Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Department of Infectious Diseases, Imperial College London, United Kingdom.
Clin Infect Dis. 2021 Aug 16;73(4):e967-e975. doi: 10.1093/cid/ciab095.
Few studies have evaluated tuberculosis control in children and adolescents. We used routine tuberculosis surveillance data to quantify age- and human immunodeficiency virus (HIV)-stratified trends over time and investigate the relationship between tuberculosis, HIV, age, and sex.
All children and adolescents (0-19 years) routinely treated for drug-susceptible tuberculosis in South Africa and recorded in a de-duplicated national electronic tuberculosis treatment register (2004-2016) were included. Age- and HIV-stratified tuberculosis case notification rates (CNRs) were calculated in four age bands: 0-4, 5-9, 10-14, and 15-19 years. The association between HIV infection, age, and sex in children and adolescents with tuberculosis was evaluated using multivariable logistic regression.
Of 719 400 children and adolescents included, 339 112 (47%) were 0-4 year olds. The overall tuberculosis CNR for 0-19 year olds declined by 54% between 2009 and 2016 (incidence rate ratio [IRR] = 0.46; 95% confidence interval [CI], .45-.47). Trends varied by age and HIV, with the smallest reductions (2013-2016) in HIV-positive 0-4 year olds (IRR = 0.90; 95% CI, .85-.95) and both HIV-positive (IRR = .84; 95% CI, .80-.88) and HIV-negative (IRR = 0.89; 95% CI, .86-.92) 15-19 year olds. Compared with 0- to 4-year-old males, odds of HIV coinfection among 15-19 year olds were nearly twice as high in females (adjusted odds ratio [aOR] = 2.49; 95% CI, 2.38-2.60) than in males (aOR = 1.35; 95% CI, 1.29-1.42).
South Africa's national response to the HIV epidemic has made a substantial contribution to the observed declining trends in tuberculosis CNRs in children and adolescents. The slow decline of tuberculosis CNRs in adolescents and young HIV-positive children is concerning. Understanding how tuberculosis affects children and adolescents beyond conventional age bands and by sex can inform targeted tuberculosis control strategies.
很少有研究评估儿童和青少年的结核病控制情况。我们使用常规结核病监测数据来量化随时间变化的年龄和人类免疫缺陷病毒（HIV）分层趋势，并调查结核病、HIV、年龄和性别之间的关系。
纳入南非常规治疗药物敏感性结核病的所有儿童和青少年（0-19 岁），并记录在一个去重的国家电子结核病治疗登记册中（2004-2016 年）。按照四个年龄组计算年龄和 HIV 分层的结核病病例报告率（CNR）：0-4 岁、5-9 岁、10-14 岁和 15-19 岁。使用多变量逻辑回归评估儿童和青少年中 HIV 感染、年龄和性别的关系。
在纳入的 719400 名儿童和青少年中，339112 名（47%）为 0-4 岁。2009 年至 2016 年，0-19 岁儿童结核病 CNR 下降了 54%（发病率比 [IRR] = 0.46；95%置信区间 [CI]，0.45-0.47）。趋势因年龄和 HIV 而异，HIV 阳性 0-4 岁儿童的降幅最小（2013-2016 年，IRR = 0.90；95%CI，0.85-0.95），HIV 阳性（IRR = 0.84；95%CI，0.80-0.88）和 HIV 阴性（IRR = 0.89；95%CI，0.86-0.92）15-19 岁儿童也是如此。与 0-4 岁的男性相比，15-19 岁的女性中 HIV 合并感染的几率是男性的两倍多（调整后的比值比[aOR] = 2.49；95%CI，2.38-2.60）。
南非对 HIV 流行的国家应对措施对观察到的儿童和青少年结核病 CNR 下降趋势做出了重大贡献。青少年和年轻 HIV 阳性儿童结核病 CNR 下降缓慢令人担忧。了解结核病如何影响传统年龄组以外的儿童和青少年以及性别，可以为有针对性的结核病控制策略提供信息。
