我们考虑了年龄、卡介苗接种和HIV感染的影响。此外，我们通过重复所有的分析来测试对关键结构假设的敏感性，而BCG的效力没有随纬度的变化。结果2010年估计与传染性结核病患者同住一个家庭的儿童中位数为15 319 701 （IQR 13 766 297-17 061 821）。2010年，儿童结核分枝杆菌感染中位数为7 591 759例（5 800 053-9 969 780），650 977名儿童（424 871-983 118）发病。累积暴露意味着2010年潜伏感染儿童的中位数为53 234 854（41 111 669-68 959 804）。该模型表明，在2010年按年龄报告结核病通报的15个国家中，35%（23- 54%）的儿科结核病病例得到了检测。预计印度将占这22个国家儿童结核病总负担的27%（22- 33%）。每个国家儿童结核病负担的预测比例与发病率相关，在4%至21%之间变化。我们的模型表明，儿童结核病的发病率高于通报的数量，特别是在幼儿中。对目前家庭接触和累积感染的估计表明，预防性治疗的机会巨大。
Background Confirmation of a diagnosis of tuberculosis in children (aged < 15 years) is challenging; under-reporting can result even when children do present to health services. Direct incidence estimates are unavailable, and WHO estimates build on paediatric notifications, with adjustment for incomplete surveillance by the same factor as adult notifications. We aimed to estimate the incidence of infection and disease in children, the prevalence of infection, and household exposure in the 22 countries with a high burden of the disease.Methods Within a mechanistic mathematical model, we combined estimates of adult tuberculosis prevalence in 2010, with aspects of the natural history of paediatric tuberculosis. In a household model, we estimated household exposure and infection. We accounted for the effects of age, BCG vaccination, and HIV infection. Additionally, we tested sensitivity to key structural assumptions by repeating all analyses without variation in BCG efficacy by latitude.Findings The median number of children estimated to be sharing a household with an individual with infectious tuberculosis in 2010 was 15 319 701 (IQR 13 766 297-17 061 821). In 2010, the median number of Mycobacterium tuberculosis infections in children was 7 591 759 (5 800 053-9 969 780), and 650 977 children (424 871-983 118) developed disease. Cumulative exposure meant that the median number of children with latent infection in 2010 was 53 234 854 (41 111 669-68 959 804). The model suggests that 35% (23-54) of paediatric cases of tuberculosis in the 15 countries reporting notifi cations by age in 2010 were detected. India is predicted to account for 27% (22-33) of the total burden of paediatric tuberculosis in the 22 countries. The predicted proportion of tuberculosis burden in children for each country correlated with incidence, varying between 4% and 21%.Interpretation Our model has shown that the incidence of paediatric tuberculosis is higher than the number of notifi cations, particularly in young children. Estimates of current household exposure and cumulative infection suggest an enormous opportunity for preventive treatment.