Cheng Shi-ming, Du Xin, Xu Min
National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Zhonghua Er Ke Za Zhi. 2006 Apr;44(4):257-61.
To analyze the results of surveillance for new smear positive pediatric tuberculosis (TB) cases at the age of 0 to 14 years in China, to understand the trend of prevalence and finding of the new smear positive pediatric cases with TB, to illuminate the significance of surveillance for pediatric TB in TB epidemiology and to explore how to prevent and control pediatric TB with the modern TB control strategy (directly observed treatment, short-course, DOTS).
According to the register of new smear positive pediatric TB cases at the age of 0 to 14 years in the National Annual Surveillance Reporting from 1992 - 2004, the proportion of new smear positive pediatric TB cases among all the new smear positive TB cases in China, the notification rate of new smear positive pediatric TB, the case detection rate of new smear positive TB in the eastern, central and west parts of China, in Beijing, Tianjin and Shanghai municipalities and 13 provinces where the modern TB control strategies have been implemented in 1992 and 15 provinces where the strategies have not been implemented except Beijing, Tianjin and Shanghai municipalities, were analyzed.
From 1992 to 2004, 31,358 new smear positive pediatric cases with TB at the age of 0 to 14 years were registered, among whom 14,727 were males (47%) and 16,631 were females (53%). The proportion of new smear positive pediatric TB cases among all the new smear positive TB cases was 1.26%, while the proportion among males was 0.89% and among females was 2.03%. The proportion among females was higher than that among males (P < 0.01). The notification rate of new smear positive pediatric cases with TB was between 0.42/100,000 and 1.08/100,000. Among the new smear positive pediatric TB cases, 44.9% were from western parts of China, followed by central and eastern parts of China and only 0.9% were from Beijing, Tianjin and Shanghai municipalities. Excluding Beijing, Tianjin and Shanghai municipalities, 13 provinces where DOTS was implemented since 1992 were compared with the other 15 provinces. The notification rate of new smear positive TB was respectively 75% and 25%. Western region of China was listed on the top in the proportion of new smear positive pediatric TB cases among all the new smear positive TB cases in every year.
Among the registered new smear positive pediatric cases with TB, the number of females was higher than that among females and the proportion among males was also higher than that among males. The number of new smear positive pediatric TB cases in western parts of China was higher than that in central and eastern parts of China and the number in DOTS area was higher than that in non-DOTS area, which meant that the case detection of pediatric TB was associated with TB epidemic and DOTS strategy. Thus, in the implementation of DOTS, strengthening the prevention and control of pediatric TB, tracing the infection source of pediatric TB has certain impact on the TB epidemiological status.
分析我国0至14岁儿童新涂阳肺结核病例的监测结果，了解儿童新涂阳肺结核病例的流行趋势及发现情况，阐明儿童结核病监测在结核病流行病学中的意义，并探讨如何运用现代结核病控制策略（直接观察下的短程督导化疗，DOTS）预防和控制儿童结核病。
依据1992 - 2004年全国年度监测报告中0至14岁儿童新涂阳肺结核病例登记情况，分析我国儿童新涂阳肺结核病例在所有新涂阳肺结核病例中的占比、儿童新涂阳肺结核病例报告率、我国东部、中部和西部地区、北京、天津和上海市以及1992年已实施现代结核病控制策略的13个省和除北京、天津和上海外未实施该策略的15个省的新涂阳肺结核病例发现率。
1992年至2004年，共登记0至14岁儿童新涂阳肺结核病例31358例，其中男性14727例（47%），女性16631例（53%）。儿童新涂阳肺结核病例在所有新涂阳肺结核病例中的占比为1.26%，男性为0.89%，女性为2.03%。女性占比高于男性（P < 0.01）。儿童新涂阳肺结核病例报告率在0.42/10万至1.08/10万之间。在儿童新涂阳肺结核病例中，44.9%来自中国西部地区，其次是中部和东部地区，仅0.9%来自北京、天津和上海市。排除北京、天津和上海，对1992年起实施DOTS的13个省与其他15个省进行比较，新涂阳肺结核病例报告率分别为75%和25%。中国西部地区每年儿童新涂阳肺结核病例在所有新涂阳肺结核病例中的占比位居榜首。
在登记的儿童新涂阳肺结核病例中，女性病例数多于男性，女性占比也高于男性。中国西部地区儿童新涂阳肺结核病例数高于中部和东部地区，实施DOTS地区的病例数高于非DOTS地区，这表明儿童结核病的病例发现与结核病流行及DOTS策略相关。因此，在实施DOTS过程中，加强儿童结核病的预防控制，追踪儿童结核病传染源对结核病流行病学状况有一定影响。
