Division of Pediatric Infectious Diseases, Dr von Hauner Children's Hospital, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany.
German Centre for Infection Research, Partner Site Munich, Munich, Germany.
PLoS One. 2021 May 10;16(5):e0250387. doi: 10.1371/journal.pone.0250387. eCollection 2021.
Majority of active tuberculosis (TB) cases in children in low-incidence countries are due to rapid progression of infection (latent TB infection (LTBI)) to disease. We aimed to assess common practice for managing paediatric LTBI in Austria, Germany and Switzerland prior to the publication of the first joint national guideline for paediatric TB in 2017.
Online-based survey amongst pediatricians, practitioners and staff working in the public health sector between July and November 2017. Data analysis was conducted using IBM SPSS.
A total of 191 individuals participated in the survey with 173 questionnaires included for final analysis. Twelve percent of respondents were from Austria, 60% from Germany and 28% from Switzerland. Proportion of children with LTBI and migrant background was estimated by the respondents to be >50% by 58%. Tuberculin skin test (TST) and interferon-γ-release-assay (IGRA), particularly Quantiferon-gold-test, were reported to be used in 86% and 88%, respectively. In children > 5 years with a positive TST or IGRA a chest x-ray was commonly reported to be performed (28%). Fifty-three percent reported to take a different diagnostic approach in children ≤ 5 years, mainly combining TST, IGRA and chest x-ray for initial testing (31%). Sixty-eight percent reported to prescribe isoniazid-monotherapy: for 9 (62%), or 6 months (6%), 31% reported to prescribe combination therapy of isoniazid and rifampicin. Dosing of isoniazid and rifampicin below current recommendations was reported by up to 22% of respondents. Blood-sampling before/during LTBI treatment was reported in >90% of respondents, performing a chest-X-ray at the end of treatment by 51%.
This survey showed reported heterogeneity in the management of paediatric LTBI. Thus, regular and easily accessible educational activities and national up-to-date guidelines are key to ensure awareness and quality of care for children and adolescents with LTBI in low-incidence countries.
在低发病国家，大多数儿童活动性结核病（TB）病例是由于潜伏性结核感染（LTBI）迅速进展为疾病。我们旨在评估 2017 年第一份联合国家儿科结核病指南发布之前，奥地利、德国和瑞士在管理儿科 LTBI 方面的常见做法。
2017 年 7 月至 11 月期间，在儿科医生、从业人员和公共卫生部门工作人员中进行了基于网络的调查。使用 IBM SPSS 进行数据分析。
共有 191 人参加了调查，其中 173 份问卷纳入最终分析。12%的受访者来自奥地利，60%来自德国，28%来自瑞士。58%的受访者估计 LTBI 儿童和移民背景的比例>50%。结核菌素皮肤试验（TST）和干扰素-γ释放试验（IGRA），特别是 Quantiferon-gold 试验，据报道分别在 86%和 88%的患者中使用。在 TST 或 IGRA 阳性的>5 岁儿童中，常报告进行胸部 X 线检查（28%）。53%的人报告说，对于≤5 岁的儿童，采取不同的诊断方法，主要是将 TST、IGRA 和胸部 X 线检查结合起来进行初步检测（31%）。68%的人报告说服用异烟肼单药治疗：9 例（62%）或 6 个月（6%），31%的人报告说联合使用异烟肼和利福平治疗。高达 22%的受访者报告说异烟肼和利福平的剂量低于目前的建议。超过 90%的受访者在 LTBI 治疗前/期间进行血液采样，51%的人在治疗结束时进行胸部 X 射线检查。
这项调查显示，儿科 LTBI 管理方面存在报告的异质性。因此，定期和方便获取的教育活动以及国家最新指南是确保在低发病国家儿童和青少年 LTBI 护理意识和质量的关键。
