Childhood TB epidemiology and treatment outcomes in Thailand: a TB active surveillance network, 2004 to 2006.
BACKGROUND
Of the 9.2 million new TB cases occurring each year, about 10% are in children. Because childhood TB is usually non-infectious and non-fatal, national programs do not prioritize childhood TB diagnosis and treatment. We reviewed data from a demonstration project to learn more about the epidemiology of childhood TB in Thailand.


METHODS
In four Thai provinces and one national hospital, we contacted healthcare facilities monthly to record data about persons diagnosed with TB, assist with patient care, provide HIV counseling and testing, and obtain sputum for culture and susceptibility testing. We analyzed clinical and treatment outcome data for patients age < 15 years old registered in 2005 and 2006.


RESULTS
Only 279 (2%) of 14,487 total cases occurred in children. The median age of children was 8 years (range: 4 months, 14 years). Of 197 children with pulmonary TB, 63 (32%) were bacteriologically-confirmed: 56 (28%) were smear-positive and 7 (4%) were smear-negative, but culture-positive. One was diagnosed with multi-drug resistant TB. HIV infection was documented in 75 (27%). Thirteen (17%) of 75 HIV-infected children died during TB treatment compared with 4 (2%) of 204 not known to be HIV-infected (p < 0.01).


CONCLUSIONS
Childhood TB is infrequently diagnosed in Thailand. Understanding whether this is due to absence of disease or diagnostic effort requires further research. HIV contributes substantially to the childhood TB burden in Thailand and is associated with high mortality.
Lolekha
Rangsima
R
Global AIDS Program, Thailand MOPH - US CDC Collaboration, Nonthaburi, Thailand. rangsimaL@th.cdc.gov
Anuwatnonthakate
Amornrat
A
Nateniyom
Sriprapa
S
Sumnapun
Surin
S
Yamada
Norio
N
Wattanaamornkiat
Wanpen
W
Sattayawuthipong
Wanchai
W
Charusuntonsri
Pricha
P
Sanguanwongse
Natpatou
N
Wells
Charles D
CD
Varma
Jay K
JK
D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011159:Population Surveillance; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*
D000995:Antitubercular Agents