title: Opportunities for chemoprophylaxis in children with culture-confirmed tuberculosis.
abstract: OBJECTIVE
  Chemoprophylaxis is an effective strategy to prevent progression of tuberculosis (TB) in vulnerable children who have had contact with an infectious source of TB. However, many operational gaps prevent implementation of routine chemoprophylaxis  in high-burden settings. The TB exposure status and disease spectrum in children diagnosed with culture-confirmed TB are described and missed opportunities for chemoprophylaxis are highlighted.
  
  
  METHODS
  All children <13 years of age diagnosed with culture-confirmed TB at a tertiary  referral hospital between March 2003 and February 2007 were included. Clinical data were collected from retrospective review of files. TB was classified as pulmonary and extra-pulmonary; disseminated TB included miliary disease and TB meningitis.
  
  
  RESULTS
  During the study period,  614 children (327, 53·3% boys, median age 32 months) were diagnosed with culture-confirmed TB. Contact with an infectious adult source case was documented in 333 (54·2%), 237 (71·2%) of whom were <5 years of age, and 24 (7·2%) were HIV-infected and ≥5 years  of age. Of those eligible for chemoprophylaxis, missed opportunities were identified in 156/221 (70·6%) children; 127 (81·4%) were <3 years of age, 39 (25%) had disseminated TB and 8 (5·1%) died. The TB source case was the mother or father in 74/156 (47·4%) children.
  
  
  CONCLUSIONS
  Opportunities for initiation of chemoprophylaxis in vulnerable children following TB exposure are often missed. Awareness should be increased among health-care workers and in the community at large regarding the importance of chemoprophylaxis in young and HIV-infected children. Health system  strengthening is required to improve delivery of chemoprophylaxis to vulnerable children in close contact with newly diagnosed infectious TB cases.
authors: Desmond Tutu Tuberculosis Centre, Department of Paediatrics & Child Health, Faculty of Health Sciences, Stellenbosch University, South Africa.
authors: K
authors: K
authors: Du Preez
authors: A C
authors: AC
authors: Hesseling
authors: A M
authors: AM
authors: Mandalakas
authors: B J
authors: BJ
authors: Marais
authors: H S
authors: HS
authors: Schaaf
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000008:administration & dosage*; D018890:Chemoprevention / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D000995:Antitubercular Agents