Research article

Childhood TB epidemiology and treatment outcomes in Thailand: a TB active surveillance network, 2004 to 2006

Rangsima Lolekha¹ , Amornrat Anuwatnonthakate² , Sriprapa Nateniyom³ , Surin Sumnapun⁴ , Norio Yamada⁵ , Wanpen Wattanaamornkiat⁶ , Wanchai Sattayawuthipong⁷ , Pricha Charusuntonsri⁸ , Natpatou Sanguanwongse⁹ , Charles D Wells¹⁰ and Jay K Varma^2,10

¹  Global AIDS Program, Thailand MOPH – U.S. CDC Collaboration, Nonthaburi, Thailand

²  TB Program, Thailand MOPH – U.S. CDC Collaboration, Nonthaburi, Thailand

³  Bureau of TB, Thailand Ministry of Public Health, Nonthaburi, Thailand

⁴  Chiang Rai Provincial Public Health Office, Chiang Rai, Thailand

⁵  Research Institute of Tuberculosis (Japan), Chiang Rai, Thailand

⁶  AIDS, TB, STI and Leprosy Section, Office of Disease Prevention and Control 7, Ubon-ratchathani, Thailand

⁷  Phuket Provincial Public Health Office, Phuket, Thailand

⁸  Health Center 41, Bangkok Metropolitan Health Administration, Bangkok, Thailand

⁹  Medicine Department, Bamrasnaradura Institute, Nonthaburi, Thailand

¹⁰  Division of TB Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, USA

author email corresponding author email

BMC Infectious Diseases 2008, 8:94doi:10.1186/1471-2334-8-94

Published:	18 July 2008

Abstract

Background

Of the 9.2 million new TB cases occurring each year, about 10% are in children. Because childhood TB is usually non-infectious and non-fatal, national programs do not prioritize childhood TB diagnosis and treatment. We reviewed data from a demonstration project to learn more about the epidemiology of childhood TB in Thailand.

Methods

In four Thai provinces and one national hospital, we contacted healthcare facilities monthly to record data about persons diagnosed with TB, assist with patient care, provide HIV counseling and testing, and obtain sputum for culture and susceptibility testing. We analyzed clinical and treatment outcome data for patients age < 15 years old registered in 2005 and 2006.

Results

Only 279 (2%) of 14,487 total cases occurred in children. The median age of children was 8 years (range: 4 months, 14 years). Of 197 children with pulmonary TB, 63 (32%) were bacteriologically-confirmed: 56 (28%) were smear-positive and 7 (4%) were smear-negative, but culture-positive. One was diagnosed with multi-drug resistant TB. HIV infection was documented in 75 (27%). Thirteen (17%) of 75 HIV-infected children died during TB treatment compared with 4 (2%) of 204 not known to be HIV-infected (p < 0.01).

Conclusion

Childhood TB is infrequently diagnosed in Thailand. Understanding whether this is due to absence of disease or diagnostic effort requires further research. HIV contributes substantially to the childhood TB burden in Thailand and is associated with high mortality.