Current Diagnosis and Treatment of Pediatric Latent Tuberculosis Infection

Treatment completion and safety profile of once-weekly 3HP regimen for tuberculosis preventive treatment in children and adolescents: a systematic review

BACKGROUND

Children and adolescents are at increased risk of progressing from latent to active tuberculosis (TB). The 3-month, once-weekly isoniazid and rifapentine (3HP) regimen offers a shorter tuberculosis preventive treatment (TPT) option. However, evidence regarding its completion rates and safety in these populations remains limited.

OBJECTIVE

To evaluate treatment completion rates and adverse events associated with the 3HP regimen in children and adolescents.

METHODS

A systematic review of studies evaluated the 3HP regimen in children and adolescents with LTBI was conducted. Databases including PubMed, Embase, Cochrane Library, and CINAHL were searched to identify relevant studies. Data on treatment completion rates and adverse events were extracted and analyzed descriptively.

RESULTS

Ten studies involving children and adolescents aged 0-20 years were reviewed. Treatment completion rates were higher with 3HP regimen ranged from 70.9 to 100%, with a favorable safety profile. Mild adverse events, including nausea, vomiting, and abdominal pain, were reported, with no serious adverse events or hepatotoxicity observed.

CONCLUSIONS

The 3HP regimen demonstrates high completion rates and safety profile in children and adolescents with LTBI, highlighting its suitability for this population. Expanding its implementation in programmatic settings is crucial to advancing global TB elimination.

Variation in Treatment of Pediatric Tuberculosis Infection in Different Provider Settings

OBJECTIVES

To evaluate implementation of rifamycin-based regimens (RBR) for pediatric tuberculosis infection (TBI) treatment among 3 provider settings in a high-incidence county.

STUDY DESIGN

A multicenter, retrospective observational study was performed across 3 sites in Los Angeles County: an academic center (AC), a general pediatrics federally qualified health center (FQHC), and department of public health (DPH) tuberculosis clinics. Patients initiated on TBI treatment age 1 months to 17 years between 2018 and 2020 were included. RBRs were defined as regimens: 3 months of weekly rifapentine and isoniazid, 4 months of daily rifampin, and 3 months of daily isoniazid and rifampin.

RESULTS

We included 424 patients: 51 from AC, 327 from DPH, and 46 from FQHC. RBR use nearly doubled during the study period (from 43% in 2018 to 82% in 2020; P < .001). FQHC had the shortest time to chest radiograph and treatment initiation; however, AC and DPH were 4 times as likely to prescribe an RBR compared to FQHC (95% CI, 2.1-7.8). AC and DPH had similar completion rates (74%) and were 2.6 times as likely to complete treatment compared to FQHC (95% CI, 1.4-4.9).

CONCLUSIONS

The use of RBRs for pediatric TBI varies significantly by clinical setting but is improving over time. Strategies are needed to improve RBR uptake, standardize care, and increase treatment completion, particularly among general pediatricians.

Latent tuberculosis may be missed by current screening practices: Analysis of interferon-gamma release assay results from a paediatric refugee clinic

AIMS

(i) To determine the prevalence of latent tuberculosis infection (LTBI) and characteristics associated with LTBI in children attending a paediatric refugee clinic and (ii) to determine whether current New South Wales (NSW) Health screening practices could miss LTBI cases.

METHODS

This was a retrospective analysis of tuberculosis (TB) screening data from refugee and asylum seeker children who attended a refugee clinic in a tertiary children's hospital during 2014 and 2015. We determined associations between LTBI and child characteristics at 5% significance levels.

RESULTS

Of 358 children attending the clinic, 235 children (66%) received interferon-gamma release assay (IGRA) testing, of whom 28 (11.9%) had positive results. Of the 28 with positive IGRAs, 12 (42.9%) would have been missed using NSW Health screening guidelines: two because they were younger than 2 years old, one who was born in Australia and 10 because they were not born in high TB incidence countries. IGRA results were not significantly associated with any of the child characteristics examined, including age, gender, travel through transit countries, boat versus plane arrival into Australia, whether the child had been in a detention centre or TB incidence in the source country.

CONCLUSIONS

We identified 12 children with LTBI who would have been missed using current NSW Health Department screening practices. These children are at risk of progression to active disease, particularly the two aged younger than 2 years old. We recommend universal screening.