Beruflich Dokumente
Kultur Dokumente
Children and
Young Adults
DR JOYCE M KADUCU
Objectives
4 3.5
Under age 5
3 2.3 2.2 Over age 5
2 1.5
1.1 0.9
1
0
I S a ir a s
A
R ID e TB l e
A rh l a s
i ar M
a e a
D M
WHO Report 2000
TB in Children
WHO estimate of TB in children
1.3 million annual cases
450,000 deaths
15% of TB in low-income countries
children vs. 6% in United States
Childhood TB as Sentinel Event
Indicates recent transmission in a
community
Rapid progression from infection to
disease
A deterioration in the control of TB thus
immediately hurts the youngest generation
(Rieder, 1997)
Children are future reservoir of disease
Rieder H. Anales Nestle, 1997
700
Male
600 Female
Per 100,000 population
500
400
300
200
100
0
<1 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54
Age (years)
Effect of HIV?
Childhood TB diagnosed by:
Combination of :
Contact with infectious adult case
Symptoms and signs
Positive tuberculin skin test
Suspicious CXR
Bacteriological confirmation
Serology
Risk factors : infection to disease
HIV
Malnutrition
Recent exposure
Young age
Short incubation period
More severe
Highest risk
More difficult to diagnose
Host factors
Effect of HIV?
Risk of Progression to Disease
Age
43% in infants (children < 1year)
25% in children aged one to five years
15% in adolescents
10% in adults
Recent Infection
Malnutrition
Immunosuppression, particularly HIV
Miller, 1963
Challenges for Surveillance
600
400
200