Risk of developing active tuberculosis following tuberculosis screening and preventive therapy for Tibetan refugee children and adolescents in India: An impact assessment.
Risk of developing active tuberculosis following tuberculosis screening and preventive therapy for Tibetan refugee children and adolescents in India: An impact assessment.
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DOI：
10.1371/journal.pmed.1003502
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发表时间：
2021-01
期刊：
影响因子：
15.8
通讯作者：
Chaisson RE
中科院分区：
文献类型：
--
作者：
Dorjee K;Topgyal S;Tsewang T;Tsundue T;Namdon T;Bonomo E;Kensler C;Lhadon D;Choetso T;Nangsel T;Dolkar T;Tsekyi T;Dorjee C;Phunkyi D;Sadutshang TD;Paster Z;Chaisson RE
在印度寄宿学校就读的西藏难民儿童和青少年的结核病发病率极高。我们在零结核儿童项目的7所学校开展了全面的病例发现和结核病预防治疗（TPT）计划。我们的目的是测量结核病感染和疾病负担，并调查在学校接受和未接受TPT的儿童和成人患结核病的风险。一个移动的小组每年在印度喜马偕尔邦的7所寄宿学校对儿童和工作人员进行结核病筛查，使用症状标准、放射照相、分子诊断和结核菌素皮肤试验。TB感染（TBI）用异烟肼和利福平或利福平的短程方案治疗。根据西藏和印度的指南治疗结核病。在2017年4月至2019年12月期间，招募了6，582名学童（中位年龄14 [IQR 11-16]岁）和807名工作人员（中位年龄40 [IQR 33-48]岁）。51%的学生和58%的工作人员是女性。对在校儿童进行了超过13，161人-年的随访（中位随访时间为2.3年）和1，800人-年的工作人员随访（中位随访2.5年），69例结核病发生在学童中，4例结核病发生在工作人员中，年发病率为524/100，000（95% CI 414-663/100，000）人-年和256/100，000（95% CI 96-683/100，000）人-年。在1，412名被诊断患有TBI的学童中，有1，192名接受了TPT。与未接受TPT的学生相比，接受TPT的学生患结核病的风险降低了79%（调整后的风险比[aHR] 0.21; 95%CI 0.07-0.69; p = 0.010），这是主要的研究结果。次要研究结局是，近期接触者的保护作用更大（aHR 0.07; 95% CI 0.01-0.42; p = 0.004）。近期接触者的患病率为28%（1，843/6，582）。采用两种不同的TPT方案（3 HR和4 R），均取得明显疗效。没有接受TPT的员工患上结核病。总体而言，2017年至2019年，结核病发病率从837/10万下降了87%，（95% CI 604- 1，129/100，000）人-年至110/100，000（95% CI 36-255/100，000）人年（p < 0.001），TBI患病率从19%（95% CI 18%-20%）降至11%（95% CI 10%-12%）（p < 0.001）。我们研究的一个局限性是，结核病发病率可能受到研究期间长期趋势的影响。在这项研究中，在学校范围内实施结核病筛查和预防性治疗计划后，我们观察到儿童和青少年结核病和TBI的负担显着减少。TPT的益处对于最近的结核病接触者尤其明显。这一举措可作为其他受结核病影响社区儿童和青少年结核病检测和预防的模式。Kunchok Dorjee及其同事调查了印度学校的西藏难民儿童接受大规模结核病预防治疗后的感染和疾病负担。结核病（TB）是世界上主要的传染病杀手，估计每年有1000万例病例和150万例死亡。每年有100万儿童患结核病，23.3万儿童死于结核病。在符合条件的儿童中，全球只有约23%接受结核病预防治疗（TPT）。在全球范围内，对儿童和青少年结核病进展和以利福平为基础的短程TPT方案的有效性缺乏了解或了解有限。在高负担、资源匮乏的环境中实施TPT的业务经验对国家方案至关重要。在印度的西藏难民儿童和青少年结核病发病率（853/10万人年）和感染率（19%）极高。为印度的儿童、青少年和藏族寄宿学校的工作人员实施了一项全面的积极病例发现和TPT方案。儿童和青少年接受3个月每日异烟肼和利福平（3 HR）或4个月每日利福平（4 R）的TPT，结核病风险降低79%;近期暴露于结核病的参与者的保护作用更大（93%）。截至2019年底，这些学校的结核病发病率下降了87%，感染率下降了42%。3 HR和4 R方案均明显有效，后者副作用较少。儿童和青少年是结核病负担高的脆弱人群，需要全球给予更多关注。在全球扩大TPT实施范围时，最近接触过TPT的个人可以成为预防性治疗的目标。在这项研究中，大规模的利福平为基础的TPT在资源有限的情况下是可行的操作，儿童，青少年和成人接受，并在预防结核病的价值。以TPT为基础的多管齐下的方法有效地减少了脆弱难民人口的结核病负担，为其他社区提供了一个可适应的模式。
Tuberculosis (TB) rates among Tibetan refugee children and adolescents attending boarding schools in India are extremely high. We undertook a comprehensive case finding and TB preventive treatment (TPT) program in 7 schools in the Zero TB Kids project. We aimed to measure the TB infection and disease burden and investigate the risk of TB disease in children and adults who did and did not receive TPT in the schools. A mobile team annually screened children and staff for TB at the 7 boarding schools in Himachal Pradesh, India, using symptom criteria, radiography, molecular diagnostics, and tuberculin skin tests. TB infection (TBI) was treated with short-course regimens of isoniazid and rifampin or rifampin. TB disease was treated according to Tibetan and Indian guidelines. Between April 2017 and December 2019, 6,582 schoolchildren (median age 14 [IQR 11–16] years) and 807 staff (median age 40 [IQR 33–48] years) were enrolled. Fifty-one percent of the students and 58% of the staff were females. Over 13,161 person-years of follow-up in schoolchildren (median follow-up 2.3 years) and 1,800 person-years of follow-up in staff (median follow-up 2.5 years), 69 TB episodes occurred in schoolchildren and 4 TB episodes occurred in staff, yielding annual incidence rates of 524/100,000 (95% CI 414–663/100,000) person-years and 256/100,000 (95% CI 96–683/100,000) person-years, respectively. Of 1,412 schoolchildren diagnosed with TBI, 1,192 received TPT. Schoolchildren who received TPT had 79% lower risk of TB disease (adjusted hazard ratio [aHR] 0.21; 95% CI 0.07–0.69; p = 0.010) compared to non-recipients, the primary study outcome. Protection was greater in recent contacts (aHR 0.07; 95% CI 0.01–0.42; p = 0.004), the secondary study outcome. The prevalence of recent contacts was 28% (1,843/6,582). Two different TPT regimens were used (3HR and 4R), and both were apparently effective. No staff receiving TPT developed TB. Overall, between 2017 and 2019, TB disease incidence decreased by 87%, from 837/100,000 (95% CI 604–1,129/100,000) person-years to 110/100,000 (95% CI 36–255/100,000) person-years (p < 0.001), and TBI prevalence decreased by 42% from 19% (95% CI 18%–20%) to 11% (95% CI 10%–12%) (p < 0.001). A limitation of our study is that TB incidence could be influenced by secular trends during the study period. In this study, following implementation of a school-wide TB screening and preventive treatment program, we observed a significant reduction in the burden of TB disease and TBI in children and adolescents. The benefit of TPT was particularly marked for recent TB contacts. This initiative may serve as a model for TB detection and prevention in children and adolescents in other communities affected by TB. Kunchok Dorjee and colleagues investigate infection and disease burden following mass tuberculosis preventive treatment for Tibetan refugee children at schools in India. Tuberculosis (TB) is the world’s leading infectious disease killer, with estimated 10 million cases and 1.5 million deaths annually. Annually, 1 million children develop TB and 233,000 children die of the disease. Of the eligible children, only around 23% receive TB preventive treatment (TPT) globally. Knowledge of TB disease progression and the effectiveness of rifampin-based short-course TPT regimens in children and adolescents is lacking or limited globally. Operational experience on TPT implementation in high-burden, resource-poor settings is crucial for national programs. Tibetan refugee children and adolescents in India have extremely high rates of TB disease (853/100,000 person-years) and infection (19%). A comprehensive active case finding and TPT program was implemented for children, adolescents, and staff members of Tibetan boarding schools in India. Children and adolescents who received TPT with 3 months of daily isoniazid and rifampin (3HR) or 4 months of daily rifampin (4R) had 79% lower risk of TB disease; the protection was greater (93%) in participants with recent exposure to TB. The schools saw an 87% decline in TB disease incidence and a 42% decline in infection prevalence at the end of 2019. Both the 3HR and 4R regimens were apparently effective; the latter had fewer side effects. Children and adolescents constitute vulnerable populations with high TB disease burden requiring greater global attention. Recently exposed individuals can be targeted for preventive treatment in the global scale-up of TPT implementation. In this study, large-scale rifampin-based TPT was operationally feasible in resource-limited settings; well accepted by children, adolescents, and adults; and valuable in preventing TB. A multipronged approach anchored by TPT effectively reduced TB burden for a vulnerable refugee population, presenting an adaptable model for other communities.
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影响因子：
158.5
作者：
Churchyard, Gavin J.;Fielding, Katherine L.;Grant, Alison D.
通讯作者：
Grant, Alison D.
影响因子：
158.5
作者：
Marks, Guy B.;Nguyen, Nhung V.;Fox, Greg J.
通讯作者：
Fox, Greg J.
影响因子：
34.3
作者：
Dodd, Peter J.;Gardiner, Elizabeth;Seddon, James A.
通讯作者：
Seddon, James A.
影响因子：
11.8
作者：
Dorjee, Kunchok;Topgyal, Sonam;Chaisson, Richard E.
通讯作者：
Chaisson, Richard E.
DOI：
10.1097/qai.0000000000000219
发表时间：
2014-08-15
影响因子：
3.6
作者：
Dowdy, David W.;Golub, Jonathan E.;Durovni, Betina
通讯作者：
Durovni, Betina