Tuberculosis preventive treatment in children and adolescents: an observational study of secondary data

Tahan, Tony Tannous; Rossoni, Andrea Maciel de Oliveira; Santos, Mauricio Bedim dos; da Silveira, Juliana Taques Pessoa; de Oliveira, Simoni Pimenta; Rodrigues, Cristina de Oliveira

doi:10.1016/j.jped.2023.02.002

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Sumário

Original article • J. Pediatr. (Rio J.) 99 (4) • 2023 • https://doi.org/10.1016/j.jped.2023.02.002 copy

Tuberculosis preventive treatment in children and adolescents: an observational study of secondary data

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze the effectiveness, safety, outcomes, and associated factors of tuberculosis preventive treatment (TPT) in children and adolescents in Paraná, southern Brazil.

Method

This was an observational cohort study with a retrospective collection of secondary data from the TPT information systems of the state of Paraná from 2009 to 2016, and tuberculosis in Brazil from 2009 to 2018.

Results

In total, 1,397 people were included. In 95.4% of the individuals, the indication for TPT was a history of patient-index contact with pulmonary tuberculosis. Isoniazid was used in 99.9% of the cases with TPT, and 87.7% completed the treatment. The TPT protection was 98.7%. Among the 18 people who had TB, 14 (77.8%) became ill after the second year of treatment, and four (22.2%) in the first two years (p < 0.001). Adverse events were reported in 3.3% of cases, most of them were gastrointestinal and medication was discontinued in only 2 (0.1%) patients. No risk factors associated with the illness were observed.

Conclusions

The authors observed a low rate of illness in pragmatics routine conditions in TPT for children and adolescents, especially within the first two years after the end of treatment, with good tolerability and a good percentage of adherence to the treatment. TPT should be encouraged to achieve the goals of the End TB Strategy of the World Health Organization as an essential strategy to reduce the incidence rate of the disease, but studies with new schemes must continue to be carried out in real-life scenarios.

Keywords
Latent tuberculosis; Latent infection; Prevention; Household contacts; Pediatrics

Characteristic	Did not progress to disease (n=1379)		Progress to disease (n=18)		P-value
Characteristic	n	%	N	%
Median age (years)	9.77 (0.27 - 18.96)		11.21 (0.77 - 18.32)		0.456¹ 1 Mann-Whitney test.
Age
< 10 years	704	51.1	6	33.3	0.158² 2 Fisher's exact test.
≥ 10 years	675	48.9	12	66.7	0.158² 2 Fisher's exact test.
Sex
Female	701	50.8	10	55.6	0.814² 2 Fisher's exact test.
Male	678	49.2	8	44.4	0.814² 2 Fisher's exact test.
Race/ skin color (N=1370)² 2 Fisher's exact test.
White	968	71.6	13	72.2	1.000² 2 Fisher's exact test.
Other	384	28.4	5	27.8	1.000² 2 Fisher's exact test.
Urban area dweller (N=1368)³ 3 For these analyses, the ignored information was disregarded, so the total N of each characteristic varied.
Yes	1256	93.0	16	88.9	0.364² 2 Fisher's exact test.
No	94	7.0	2	11.1	0.364² 2 Fisher's exact test.
Being institutionalized (N=1396)³ 3 For these analyses, the ignored information was disregarded, so the total N of each characteristic varied.
Yes	21	1.5	0	0.0	1.000² 2 Fisher's exact test.
No	1357	98.5	18	100.0	1.000² 2 Fisher's exact test.
Patient household index (N=1333)³ 3 For these analyses, the ignored information was disregarded, so the total N of each characteristic varied.
Yes	1240	94.2	17	100.0	0.366² 2 Fisher's exact test.
No	76	5.8	0	0.0	0.366² 2 Fisher's exact test.
Patient bacilliferous index (N=1333)³ 3 For these analyses, the ignored information was disregarded, so the total N of each characteristic varied.
Yes	1184	90.0	16	94.1	1.000² 2 Fisher's exact test.
No	132	10.0	1	5.9	1.000² 2 Fisher's exact test.

Characteristic	Did not progress to disease		Progress to disease		P-value
Characteristic	n	%	N	%
Performed BCG (N=1373)¹ 1 The ignored information was disregarded for these analyses, so the total N of each characteristic varied.
Yes	1342	99.0	18	100.0	1.000² 2 Fisher's exact test.
No	13	1.0	0	0.0	1.000² 2 Fisher's exact test.
HIV (N=327)¹ 1 The ignored information was disregarded for these analyses, so the total N of each characteristic varied.
Positive	16	5.0	0	0.0	1.000² 2 Fisher's exact test.
Negative	305	95.0	6	100.0	1.000² 2 Fisher's exact test.
Tuberculin test (N=1392)¹ 1 The ignored information was disregarded for these analyses, so the total N of each characteristic varied.
Reactor	1209	88.0	17	94.4	0.713² 2 Fisher's exact test.
Nonreactor	165	12.0	1	5.6	0.713² 2 Fisher's exact test.
Median tuberculin test (mm) (N=1392)¹ 1 The ignored information was disregarded for these analyses, so the total N of each characteristic varied.	11 (0-23)		12 (0-30)		0.832³ 3 Mann-Whitney test.
Drug used (N=1383)¹ 1 The ignored information was disregarded for these analyses, so the total N of each characteristic varied.
Isoniazid	1363	99.8	18	100.0	1.000² 2 Fisher's exact test.
Other	2	0.2	0	0.0	1.000² 2 Fisher's exact test.
Presented adverse events (N=974)¹ 1 The ignored information was disregarded for these analyses, so the total N of each characteristic varied.
Yes	32	3.3	0	0.0	1.000² 2 Fisher's exact test.
No	928	96.7	14	100.0	1.000² 2 Fisher's exact test.
Treatment (N=1000)¹ 1 The ignored information was disregarded for these analyses, so the total N of each characteristic varied.
Complete	865	87.8	12	80.0	0.415² 2 Fisher's exact test.
Incomplete	120	12.2	3	20.0	0.415² 2 Fisher's exact test.

Variable	Value	Standard error	Risk ratio	CI95%		P-value
Less than 10 years of age	0.761	0.515	2.141	0.781	5.871	0.139
Sex	−0.283	0.478	0.753	0.296	1.921	0.553
Ethnicity	0.023	0.532	1.023	0.361	2.901	0.966
Contact tuberculosis	0.072	1.040	1.074	0.140	8.242	0.945
PPD Reactor	−0.054	1.056	0.948	0.120	7.504	0.959
Self-administered treatment	0.560	0.519	1.751	0.633	4.845	0.281
Proper treatment	0.570	0.521	1.767	0.637	4.908	0.274

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[1] Institution or service with which the work is associated for indexing in Index Medicus/MEDLINE, City, Country. Postgraduate Course in Child and Adolescent Health, Pediatrics Department, Federal University of Paraná.