Paediatrics (RCH) - Research Publications

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    Tuberculosis in adolescents and young adults: epidemiology and treatment outcomes in the Western Cape
    Snow, K ; Hesseling, AC ; Naidoo, P ; Graham, SM ; Denholm, J ; du Preez, K (INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D), 2017-06-01)
    SETTING: Western Cape Province, South Africa. OBJECTIVES: To characterise tuberculosis (TB) epidemiology, disease presentation and treatment outcomes among adolescents (age 10-19 years) and young adults (age 20-24 years) in the Western Cape. DESIGN: A retrospective, cross-sectional review of routine patient-level data from the Electronic TB Register (ETR.Net) for 2013. Site of TB disease, human immunodeficiency virus (HIV) status and TB treatment outcomes were analysed by 5-year age groups (<5, 5-9, 10-14, 15-19, 20-24 and 25 years of age). TB notification rates were calculated using census data. RESULTS: Adolescents and young adults comprised 18.0% of all new TB notifications in 2013. The notification rate was 141 TB cases/100 000 person-years (py) among 10-14 year olds, 418/100 000 py among 15-19 year olds and 627/100 000 py among 20-24 year olds. HIV prevalence among TB patients was 10.9% in 10-14 year olds, 8.8% in 15-19 year olds and 27.2% in 20-24 year olds. Older adolescents (age 15-19 years) and young adults (age 20-24 years) with HIV co-infection had poor treatment outcomes: 15.6% discontinued treatment prematurely and 4.0% died. CONCLUSIONS: Young people in the Western Cape suffer a substantial burden of TB, and those with TB-HIV co-infection are at high risk of treatment discontinuation.
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    Tuberculosis in pregnant women and neonates: A meta-review of current evidence
    Snow, KJ ; Bekker, A ; Huang, GK ; Graham, SM (Elsevier BV, 2020)
    Pregnant women and their infants are a vulnerable but neglected population in tuberculosis (TB) control efforts. Recent advances in TB prevention, diagnosis and treatment have implications for their care, despite their frequent exclusion from research. We have conducted a meta-review of current evidence and clinical guidelines for TB prevention, diagnosis and management in pregnant women and neonates, focusing on review articles published since 2010. The actual burden of TB in pregnancy is unmeasured, but has been estimated at 216,500 cases per year. Although the effect of pregnancy on TB risk is uncertain and controversial, two large whole-of-population studies found that pregnancy was associated with a two- to three-fold increase in risk of TB. Congenital TB is rare but extremely serious. Neonates exposed to TB after delivery will be at high risk of disease, and preventive therapy is recommended once disease has been ruled out. At present, there is limited evidence regarding the performance of different screening strategies for pregnant women, appropriate drug dosing for either pregnant women or neonates, and the safety of most second-line drugs in pregnancy. High quality evidence on these topics is needed, as are detailed guidelines to inform efforts by TB control programs and clinicians working with pregnant women and their infants.
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    Adolescent tuberculosis
    Snow, KJ ; Cruz, AT ; Seddon, JA ; Ferrand, RA ; Chiang, SS ; Hughes, JA ; Kampmann, B ; Graham, SM ; Dodd, PJ ; Houben, RM ; Denholm, JT ; Sawyer, SM ; Kranzer, K (ELSEVIER SCI LTD, 2020-01-01)
    Adolescence is characterised by a substantial increase in the incidence of tuberculosis, a known fact since the early 20th century. Most of the world's adolescents live in low-income and middle-income countries where tuberculosis remains common, and where they comprise a quarter of the population. Despite this, adolescents have not yet been addressed as a distinct population in tuberculosis policy or within tuberculosis treatment services, and emerging evidence suggests that current models of care do not meet their needs. This Review discusses up-to-date information about tuberculosis in adolescence, with a focus on the management of infection and disease, including HIV co-infection and rifampicin-resistant tuberculosis. We outline the progress in vaccine development and highlight important directions for future research.
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    Explaining variation in the burden of child and adolescent tuberculosis
    Snow, KJ ; Sawyer, SM ; Denholm, JT ; Graham, SM (European Respiratory Society, 2019-06)
    We read with interest the recent publication by Chen et al regarding the burden of notified tuberculosis (TB) among adolescents and young adults in Taiwan[1]. The authors report that 10-24 year olds constituted only 5.2% of all newly diagnosed TB patients in Taiwan from 2005 to 2016, and that this percentage declined from around 6% in 2005 to around 4% in 2016. They contrast these figures with our estimate that young people constitute 17% of all people developing incident TB globally in 2012[2]. There are several factors that explain this apparently large discrepancy.
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    Tuberculosis among children, adolescents and young adults in the Philippines: a surveillance report
    Snow, K ; Yadav, R ; Denholm, J ; Sawyer, S ; Graham, S (WORLD HEALTH ORGANIZATION, REGIONAL OFFICE WESTERN PACIFIC, 2018-10-01)
    The Philippines, a country with a young population, is currently experiencing an intense and persistent tuberculosis epidemic. We analysed patient-based national surveillance data to investigate the epidemiology of reported tuberculosis among children (aged 0-9 years), adolescents (aged 10-19 years) and young adults (aged 20-24 years) to better understand the burden of disease and treatment outcomes in these age groups. Descriptive analyses were performed to assess age-related patterns in notifications and treatment outcomes. Data quality was assessed against international benchmarks at the national and regional levels. Overall, 27.3% of tuberculosis notifications for the Philippines in 2015 pertained to children, adolescents and young adults aged 0-24 years. Treatment outcomes were generally favourable, with 81% of patients being cured or completing treatment. The data quality assessment revealed substantial regional variation in some indicators and suggested potential underdetection of tuberculosis in children aged 0-4 years. Children, adolescents and young adults in the Philippines constitute a substantial proportion of patients in the national tuberculosis surveillance data set. Long-term progress against tuberculosis in the Philippines relies on improving the control of tuberculosis in these key age groups.
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    Incidence and prevalence of bacteriologically confirmed pulmonary tuberculosis among adolescents and young adults: a systematic review
    Snow, KJ ; Nelson, LJ ; Sismanidis, C ; Sawyer, SM ; Graham, SM (CAMBRIDGE UNIV PRESS, 2018-06-01)
    The burden of tuberculosis (TB) among adolescents and young adults in endemic settings is poorly characterised. This study aimed to review published and unpublished estimates of the incidence and prevalence of bacteriologically confirmed TB among young people aged 10-24 years. We searched PubMed and World Health Organization archives for publications and unpublished data from population-based epidemiologic studies reporting confirmed pulmonary TB among young people, conducted from January 2000 onwards. We identified 27 publications and unpublished data from two national surveys, representing a total of 26 studies in 19 countries. The prevalence of bacteriologically confirmed TB ranged from 45 to 799 per 100 000 in the Asia-Pacific region and from 160 to 462 per 100 000 in African settings. We did not identify any epidemiologic studies of confirmed TB among adolescents living with human immunodeficiency virus (HIV). Many studies were excluded due to absent or inadequately reported age-specific data. Adolescents and young adults living in many endemic settings appear to be at substantial risk of developing active TB. There is a pressing need to improve the routine reporting of age in epidemiologic studies of TB, and to generate high-quality epidemiologic data regarding TB among adolescents living with HIV.
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    The incidence of tuberculosis among adolescents and young adults: a global estimate
    Snow, KJ ; Sismanidis, C ; Denholm, J ; Sawyer, SM ; Graham, SM (EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2018-02-01)
    Historical data show that the risk of tuberculosis increases dramatically during adolescence, and young people face unique challenges in terms of case detection and effective treatment. However, little is known about the burden of tuberculosis among young people in the modern era. This study aimed to provide the first estimates of the global and regional incidence of tuberculosis among young people aged 10-24 years.Using the World Health Organization (WHO) database of tuberculosis notifications for 2012, we estimated the burden of tuberculosis among young people by WHO region. Adjustments were made for incomplete age disaggregation and underreporting, using supplementary data from several countries representing diverse tuberculosis epidemics.We estimate that 1.78 million (uncertainty interval (UI) 1.23-3.00 million) young people developed tuberculosis in 2012, accounting for 17% of all new tuberculosis cases globally. Young people in the WHO South East Asian Region (721 000, UI 473 000-1.35 million) and the WHO African Region (534 000, UI 359 000-912 000) experienced the greatest number of tuberculosis episodes.Young people suffer a considerable burden of tuberculosis. Age-specific burden of disease estimation for this age group is complicated by incomplete age disaggregation of tuberculosis data, highlighting the importance of continued surveillance system strengthening.