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Ongoing challenges to understanding multidrug and rifampicin-resistant tuberculosis in children versus adults

C. Finn McQuaid, Ted Cohen, Anna S. Dean, Rein M.G.J. Houben, Gwenan M. Knight, Matteo Zignol, Richard G. White
European Respiratory Journal 2020; DOI: 10.1183/13993003.02504-2020
C. Finn McQuaid
1TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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  • For correspondence: finn.mcquaid@lshtm.ac.uk
Ted Cohen
2Yale School of Public Health, Laboratory of Epidemiology and Public Health, New Haven, CT, USA
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Anna S. Dean
3Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
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Rein M.G.J. Houben
1TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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  • ORCID record for Rein M.G.J. Houben
Gwenan M. Knight
1TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Matteo Zignol
3Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
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Richard G. White
1TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Abstract

Previous analyses suggest children with tuberculosis (TB) are no more or no less likely to have multidrug- or rifampicin-resistant TB (MDR/RR-TB) than adults. However, the availability of new data, particularly for high MDR/RR-TB burden countries, suggest updates of country-specific estimates are warranted.

We used data from population-representative surveys and surveillance collected between 2000 and 2018 to compare the odds ratio (OR) of MDR/RR-TB among children (<15 years) with TB, compared to the odds of MDR/RR-TB among adults (≥15 years) with TB.

In most settings (45/55 countries), and globally as a whole, there is no evidence that age is associated with odds of MDR/RR-TB. However, in some settings such as former Soviet Union countries in general, and Georgia, Kazakhstan, Lithuania, Tajikistan and Uzbekistan in particular, as well as Peru, MDR/RR-TB is positively associated with age ≥15. Meanwhile, in Western Europe in general, and the UK, Poland, Finland and Luxembourg in particular, MDR/RR-TB is positively associated with age <15. Sixteen countries had sufficient data to compare over time between 2000–2011 and 2012–2018, with evidence for decreases in the OR in children compared to adults in Germany, Kazakhstan and the USA.

Our results support findings that in most settings a child with TB is as likely as an adult with TB to have MDR/RR-TB. However, setting-specific heterogeneity requires further investigation. Further, the OR for MDR/RR-TB in children compared to adults is generally either stable or decreasing. There are important gaps in detection, recording and reporting of drug resistance among paediatric TB cases, limiting our understanding of transmission risks and measures needed to combat the global TB epidemic.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. McQuaid has nothing to disclose.

Conflict of interest: Dr. Cohen has nothing to disclose.

Conflict of interest: Dr. Dean has nothing to disclose.

Conflict of interest: Dr. Houben has nothing to disclose.

Conflict of interest: Dr. Knight has nothing to disclose.

Conflict of interest: Dr. Zignol has nothing to disclose.

Conflict of interest: Dr. White has nothing to disclose.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received June 25, 2020.
  • Accepted August 6, 2020.
  • Copyright ©ERS 2020
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Ongoing challenges to understanding multidrug and rifampicin-resistant tuberculosis in children versus adults
C. Finn McQuaid, Ted Cohen, Anna S. Dean, Rein M.G.J. Houben, Gwenan M. Knight, Matteo Zignol, Richard G. White
European Respiratory Journal Jan 2020, 2002504; DOI: 10.1183/13993003.02504-2020

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Ongoing challenges to understanding multidrug and rifampicin-resistant tuberculosis in children versus adults
C. Finn McQuaid, Ted Cohen, Anna S. Dean, Rein M.G.J. Houben, Gwenan M. Knight, Matteo Zignol, Richard G. White
European Respiratory Journal Jan 2020, 2002504; DOI: 10.1183/13993003.02504-2020
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