Carvalho Anna Cristina Calçada, Cardoso Claudete Aparecida Araújo, Martire Terezinha Miceli, Migliori Giovanni Battista, Sant'Anna Clemax Couto
Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
Departamento Materno Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, Brazil.
J Bras Pneumol. 2018 Apr;44(2):134-144. doi: 10.1590/s1806-37562017000000461.
Tuberculosis continues to be a public health priority in many countries. In 2015, tuberculosis killed 1.4 million people, including 210,000 children. Despite the recent progress made in the control of tuberculosis in Brazil, it is still one of the countries with the highest tuberculosis burdens. In 2015, there were 69,000 reported cases of tuberculosis in Brazil and tuberculosis was the cause of 4,500 deaths in the country. In 2014, the World Health Organization approved the End TB Strategy, which set a target date of 2035 for meeting its goals of reducing the tuberculosis incidence by 90% and reducing the number of tuberculosis deaths by 95%. However, to achieve those goals in Brazil, there is a need for collaboration among the various sectors involved in tuberculosis control and for the prioritization of activities, including control measures targeting the most vulnerable populations. Children are highly vulnerable to tuberculosis, and there are particularities specific to pediatric patients regarding tuberculosis development (rapid progression from infection to active disease), prevention (low effectiveness of vaccination against the pulmonary forms and limited availability of preventive treatment of latent tuberculosis infection), diagnosis (a low rate of bacteriologically confirmed diagnosis), and treatment (poor availability of child-friendly anti-tuberculosis drugs). In this review, we discuss the epidemiology, clinical manifestations, and prevention of tuberculosis in childhood and adolescence, highlighting the peculiarities of active and latent tuberculosis in those age groups, in order to prompt reflection on new approaches to the management of pediatric tuberculosis within the framework of the End TB Strategy.
在许多国家，结核病仍然是公共卫生领域的重点关注对象。2015年，结核病导致140万人死亡，其中包括21万儿童。尽管巴西近期在结核病控制方面取得了进展，但它仍是结核病负担最高的国家之一。2015年，巴西报告了6.9万例结核病病例，结核病导致该国4500人死亡。2014年，世界卫生组织批准了《终止结核病战略》，该战略设定了到2035年实现其将结核病发病率降低90%以及将结核病死亡人数减少95%目标的截止日期。然而，要在巴西实现这些目标，参与结核病控制的各个部门需要开展合作，并对各项活动进行优先排序，包括针对最脆弱人群的控制措施。儿童极易感染结核病，而且儿科患者在结核病发展（从感染迅速进展为活动性疾病）、预防（针对肺部形式的疫苗接种效果不佳以及潜伏性结核感染预防性治疗的可及性有限）、诊断（细菌学确诊诊断率低）和治疗（适合儿童的抗结核药物可及性差）方面存在特殊情况。在本综述中，我们讨论儿童和青少年结核病的流行病学、临床表现及预防，强调这些年龄组中活动性和潜伏性结核病的特殊性，以便在《终止结核病战略》框架内促使人们思考管理儿童结核病的新方法。
