Tuberculin skin test conversion and primary progressive tuberculosis disease in the first 5 years of life: a birth cohort study from Cape Town, South Africa
Tuberculin skin test conversion and primary progressive tuberculosis disease in the first 5 years of life: a birth cohort study from Cape Town, South Africa
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DOI：
10.1016/s2352-4642(17)30149-9
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发表时间：
2018-01-01
影响因子：
36.4
通讯作者：
Zar, Heather J.
中科院分区：
文献类型：
--
作者：
Martinez, Leonardo;le Roux, David M.;Zar, Heather J.
背景结核病是全球儿童死亡的主要原因。然而，婴儿期结核病的流行病学和负担还不清楚。我们的目的是调查结核菌素皮试转换和结核病的Drakenstein儿童健康研究，南非出生队列在社区中，结核病的发病率是hyperendemic.Methods在这个前瞻性的出生队列研究中，我们招募了孕妇年龄大于18岁之间的20和28周的妊娠，谁参加产前保健在城郊，贫困的南非设置。我们对他们的孩子从出生到2017年4月1日或5岁进行了肺结核随访。所有儿童在出生时都接种了卡介苗。在6、12、24、36、48和60个月大的儿童以及下呼吸道感染时进行了皮肤试验。10 mm或以上的硬结反应被认为是结核菌素皮肤试验的转换。结果在915对母子（201 [22%] HIV阳性母亲和2 [< 1%] HIV阳性儿童）中，147（16%）名儿童结核菌素皮肤试验转换，随着年龄的增长累积风险增加（0 . 05 ± 0. 05）。6个月时，0 . 12个月时17例，0例。24个月时为22，0。37岁，36个月）。每100个儿童年，发病率为11。8（95% CI 10 . 0-13 . 8)结核菌素皮试转换，2 . 9（2 . 4-3 . 7)所有确诊的肺结核，和0。7（0 . 4-1 . 0)用于微生物学确诊的结核病。异烟肼预防性治疗可有效避免疾病进展（校正风险比0。22，95% CI 0。08-0 . 63; p< 0 . 0001）。患有下呼吸道感染的儿童比没有下呼吸道感染的儿童更容易患结核病（2。27，1。42-3 . 62; p< 0 . 0001).应更加重视生命的最初几年，因为这是结核病感染和疾病的传播和临床表现的高负担时期。在高负担环境中，需要采取多方面的干预措施，如异烟肼预防性治疗和对患有下呼吸道感染的婴儿进行结核病筛查，从生命早期开始。版权（C）作者。由Elsevier Ltd.出版。这是一篇开放获取文章，使用CC BY 4.0许可证。
Background Tuberculosis is a leading cause of global childhood mortality. However, the epidemiology and burden of tuberculosis in infancy is not well understood. We aimed to investigate tuberculin skin test conversion and tuberculosis in the Drakenstein Child Health study, a South African birth cohort in a community in which tuberculosis incidence is hyperendemic.Methods In this prospective birth cohort study, we enrolled pregnant women older than 18 years who were between 20 and 28 weeks' gestation and who were attending antenatal care in a peri-urban, impoverished South African setting. We followed up their children for tuberculosis from birth until April 1, 2017, or age 5 years. All children received BCG vaccination at birth. Tuberculin skin tests were administered to children at 6, 12, 24, 36, 48, and 60 months of age, and at the time of a lower respiratory tract infection. An induration reaction of 10 mm or more was considered to be a tuberculin skin test conversion. To prevent boosting, we censored children with a reactive, negative tuberculin skin test.Findings Among 915 mother-child pairs (201 [22%] HIV-positive mothers and two [< 1%] HIV-positive children), 147 (16%) children had tuberculin skin test conversion, with increasing cumulative hazard with age (0 . 08 at 6 months, 0 . 17 at 12 months, 0 . 22 at 24 months, and 0 . 37 at age 36 months). For every 100 child-years, the incidence was 11 . 8 (95% CI 10 . 0-13 . 8) for tuberculin skin test conversion, 2 . 9 (2 . 4-3 . 7) for all diagnosed tuberculosis, and 0 . 7 (0 . 4-1 . 0) for microbiologically confirmed tuberculosis. Isoniazid preventive therapy was effective in averting disease progression (adjusted hazard ratio 0 . 22, 95% CI 0 . 08-0 . 63; p< 0 . 0001). Children with a lower respiratory tract infection were significantly more likely to also have tuberculosis than were those without one (2 . 27, 1 . 42-3 . 62; p< 0 . 0001).Interpretation Greater focus should be placed on the first years of life as a period of high burden of transmission and clinical expression of tuberculosis infection and disease. Multifaceted interventions, such as isoniazid preventive therapy and tuberculosis screening of infants with LRTIs, beginning early in life, are needed in high-burden settings. Copyright (c) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.