Pub Date : 2025-01-01DOI: 10.1016/S2352-4642(24)00301-8
Ilan Cerna-Turoff , Karen M Devries
{"title":"End violence against children and adolescents: integrate climate policy into the 2030 SDGs","authors":"Ilan Cerna-Turoff , Karen M Devries","doi":"10.1016/S2352-4642(24)00301-8","DOIUrl":"10.1016/S2352-4642(24)00301-8","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Pages 7-8"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>A resurgence of pertussis has increased the demand for low-cost vaccines. The aim of this study was to test the immunogenicity of a booster acellular monovalent pertussis vaccine containing reduced-dose (2 μg) recombinant pertussis toxin (PT) and 5 μg filamentous haemagglutinin (FHA; ap<sub>gen</sub>) against a version of ap<sub>gen</sub> containing tetanus and reduced-dose diphtheria toxoids (Tdap<sub>gen</sub>) and a licensed vaccine containing chemically detoxified PT and FHA combined with tetanus toxoid and reduced-dose diphtheria toxoid (Tdap<sub>chem</sub>).</div></div><div><h3>Methods</h3><div>This phase 2/3, observer-blinded, randomised, controlled, non-inferiority trial was done in adolescents aged 9–17 years at two clinical research centres in Bangkok and Pathum Thani, Thailand. Eligible participants were screened and randomly assigned (1:1:1) to receive one booster dose of ap<sub>gen</sub>, Tdap<sub>gen</sub>, or Tdap<sub>chem</sub> vaccine. Participants were followed up until day 336 post-immunisation. The primary endpoint was non-inferior seroconversion rates in Tdap<sub>gen</sub> and Tdap<sub>chem</sub> vaccine groups, with seroconversion rate defined as the proportion of participants with at least a four-fold increase on day 28 post-immunisation relative to baseline of anti-PT and anti-FHA IgG. The non-inferiority for seroconversion rates of anti-PT and anti-FHA IgG was defined as the lower bound of the two-sided 95% CI of the seroconversion rate for Tdap<sub>gen</sub> compared with Tdap<sub>chem</sub> exceeding −10%. Immunogenicity was analysed in the per-protocol population. All safety data were collected, and the prevalence of adverse events was analysed in the intention-to-treat population. This trial was registered on the Thai Clinical Trial Registry (TCTR20181031001).</div></div><div><h3>Findings</h3><div>Between June 18, and Aug 3, 2019, 450 adolescents (mean age 12·1 years, SD 2·5) were enrolled and randomly assigned (150 participants in each group). Day 28 anti-PT IgG seroconversion rates were 141 (94%) of 150 participants who received Tdap<sub>gen</sub> (95% CI 88·8–97·0) and 105 (71%) of 149 participants who received Tdap<sub>chem</sub> (62·7–77·2; p<0·0001). Day 28 anti-FHA IgG seroconversion rates were 144 (96%) of 150 participants who received Tdap<sub>gen</sub> (91·4–98·3) and 124 (83%) of 149 participants who received Tdap<sub>chem</sub> (76·4–88·4; p<0·0001). The difference in seroconversion rates was 23·5% (95% CI 15·3–31·8) for anti-PT IgG and 12·8% (6·0–19·6) for anti-FHA IgG, when comparing the Tdap<sub>gen</sub> versus the Tdap<sub>chem</sub> vaccine group. No vaccine-related serious adverse events were reported.</div></div><div><h3>Interpretation</h3><div>Recombinant Tdap<sub>gen</sub> vaccine showed non-inferior immunogenicity compared with Tdap<sub>chem</sub> at day 28 in terms of seroconversion rate of anti-PT IgG and anti-FHA IgG relative to baseline. The reduced-dose ap
{"title":"A reduced-dose recombinant pertussis vaccine booster in Thai adolescents: a phase 2/3, observer-blinded, randomised controlled, non-inferiority trial","authors":"Prof Thanyawee Puthanakit MD , Auchara Tangsathapornpong MD , Suvaporn Anugulruengkitt PhD , Rapisa Nantanee MD , Pornumpa Bunjoungmanee MD , Souad Mansouri PhD , Librada Fortuna MD , Wassana Wijagkanalan PhD , Terapong Tantawichien MD , TDA205 study team","doi":"10.1016/S2352-4642(24)00173-1","DOIUrl":"10.1016/S2352-4642(24)00173-1","url":null,"abstract":"<div><h3>Background</h3><div>A resurgence of pertussis has increased the demand for low-cost vaccines. The aim of this study was to test the immunogenicity of a booster acellular monovalent pertussis vaccine containing reduced-dose (2 μg) recombinant pertussis toxin (PT) and 5 μg filamentous haemagglutinin (FHA; ap<sub>gen</sub>) against a version of ap<sub>gen</sub> containing tetanus and reduced-dose diphtheria toxoids (Tdap<sub>gen</sub>) and a licensed vaccine containing chemically detoxified PT and FHA combined with tetanus toxoid and reduced-dose diphtheria toxoid (Tdap<sub>chem</sub>).</div></div><div><h3>Methods</h3><div>This phase 2/3, observer-blinded, randomised, controlled, non-inferiority trial was done in adolescents aged 9–17 years at two clinical research centres in Bangkok and Pathum Thani, Thailand. Eligible participants were screened and randomly assigned (1:1:1) to receive one booster dose of ap<sub>gen</sub>, Tdap<sub>gen</sub>, or Tdap<sub>chem</sub> vaccine. Participants were followed up until day 336 post-immunisation. The primary endpoint was non-inferior seroconversion rates in Tdap<sub>gen</sub> and Tdap<sub>chem</sub> vaccine groups, with seroconversion rate defined as the proportion of participants with at least a four-fold increase on day 28 post-immunisation relative to baseline of anti-PT and anti-FHA IgG. The non-inferiority for seroconversion rates of anti-PT and anti-FHA IgG was defined as the lower bound of the two-sided 95% CI of the seroconversion rate for Tdap<sub>gen</sub> compared with Tdap<sub>chem</sub> exceeding −10%. Immunogenicity was analysed in the per-protocol population. All safety data were collected, and the prevalence of adverse events was analysed in the intention-to-treat population. This trial was registered on the Thai Clinical Trial Registry (TCTR20181031001).</div></div><div><h3>Findings</h3><div>Between June 18, and Aug 3, 2019, 450 adolescents (mean age 12·1 years, SD 2·5) were enrolled and randomly assigned (150 participants in each group). Day 28 anti-PT IgG seroconversion rates were 141 (94%) of 150 participants who received Tdap<sub>gen</sub> (95% CI 88·8–97·0) and 105 (71%) of 149 participants who received Tdap<sub>chem</sub> (62·7–77·2; p<0·0001). Day 28 anti-FHA IgG seroconversion rates were 144 (96%) of 150 participants who received Tdap<sub>gen</sub> (91·4–98·3) and 124 (83%) of 149 participants who received Tdap<sub>chem</sub> (76·4–88·4; p<0·0001). The difference in seroconversion rates was 23·5% (95% CI 15·3–31·8) for anti-PT IgG and 12·8% (6·0–19·6) for anti-FHA IgG, when comparing the Tdap<sub>gen</sub> versus the Tdap<sub>chem</sub> vaccine group. No vaccine-related serious adverse events were reported.</div></div><div><h3>Interpretation</h3><div>Recombinant Tdap<sub>gen</sub> vaccine showed non-inferior immunogenicity compared with Tdap<sub>chem</sub> at day 28 in terms of seroconversion rate of anti-PT IgG and anti-FHA IgG relative to baseline. The reduced-dose ap","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Pages 900-909"},"PeriodicalIF":19.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/S2352-4642(24)00255-4
Prof Akash Deep MD , Emma C Alexander MBBS , Joe Brierley MBChB , Mihaela Damian MD , Anish Gupta MBBS , Valerie McLin MD , Moinak Sen Sarma MBBS , James E Squires MD , Barbara E Wildhaber MD
Paediatric acute liver failure is a devastating condition with high morbidity and mortality, which is challenging to manage for the hepatologist, intensivist, and associated specialists. Emergency liver transplantation is required for 10–20% of patients, but for 10% of critically ill children, liver transplantation is deemed unsuitable; the child might be too unwell, or the underlying cause might carry a poor prognosis. Other social, logistical, or ethical considerations are often relevant. Liver transplantation when a patient is too unwell creates perioperative risk to the child that could lead to morbidity, mortality, and potential graft wastage, which is detrimental for others on the waiting list. Donor liver scarcity should prompt an evaluation of whether a transplant is justified through a holistic multidisciplinary lens that considers medical, social, logistical, and ethical concerns. In this Review, we explore, from a multidisciplinary perspective, why a critically unwell child with paediatric acute liver failure might be unsuitable for liver transplantation.
{"title":"Paediatric acute liver failure: a multidisciplinary perspective on when a critically ill child is unsuitable for liver transplantation","authors":"Prof Akash Deep MD , Emma C Alexander MBBS , Joe Brierley MBChB , Mihaela Damian MD , Anish Gupta MBBS , Valerie McLin MD , Moinak Sen Sarma MBBS , James E Squires MD , Barbara E Wildhaber MD","doi":"10.1016/S2352-4642(24)00255-4","DOIUrl":"10.1016/S2352-4642(24)00255-4","url":null,"abstract":"<div><div>Paediatric acute liver failure is a devastating condition with high morbidity and mortality, which is challenging to manage for the hepatologist, intensivist, and associated specialists. Emergency liver transplantation is required for 10–20% of patients, but for 10% of critically ill children, liver transplantation is deemed unsuitable; the child might be too unwell, or the underlying cause might carry a poor prognosis. Other social, logistical, or ethical considerations are often relevant. Liver transplantation when a patient is too unwell creates perioperative risk to the child that could lead to morbidity, mortality, and potential graft wastage, which is detrimental for others on the waiting list. Donor liver scarcity should prompt an evaluation of whether a transplant is justified through a holistic multidisciplinary lens that considers medical, social, logistical, and ethical concerns. In this Review, we explore, from a multidisciplinary perspective, why a critically unwell child with paediatric acute liver failure might be unsuitable for liver transplantation.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Pages 921-932"},"PeriodicalIF":19.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/S2352-4642(24)00312-2
Mark Tomlinson , James Radner
{"title":"Children are not future producers and customers: a plea for the moral imperative of acting now","authors":"Mark Tomlinson , James Radner","doi":"10.1016/S2352-4642(24)00312-2","DOIUrl":"10.1016/S2352-4642(24)00312-2","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 3","pages":"Pages 152-153"},"PeriodicalIF":19.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142694084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The rates of most paediatric infectious diseases declined during the initial phase of the COVID-19 pandemic due to the implementation of non-pharmaceutical interventions. However, after the gradual release of these interventions, resurgences of infections occurred with notable variations in incidence, clinical manifestations, pathogen strains, and age distribution. This Review seeks to explore these changes and the rare clinical manifestations that were made evident during the resurgence of known childhood infections. The magnitude of resurgences was possibly caused by a profound population immunity debt to specific pathogens in combination with the coinciding reappearance of viral and bacterial infections, rather than novel pathogen variants, increased antimicrobial resistance, or altered childhood immune function. As the usual patterns of paediatric infectious diseases were disrupted during the COVID-19 pandemic, the consequences of a population immunity debt were unravelled, and new insights into pathogen transmissibility, disease pathogenesis, and rare clinical manifestations were revealed.
{"title":"The pattern of childhood infections during and after the COVID-19 pandemic","authors":"Ulrikka Nygaard PhD , Mette Holm PhD , Prof Helena Rabie PhD , Maren Rytter PhD","doi":"10.1016/S2352-4642(24)00236-0","DOIUrl":"10.1016/S2352-4642(24)00236-0","url":null,"abstract":"<div><div>The rates of most paediatric infectious diseases declined during the initial phase of the COVID-19 pandemic due to the implementation of non-pharmaceutical interventions. However, after the gradual release of these interventions, resurgences of infections occurred with notable variations in incidence, clinical manifestations, pathogen strains, and age distribution. This Review seeks to explore these changes and the rare clinical manifestations that were made evident during the resurgence of known childhood infections. The magnitude of resurgences was possibly caused by a profound population immunity debt to specific pathogens in combination with the coinciding reappearance of viral and bacterial infections, rather than novel pathogen variants, increased antimicrobial resistance, or altered childhood immune function. As the usual patterns of paediatric infectious diseases were disrupted during the COVID-19 pandemic, the consequences of a population immunity debt were unravelled, and new insights into pathogen transmissibility, disease pathogenesis, and rare clinical manifestations were revealed.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Pages 910-920"},"PeriodicalIF":19.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/S2352-4642(24)00308-0
The Lancet Child & Adolescent Health
{"title":"The world in 2024 was not all right for children","authors":"The Lancet Child & Adolescent Health","doi":"10.1016/S2352-4642(24)00308-0","DOIUrl":"10.1016/S2352-4642(24)00308-0","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Page 843"},"PeriodicalIF":19.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-05DOI: 10.1016/S2352-4642(24)00256-6
Fernanda Bruzadelli Paulino da Costa PhD , Prof Mark P Nicol PhD , Maresa Botha MBChB , Lesley Workman MPH , Prof Ricardo Alexandre Arcêncio PhD , Prof Heather J Zar PhD , Leonardo Martinez PhD
<div><h3>Background</h3><div>Paediatric tuberculosis leads to more than 200 000 deaths annually. We aimed to investigate the incidence of <em>Mycobacterium tuberculosis</em> infection and tuberculosis disease in the first decade of life in the Drakenstein Child Health Study (DCHS), a South African cohort in a community with high tuberculosis and HIV incidence.</div></div><div><h3>Methods</h3><div>In this prospective birth cohort study, we enrolled pregnant women aged 18 years or older who were between 20 and 28 weeks’ of gestation in a peri-urban setting outside of Cape Town, South Africa. We followed up their children for tuberculosis until age 10 years. To measure <em>M tuberculosis</em> infection tuberculin skin tests were administered to children at age 6 months, 12 months, and then annually in children with a negative test, and at the time of a lower respiratory tract infection. Tuberculin skin test conversion was defined by an induration reaction of 10 mm or more. To measure tuberculosis disease, active surveillance was done throughout follow-up. Each episode of presumed tuberculosis disease was investigated using sputum induction, tested with Xpert MTB/RIF and liquid culture for <em>M tuberculosis</em>. Survival analyses were performed and multivariable Cox regression was used to measure factors associated with <em>M tuberculosis</em> infection or disease.</div></div><div><h3>Findings</h3><div>Between March 5, 2012, and March 31, 2015, 1137 women and their 1143 children (248 [21·7%] of 1143 children were HIV-exposed, two [0·2%] children with HIV) were included in the analysis. Children were followed up for 8870 person-years (median follow-up 9·1 years [IQR 8·2–10·2]). The annual risk of tuberculin conversion during follow-up was 6·6 infections per 100 person-years (95% CI 5·8–7·3) but ranged from 4–9 infections per 100 person-years over the follow-up period. 98 children developed tuberculosis (1105 cases per 100 000 person-years; 95% CI 906–1347). The cumulative hazard of tuberculin conversion was 36% (95% CI 32–41) at age 8 years and the cumulative hazard of tuberculosis disease was 10% (8–12) at age 10 years. Preventive treatment was associated with a reduction in tuberculosis disease among children who had tuberculin conversion (adjusted hazard ratio 0·23 [95% CI 0·12–0·47]). Most cases of tuberculosis disease (78 [79%; 95% CI 69–86] of 98 children) occurred among children who had tuberculin skin test conversion but were not administered preventive treatment.</div></div><div><h3>Interpretation</h3><div>In this prospective South African birth cohort, <em>M tuberculosis</em> transmission was consistently high throughout the first decade of life leading to approximately 10% of children developing tuberculosis disease. A multipronged approach to decrease paediatric tuberculosis is needed that combines preventive treatment for children at risk, reducing community <em>M tuberculosis</em> transmission, and active case finding.</div></div><div>
背景：小儿结核病每年导致 20 多万人死亡。德拉肯斯坦儿童健康研究（Drakenstein Child Health Study，DCHS）是南非一个结核病和艾滋病高发社区的一个队列，我们的目的是调查该研究中结核分枝杆菌感染和结核病在婴儿出生后头十年的发病率：在这项前瞻性出生队列研究中，我们在南非开普敦郊外的近郊区招募了年龄在 18 岁或 18 岁以上、妊娠期在 20 到 28 周之间的孕妇。我们对她们的孩子进行了结核病跟踪调查，直到他们 10 岁。为了测量 M 型结核病感染情况，我们在儿童 6 个月大和 12 个月大时对其进行了结核菌素皮试，然后每年对皮试呈阴性的儿童以及在下呼吸道感染时进行皮试。结核菌素皮试转阴的定义是压痕反应达到或超过 10 毫米。为了测量结核病，在整个随访过程中都进行了积极的监测。每次推测的结核病发作都要进行痰液诱导检查，并用 Xpert MTB/RIF 和液体培养法检测结核杆菌。研究人员进行了生存分析，并采用多变量考克斯回归法测定了与结核杆菌感染或疾病相关的因素：2012年3月5日至2015年3月31日期间，1137名妇女及其1143名子女（1143名子女中有248名[21-7%]暴露于HIV，2名[0-2%]感染HIV）被纳入分析。对儿童的随访时间为 8870 人年（中位数随访时间为 9-1 年 [IQR 8-2-10-2]）。在随访期间，结核菌素转阴的年风险为每 100 人年 6-6 例（95% CI 5-8-7-3），但在随访期间，每 100 人年的感染率为 4-9 例。98 名儿童患上了结核病（每 10 万人年中有 1105 例；95% CI 906-1347）。8 岁时结核菌素转阴的累积风险为 36%（95% CI 32-41），10 岁时结核病的累积风险为 10%（8-12）。在结核菌素转阴的儿童中，预防性治疗与结核病发病率的降低有关（调整后的危险比为 0-23 [95% CI 0-12-0-47]）。大多数结核病病例（98 名儿童中的 78 例 [79%；95% CI 69-86]）发生在结核菌素皮试转阴但未接受预防性治疗的儿童中：在这一前瞻性南非出生队列中，M 型结核病的传播率在儿童出生后的头十年一直居高不下，导致约 10% 的儿童罹患结核病。需要采取多管齐下的方法来减少小儿结核病的发病率，将对高危儿童的预防性治疗、减少社区间的结核病传播和积极的病例发现结合起来：比尔及梅林达-盖茨基金会、南非医学研究委员会和南非国家研究基金会。
{"title":"Mycobacterium tuberculosis infection and tuberculosis disease in the first decade of life: a South African birth cohort study","authors":"Fernanda Bruzadelli Paulino da Costa PhD , Prof Mark P Nicol PhD , Maresa Botha MBChB , Lesley Workman MPH , Prof Ricardo Alexandre Arcêncio PhD , Prof Heather J Zar PhD , Leonardo Martinez PhD","doi":"10.1016/S2352-4642(24)00256-6","DOIUrl":"10.1016/S2352-4642(24)00256-6","url":null,"abstract":"<div><h3>Background</h3><div>Paediatric tuberculosis leads to more than 200 000 deaths annually. We aimed to investigate the incidence of <em>Mycobacterium tuberculosis</em> infection and tuberculosis disease in the first decade of life in the Drakenstein Child Health Study (DCHS), a South African cohort in a community with high tuberculosis and HIV incidence.</div></div><div><h3>Methods</h3><div>In this prospective birth cohort study, we enrolled pregnant women aged 18 years or older who were between 20 and 28 weeks’ of gestation in a peri-urban setting outside of Cape Town, South Africa. We followed up their children for tuberculosis until age 10 years. To measure <em>M tuberculosis</em> infection tuberculin skin tests were administered to children at age 6 months, 12 months, and then annually in children with a negative test, and at the time of a lower respiratory tract infection. Tuberculin skin test conversion was defined by an induration reaction of 10 mm or more. To measure tuberculosis disease, active surveillance was done throughout follow-up. Each episode of presumed tuberculosis disease was investigated using sputum induction, tested with Xpert MTB/RIF and liquid culture for <em>M tuberculosis</em>. Survival analyses were performed and multivariable Cox regression was used to measure factors associated with <em>M tuberculosis</em> infection or disease.</div></div><div><h3>Findings</h3><div>Between March 5, 2012, and March 31, 2015, 1137 women and their 1143 children (248 [21·7%] of 1143 children were HIV-exposed, two [0·2%] children with HIV) were included in the analysis. Children were followed up for 8870 person-years (median follow-up 9·1 years [IQR 8·2–10·2]). The annual risk of tuberculin conversion during follow-up was 6·6 infections per 100 person-years (95% CI 5·8–7·3) but ranged from 4–9 infections per 100 person-years over the follow-up period. 98 children developed tuberculosis (1105 cases per 100 000 person-years; 95% CI 906–1347). The cumulative hazard of tuberculin conversion was 36% (95% CI 32–41) at age 8 years and the cumulative hazard of tuberculosis disease was 10% (8–12) at age 10 years. Preventive treatment was associated with a reduction in tuberculosis disease among children who had tuberculin conversion (adjusted hazard ratio 0·23 [95% CI 0·12–0·47]). Most cases of tuberculosis disease (78 [79%; 95% CI 69–86] of 98 children) occurred among children who had tuberculin skin test conversion but were not administered preventive treatment.</div></div><div><h3>Interpretation</h3><div>In this prospective South African birth cohort, <em>M tuberculosis</em> transmission was consistently high throughout the first decade of life leading to approximately 10% of children developing tuberculosis disease. A multipronged approach to decrease paediatric tuberculosis is needed that combines preventive treatment for children at risk, reducing community <em>M tuberculosis</em> transmission, and active case finding.</div></div><div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Pages 891-899"},"PeriodicalIF":19.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：