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Symptom-based screening of child tuberculosis contacts: improved feasibility in resource-limited settings.
Pediatrics. 2008 Jun; 121(6):e1646-52.OBJECTIVE: National tuberculosis programs in tuberculosis-endemic countries rarely implement active tracing and screening of child tuberculosis contacts, mainly because of resource constraints. We aimed to evaluate the safety and feasibility of applying a simple symptom-based approach to screen child tuberculosis contacts for active disease. METHODS: We conducted a prospective observational study from January through December 2004 at 3 clinics in Cape Town, South Africa. All of the children <5 years old in household contact with an adult tuberculosis source case were assessed by documenting current symptoms and tuberculin skin test and chest radiograph results. RESULTS: During the study period, 357 adult tuberculosis cases were identified; 195 cases (54.6%) had sputum smear and/or culture positive results and were in household contact with children aged <5 years. Complete information was available for 252 of 278 children; 176 (69.8%) were asymptomatic at the time of screening. Tuberculosis treatment was administered to 33 (13.1%) of 252; 27 were categorized as radiologically "certain tuberculosis," the majority (n = 22) of which had uncomplicated hilar adenopathy. The negative predictive value of symptom-based screening varied according to the case definition used, with 95.5% including all of the children treated for tuberculosis and 97.1% including only those with radiologically "certain tuberculosis." CONCLUSIONS: Our findings support current World Health Organization recommendations, demonstrating that symptom-based screening of child tuberculosis contacts should improve feasibility in resource-limited settings and seems to be safe.
Chronicles. 1983 Jun; 3(1):11-4.Analyzes the anti-tuberculosis (BCG) vaccine controversy. The vaccine was highly controversial at the beginning due to difficulties in standardization, maintenance of efficacy, and in the methods of applying the vaccine. Nevertheless, BCG gained increasing acceptance and is used widely in France, Germany, Norway, Sweden and Japan. It is also 1 of the vaccines regularly employed in the worldwide immunization campaign of the World Health Organization. A number of well controlled prospective studies have been done in the last 50 years in several countries to determine the efficacy of BCG. The studies give contradictory results which may prove that under certain conditions, BCG has a clear protective effect against infection from human virulent tubercle bacilli. The 1982 evaluation after 10 years showed a 45% protective efficacy. On the basis of an extended review of BCG vaccination, it is recommended that the use of BCG be continued. However, there are situations where the effectiveness of BCG cannot be predicted with certainty, and it is recommended that every effort be made to identify local factors that may modify the outcome of BCG vaccination. The worldwide tuberculosis problem presents differing patterns in different countries, making a single recommendation for all situations unwise. The BCG program chosen should be based on the epidemiological situation in each country. The authors conclude that BCG vaccination, together with chemoprophylaxis and chemotherapy, can play an important role in controlling tuberculosis, which still constitutes 1 of the major world health problems. (summaries in SPA, POR, ARA)