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疾病管制局 第三組 Nov. 2009

Tuberculosis in Children who Had Contact with TB --- a Preliminary Evaluation of a National LTBI Program in Taiwan. 疾病管制局 第三組 Nov. 2009. Background.

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疾病管制局 第三組 Nov. 2009

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  1. Tuberculosis in Children who Had Contact with TB --- a Preliminary Evaluation of a National LTBI Program in Taiwan 疾病管制局 第三組 Nov. 2009

  2. Background • Contact tracing program in Taiwan has been strengthened through free-charge policy to all close contacts of confirmed tuberculosis (TB) cases since 2007, July. • Latent TB infection (LTBI) Treatment has been provided to children contacts aged 12 years or younger through directly observed preventive therapy (DOPT) since 2008, April.

  3. Methods • Contact aged 12 years and younger registered and had at least one TST result during Apr. 1, 2008~ May, 30, 2009, 14 months. • The data was obtained from the National Surveillance Network of Communicable Disease (NSNCD), Centers for Disease Control, Taiwan. • All contacts were followed-up until Oct, 7, 2009. • Not analysis if the index case was excluded.

  4. Results A total of 6145 closed contacts aged 12 or younger were followed up Index of 5861 contacts are pulmonary TB 4917 (84%) contacts had very contagious index <smear (+) or culture(+) or CXR with cavitation> 0~4 year: 27% 5~9 year: 46% 10~12 year: 27% 1369(28%) TST>=10mm 3548 (72%) TST<10mm 478 (13.5%) received prophylaxis 857(62.6%) LTBI treatment 512(37%) no LTBI treatment 1845(52%) 2nd TST <461 (96%) > 1703(48%) no 2nd TST (90% on DOPT) 17 prophylaxis already 1686(99%) no further manage 450 (24.4%) conversion 196 start LTBI (10 DC, 4 refused, 2 INH R) 123 already prophylaxis (13 DC, 5 were INH R, 4 AE) 131 no further manage (29%) 1395(75.6%) no conversion 21 start tx (12 then DC) 338 already prophylaxis (327 then DC)

  5. Those Who Developed TB • There were 31 children reported to TCDC in contacts as TB and 16 children were confirmed to be TB: • age 7M~12Y, median 8.5Y, • 6 bacteriology proved, 14 PTB, 2EPTB (one mediastinal only, one neck + mediastinal)

  6. The Distribution of Those with TB Diagnosis 1369(28%) TST>=10mm 3548 (72%) TST<10mm 2 (1*) 478 (13.5%) received prophylaxis 857(62.6%) LTBI treatment 512(37%) no LTBI treatment 1845(52%) 2nd TST <461 (96%) > 1703(48%) no 2nd TST 3 2 8 (4 susp. During contact tracing, 1*) (90% on DOPT) 1 (1*) 17 prophylaxis already 1686(99%) no further manage 450 (24.4%) conversion 196 start LTBI (10 DC, 4 refused, 2 INH R) 123 already prophylaxis (13 DC, 5 were INH R, 4 AE) 131 no further manage (29%) 1395(75.6%) no conversion 21 start tx (12 then DC) 338 already prophylaxis (327 then DC)

  7. If They Received LTBI Treatment Early • The incidence rate of 1379~1562 per 100000 person in those TST (+) but who did not received LTBI. • Overall, six~seven episodes of tuberculosis (38~44%) might be preventable through prophylaxis/LTBI treatment program.

  8. Conclusions • LTBI treatment is recommended for all contact children of contagious pulmonary TB. • Diagnosis and treatment of LTBI has been improving through this national LTBI program. • This preliminary analysis demonstrated that up to 44% of TB cases in children contacts could be prevented if treatment was provided in time.

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