Apolisi Ivy, Cox Helen, Tyeku Nolitha, Daniels Johnny, Mathee Shaheed, Cariem Rabia, Douglas-Jones Bianca, Ngambu Noluvo, Mudaly Vanessa, Mohr-Holland Erika, Isaakidis Petros, Pfaff Colin, Furin Jennifer, Reuter Anja
Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa.
Institute of Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Disease Research, Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
Open Forum Infect Dis. 2023 Feb 21;10(3):ofad087. doi: 10.1093/ofid/ofad087. eCollection 2023 Mar.
Children and adolescents with household exposure to multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) are at high risk of developing TB disease. Tuberculosis preventive therapy (TPT) is recommended, but programmatic experience is limited, particularly for adolescents.
We conducted a prospective cohort study to describe MDR/RR-TB diagnosis and TPT provision for individuals aged <18 years with MDR/RR-TB exposure. Participants were assessed for TB either in homes or health facilities, with referral for chest x-ray or specimen collection at clinician discretion. The TPT regimens included levofloxacin, isoniazid, or delamanid monotherapy for 6 months, based on source patient drug-resistance profile.
Between March 1, 2020 and July 31, 2021, 112 participants were enrolled; median age was 8.5 years, 57 (51%) were female, and 6 (5%) had human immunodeficiency virus. On screening, 11 (10%) were diagnosed with TB: 10 presumptive MDR/RR-TB and 1 drug-susceptible TB. Overall, 95 (94% of 101) participants started TPT: 79 with levofloxacin, 9 with isoniazid, and 7 with delamanid. Seventy-six (80%) completed TPT, 12 (13%) were lost to follow up, and 7 (7%) stopped TPT early due to adverse events. Potential adverse events were reported for 12 (13%) participants; none were serious. There were no further TB diagnoses (200 days median follow up).
Post-MDR/RR-TB exposure management for children and adolescents resulted in significant MDR/RR-TB detection and both high TPT initiation and completion. Tuberculosis preventive monotherapy was well tolerated and there were no further TB diagnoses after initial assessment. Key factors supporting these outcomes included use of pediatric formulations for young children, monotherapy, and community-based options for assessment and follow up.
有家庭接触耐多药或利福平耐药结核病（MDR/RR-TB）的儿童和青少年患结核病的风险很高。推荐进行结核病预防性治疗（TPT），但项目经验有限，尤其是针对青少年。
我们开展了一项前瞻性队列研究，以描述MDR/RR-TB暴露的18岁以下个体的MDR/RR-TB诊断和TPT提供情况。参与者在家庭或医疗机构接受结核病评估，临床医生酌情转诊进行胸部X光检查或标本采集。根据源患者的耐药情况，TPT方案包括左氧氟沙星、异烟肼或地拉曼胺单药治疗6个月。
在2020年3月1日至2021年7月31日期间，共招募了112名参与者；中位年龄为8.5岁，57名（51%）为女性，6名（5%）感染了人类免疫缺陷病毒。筛查时，11名（10%）被诊断为结核病：10名疑似MDR/RR-TB和1名药物敏感结核病。总体而言，95名（101名中的94%）参与者开始接受TPT：79名使用左氧氟沙星，9名使用异烟肼，7名使用地拉曼胺。76名（80%）完成了TPT，12名（13%）失访，7名（7%）因不良事件提前停止TPT。12名（13%）参与者报告了潜在不良事件；均不严重。没有进一步的结核病诊断（中位随访200天）。
对儿童和青少年进行MDR/RR-TB暴露后管理，显著检测出MDR/RR-TB，TPT启动率和完成率均很高。结核病预防性单药治疗耐受性良好，初始评估后没有进一步的结核病诊断。支持这些结果的关键因素包括为幼儿使用儿科制剂、单药治疗以及基于社区的评估和随访选择。
