High Prevalence of Active and Latent Tuberculosis in Children and Adolescents in Tibetan Schools in India: The Zero TB Kids Initiative in Tibetan Refugee Children
High Prevalence of Active and Latent Tuberculosis in Children and Adolescents in Tibetan Schools in India: The Zero TB Kids Initiative in Tibetan Refugee Children
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DOI：
10.1093/cid/ciy987
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发表时间：
2019-09-01
影响因子：
11.8
通讯作者：
Chaisson, Richard E.
中科院分区：
文献类型：
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作者：
Dorjee, Kunchok;Topgyal, Sonam;Chaisson, Richard E.
背景在印度的西藏难民中，结核病（TB）患病率很高，几乎一半的病例发生在包括学校在内的集体设施中。一个全面的计划，结核病病例发现和治疗结核病感染（TBI）进行了学校的藏族难民childhood.Methods学童和工作人员在西藏学校在喜马偕尔邦，印度，进行了筛查结核病的算法，使用症状，胸部X线摄影，分子诊断和结核菌素皮肤试验。活动性结核病患者接受治疗，TBI患者接受3个月的异烟肼-利福平预防治疗。结果从2017年4月至2018年3月，我们筛查了11所藏族学校的5391名学童（中位年龄13岁）和786名工作人员。在学龄儿童中发现46例结核病病例，包括1例多重耐药结核病病例，患病率为每10万人853例。1名工作人员被诊断为广泛耐药结核病。大多数病例（66%）为亚临床病例。在完成测试的5234名学生中有930名（18%）和634名工作人员中有334名（53%）发现了TBI。寄宿学校的儿童比走读学校的儿童有更高的TBI患病率（915/5020 [18%] vs 15/371 [4%]; P <0.01）。799 888（90%）学童和101 332（30%）的工作人员TBI提供预防性治疗; 857（95%）人成功完成therapy.Conclusions藏族学童结核病患病率极高。实现了有效的主动病例发现和儿童预防性治疗的高吸收和完成。在领导和社区动员下，结核病控制可以在人口一级实施。
Background Tuberculosis (TB) prevalence is high among Tibetan refugees in India, with almost half of cases occurring in congregate facilities, including schools. A comprehensive program of TB case finding and treatment of TB infection (TBI) was undertaken in schools for Tibetan refugee children.Methods Schoolchildren and staff in Tibetan schools in Himachal Pradesh, India, were screened for TB with an algorithm using symptoms, chest radiography, molecular diagnostics, and tuberculin skin testing. Individuals with active TB were treated and those with TBI were offered isoniazid-rifampicin preventive therapy for 3 months.Results From April 2017 to March 2018, we screened 5391 schoolchildren (median age, 13 years) and 786 staff in 11 Tibetan schools. Forty-six TB cases, including 1 with multidrug resistance, were found in schoolchildren, for a prevalence of 853 per 100 000. Extensively drug-resistant TB was diagnosed in 1 staff member. The majority of cases (66%) were subclinical. TBI was detected in 930 of 5234 (18%) schoolchildren and 334 of 634 (53%) staff who completed testing. Children in boarding schools had a higher prevalence of TBI than children in day schools (915/5020 [18%] vs 15/371 [4%]; P < .01). Preventive therapy was provided to 799 of 888 (90%) schoolchildren and 101 of 332 (30%) staff with TBI; 857 (95%) people successfully completed therapy.Conclusions TB prevalence is extremely high among Tibetan schoolchildren. Effective active case finding and a high uptake and completion of preventive therapy for children were achieved. With leadership and community mobilization, TB control is implementable on a population level.