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Global isoniazid-resistant TB cases in children varies widely
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More than 120,000 children worldwide are estimated to become infected with isoniazid-resistant forms of tuberculosis annually, with the greatest proportion occurring in Europe, according to study results.
“We present the first global and regional estimates of the proportion of children with TB who have isoniazid-resistant disease, showing large geographic variations in risk of resistance,” Courtney M. Yuen, PhD, of the division of global health equity at Brigham and Women’s Hospital, and colleagues wrote. “The large number of child cases signals extensive ongoing transmission from adults with isoniazid-resistant TB. The risk of isoniazid-resistance must be considered when evaluating treatment options for children with disease or latent infection to avoid inadequate treatment and consequent poor outcomes.”
Yuen and colleagues sought to estimate the proportion of children with isoniazid-resistant TB and incident isoniazid-resistant TB cases in children by region. They conducted a systemic literature review to assess the association between rates of isoniazid-resistance among children vs. treatment-naive adults.
The analysis included 32 countries and territories, with a median of 14 children per study. The researchers estimated that 12.1% (95% CI, 9.8%-14.85) of all children with TB had isoniazid-resistant disease. This corresponded to 120,872 (95% CI, 96,628-149,059) incident cases of isoniazid-resistant TB in children during 2010. The majority of cases were estimated to occur in the Western Pacific and Southeast Asia. The highest proportions of child isoniazid-resistant TB cases were estimated to occur in the European region (26.1%; 95% CI, 20%-33.6%).
“Our findings have critical implications for the diagnosis and treatment of both TB disease and infection,” Yuen and colleagues wrote. “The scope and regional variation of the problem underline the importance of understanding the local epidemiology of isoniazid-resistant TB and the drug-resistant profiles of adult cases, which are the likely source cases for the children around them.” – by Jennifer Southall
Disclosure: Yuen reports receiving salary support through a grant from Janssen to Harvard Medical School. The study was funded by a grant from Janssen to Harvard Medical School and by an NIH award. Please the see the full study for a list of all other authors’ relevant financial disclosures.
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