Microscopic image of rod-shaped Mycobacterium tuberculosis in digital form. Credit: CDC NIAID

According to a new model study published in the study, one in five cases of multidrug-resistant tuberculosis (MDR-TB) in children under the age of 15 can be prevented by managing household contact. The Lancet Global Health.

A study by the London School of Hygiene and Tropical Medicine (LSHTM), the University of Sheffield and Imperial College London shows that this testing and treatment strategy can prevent up to 3950 deaths and 5870 cases in children under the age of 15. He also suggests tracking people’s home contact with MDR-TB is likely to be cost-effective in most places with high TB ​​prevalence.

Contact management, which includes working with TB patients to encourage their home contacts to TB screening and suggestions preventive treatment for those eligible, not implemented as often as one would like. The reasons for this are complex. In many countries with limited resources, management of household contacts is not considered a priority, as many TB control programs are mainly focused on the treatment of TB patients who are symptomatic and are in medical settings. In addition, instructions on how to manage contact with MDR-TB are conflicting and based on poor quality evidence.

Scientists say the study could be a turning point in showing the effectiveness of this strategy in terms of its low cost and significant impact on disease and death prevention.

Dr Finn McQueed, an associate professor at LSHTM and one of the study’s authors, said: “Children are a marginalized group in TB treatment and are very vulnerable to MDR-TB. the difference. Our work has shown that these interventions can be cost-effective in most countries. “

Recent WHO estimates show that more than a million children get TB each year, but only about half of them are diagnosed and treated. Nearly a quarter of children with tuberculosis die; almost all of them are undiagnosed, making tuberculosis the leading cause of infant mortality. Of the 30,000 estimated to have MDR-TB, only about 15% are diagnosed, and those who do not treat also have a high risk of death. However, with proper treatment, the results of MDR-TB are very good.

Exact figures on the extent to which TB transmission may be related to household infection are unknown, but estimates range from 10% to 30%, with no data on MDR-TB. This is likely to have increased as a result of the COVID-19 pandemic: more time spent at home and fewer people diagnosed. The percentage of cases of household infection is much lower for adults.

The study used mathematical modeling to look at the impact and cost-effectiveness for 213 countries of tracking children’s contact with MDR-TB to find out if they have TB, and to suggest preventative treatment for contacts who are not sick but at risk.

Dr McQuaid said: “This paper can provide guidance for policymakers who choose TB intervention methods, such as contact tracking and preventive treatment, given which schemes and to whom to provide. He emphasizes how the relative importance of these elements varies by setting.” .

Dr James Sedon, a reader at Global Child Health at Imperial and another co-author of the study, added: “International and national decision-makers can use our findings to advocate for better as well as more focused and relevant interventions when it comes to housekeeping MDR-TB and preventive treatment ”.

As the main recipients of TB prevention treatment, this study was limited to children. However, the high cost of MDR-TB treatment means that this intervention can be cost-effective for adults as well.

Dr Seddon said: “I would like to see research funders and national TB programs use this study to motivate further research in specific settings to determine whether MDR-TB management can be a useful tool for weight loss MDR-TV in children.

The authors acknowledge the limitations of the study, including the fact that the impact of the intervention on preventing further transmission of Mycobacterium tuberculosis was not considered. This will further increase benefits and profitability. The study, however, provided for maximum coverage of the intervention, which may be unattainable in practice.

Children and adults can transmit SARS-CoV-2 household

Additional information:
Peter J. Dodd et al., Global Impact of Home Contact Management for Children on Multiple Drug Tuberculosis and Rifampicin Resistance, Death and Health Care Costs in 2019: A Modeling Study The Lancet Global Health (2022). DOI: 10.1016 / S2214-109X (22) 00113-9

Citation: 20% of cases of multidrug-resistant tuberculosis in children could have been prevented by examination and treatment at home (May 20, 2022, May 20), obtained May 20, 2022 from https://medicalxpress.com/news/2022 -05-multi-drug- resistance-tuberculosis-cases-children-averted.html

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