Your SlideShare is downloading. ×
0
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
ptbnet Barcelona 2009 BK
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

ptbnet Barcelona 2009 BK

370

Published on

This file contains the presentation on behalf of ptbnet at the National Spanish TB meeting in Barcelona in December 2009

This file contains the presentation on behalf of ptbnet at the National Spanish TB meeting in Barcelona in December 2009

Published in: Health & Medicine, Technology
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
370
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Tuberculosis  in  children  in  Europe   -­‐  the  ptbnet   Beate  Kampmann  FRCPCH  PhD   A/Professor  in  Paediatric  Infec;on  &  Immunity   Consultant  Paediatrician   Imperial  College  London,  UK   and     Ins;tute  of  Infec;ous  Diseases  and  Molecular  Medicine   University  of  Cape  Town,  RSA   XIII  Taller  Internacional  sobre  Tuberculosis  UITB-­‐2009,  Barcelona  1  de  Diciembre  2009  
  • 2. Presentation overview Acknowledgement & Thanks Childhood TB- special considerations Childhood TB- epidemiology Issues in Europe The rationale for the ptbnet Summary of European Practices Outlook
  • 3. Paediatric TB: special & Thanks Acknowledgement considerations •  Significant  Morbidity  and  Mortality    1.4  million  cases  annually  (95%  developing  countries)      450,000  Deaths    es;mated  10-­‐15%  of  global  burden  related  to  childhood  TB   •   Different  clinical  spectrum  of  disease    5-­‐10%  <  2  yr  meningi;s      disseminated  disease  more  common   • Remains  a  diagnos;c  challenge    paucibacillary,  rarely  culture  confirmed  :    Sputum  smear  posi;ve  in  10.3%  (10-­‐14yr),  1.8%  (5-­‐9)  and1.6%  (<5)    Cultures  posi;ve  21%  (10-­‐14),  5%  (5-­‐9)  and  4.2%  (<5),     •   Co  infec;on  with  HIV-­‐  clinically  very  difficult  to  dis;nguish  
  • 4. Tuberculosis  in  children  differs  from  adults   Acknowledgement & Thanks •     Immune  responses  are    Age-­‐dependent:  Following  infec;on  40%  <  2  yr,  25%  2-­‐5  yr  and    5-­‐15%  of  older  children  will  develop  disease  within  2  years   •   Majority  of  disease  results  from  progression  of  primary    infec;on   rather  than  reac;va;on    might  affect  detectable  immune  responses     •   More  likely  to  be  extrapulmonary  and  disseminated,      par;cularly  in  infants   Newton,  Kampmann  The  Lancet  Infec?ous  Diseases,  August  2008;  Vol  8:  498-­‐510  
  • 5. Paediatric TB: Diagnostic challenges Thanks low bacillary load Acknowledgement & due to
  • 6. Diagnostic approaches Acknowledgement & Thanks Microbiological   Immunological   Organism   Host  response   smear          culture            DNA   skin  test                    an;gen-­‐specific                                                        produc;on  of  IFNγ
  • 7. Paediatric TB: Epidemiology Acknowledgement & Thanks •   of  the  9  million  annual  TB  cases,  about  1  million  (11%)  occur  in   children  (under  15  years  of  age).   •   reported  percentage  of  all  TB  cases  occurring  in  children  varies    (from  3%  to  more  than  25%)   • Children  can  present  with  TB  at  any  age,  but  the  most  common       age  is  between  1  and  4  years   •   Most  children  will  have  a  known  household  contact   •   Chemopropphylaxis  is  a  recommended  interven;on  
  • 8. Percentage of TB cases of foreign origin, 2006 Acknowledgement & Thanks Not  included  or  not  repor;ng  to  EuroTB   0%  –  4%                                 5%  –  19%                 20%  –  49%   >  49%   Andorra   Malta                                   Monaco                     San  Marino       Trends  in  incidence  of  TB  in  children  under  15  years     by  ethnic  group  in  London,  2001-­‐2006  
  • 9. UK: Tuberculosis  rates  in  persons  born  abroad  by  age Development  of  TB     in  immigrant  children   Sources:  Enhanced  Tuberculosis  Surveillance,  Labour  Force  Survey  popula?on  es?mates,  Abubakar  et  al  Arch.  Dis.  Child.  2008;93;1017-­‐1021;  
  • 10.          Children  with  TB  at  Imperial  HCT       Ethnicity  and  country  of  birth:     south asian Travel to TB endemic countries 29% yes no dk black african afro-caribbean dk black african caucasian 5% 47% SE asian mixed race arab no south asian arab 39% 5% no dk household visitor mixed race yes 4% 56% visitor SE asian 6% 6% afro-caribbean caucasian 2% no 7% Country of Birth 28% dk UK 4% 38% UK household non-UK 62% non-UK 62%
  • 11. Issues  for  children  with  TB  in  Europe   Acknowledgement & Thanks •   Incidence  and  prevalence  vary  depending  on  countries   •   Data  on  childhood  TB  are  not  recorded  as  systema;cally-­‐      -­‐  no  age-­‐related  repor;ng  (0-­‐14)   •   Children  are  infected  from  adult  contacts,  but  the  contact  details  are  not  recorded   •   Clinical  prac;ce  for  preven;on  varies  from  country  to  country   •   Chemoprophylaxis  protocols  vary   •   Monitoring  varies   •   No  idea  about  MDR  prevalence  in  children   •   Treatment  /(MDR)  protocols  derived  from  adult  prac;ce  
  • 12. ECDC-­‐  reported  variables Acknowledgement & Thanks Total  No  of  cases  and  No;fica;on  rate/100  000   Sex  ra;o   Median  age  group-­‐  na;onals  and  non-­‐na;onals   New  (never  treated)   Foreign  born   Culture  posi;ve   pTB   HIV  posi;ve  TB  cases-­‐  not  stra;fied  for  children   TB  deaths   Drug  resistance   Treatment  outcome  
  • 13. 2  Key  recommendaCons:   A.  2  age  bands  to  be  reported:  0-­‐4,  5-­‐14   “Enumera;ng  children  with  TB  is  a  key   step  in  bringing  their  management  into  the  mainstream  of  the     Stop  TB  Strategy  as  part  of  rou;ne  NTP  ac;vi;es.”   B.    Dosage  adjustments  for  TB  therapy   “revised  recommended  dose  of  Ethambutol  is  now  20  mg/kg  (range   15–25  mg/kg)  daily.  
  • 14. what else can&we do? Acknowledgement Thanks to  improve  the  care  for  children  with  TB     in  Europe          by  crea;ng  a  network  of  pediatric  experts  in  TB  in  Europe     -­‐  to  more  accurately  describe  ac;ve  and  latent  TB  in  children  in  Europe   -­‐  to    iden;fy  differences  in  prac;ce  between  European  countries   -­‐  to  improve  clinical  management  and  research  in  childhood  TB  in  Europe   -­‐   to  develop  a  European  "expert  panel"  for  consulta;on  on  paediatric  TB        and  possibly  a  training  course                                      clinicians   -­‐  to  conduct  collaboraCve  research                            epidemiologists        laboratory  scien;sts                
  • 15. •   founded  in  April  2009     •   to  date:  25  members  from  15  European      countries,  incl  Eastern  Europe   •   includes  clinicians,  epidemiologists  and        laboratory  scien;sts        www.ptbnet.org   Aims   •   enhance  the  understanding  of  the  pediatric  aspects  of  tuberculosis   •   facilitate  collaboraCve  research  studies    for  childhood  TB  in  Europe     •   provide  expert  opinion  through  excellence  in  science  and  teaching   •   establish  a  beler  evidence  base  for  diagnosis  and  treatment  of  TB          in  children  
  • 16. April  09   Agenda   1.  PresentaCons  from  each  country:   Theme  1:  Data  capture  for  TB  in  your  country   Theme  2:  Prac;cal  Care  for  children  in  your   country/at  your  hospital     2.  Data  collecCon:     Discussion  of  shared  database  op;ons   3.  Discussion  of  mulCcentre  studies:   Defining  research  priori;es  and  possible  future   studies   4.  Conclusions  and  future  plans:   What  do  we  want  to  be/do   Possible  funding  streams-­‐  where  to  go  
  • 17. Acknowledgement & Thanks Summary  of  ptbnet-­‐data:  Epidemiology   140   120   100   80   total  no  of  cases/100  000   60   percentage  of  ped.  cases   40   20   0   Na?onal  TB  guidelines  for  children   Yes:  8/11  (72%)   No:  2/11  (18%)   Proposed:  1/11  (9%)  
  • 18. Summary  of  ptbnet-­‐data:       Acknowledgement & Thanks MDR  -­‐  TB     percentage  of  MDR  TB   18   16   14   12   10   8   6   percentage  of  MDR  TB   4   2   0   percentage  of  MDR  TB   Austria   Belgium   Greece   Holland   Italy   Lithuania   No  data  in  children   Romania   Spain   Turkey  
  • 19. Summary  of  ptbnet-­‐data:     PrevenCon  and  Treatment   •   Rou;ne  use  of  BCG:  7/11   •   Targeted  use  of  BCG:  2/11   •   No  BCG:  4/11   •   Chemoprophylaxis:  11/11,  but  ages  vary,  as  do  regimes   •   Treatment:  available  free  of  charge  
  • 20. Summary  of  ptbnet-­‐data:   TB  and  HIV •   Few  data  available  on  prevalence  of  HIV  in  children  with  ac;ve  TB   •   Only  2/11  countries  rou;nely  test  TB  cases  for  HIV   •   HIV  results  generally  not  recorded  in  repor;ng  systems  
  • 21. Summary  of  ptbnet-­‐data:     Use  of  Interferon-­‐gamma  release  Assays  (IGRA)     •   IGRA  Recommended  in  8/11  countries   •   Widely  used  for  diagnosis  of  ac;ve  TB   •   Used  for  LTBI  screening  in  only  4  countries   •   QFG-­‐IT  preferred  test  (7/11  vs  3/11)   •   Data  in  different  age  groups  could  be  combined        to  comment  on  age-­‐related  performance  
  • 22. Future  plans  of  the  ptbnet   1.  Designated  database   Consensus  that  a  paediatric  database  is  highly  desirable   ?  Use  exis;ng  plasorms  or  start  from  scratch   ?  ECDC  informa;on-­‐  too  limited,  disease  only   ?  Should  be  able  to  combine  with  adult  data  (contacts)   ?  What  to  include   Needs  to  not  just  focus  on  TB  disease  but  include  exposure/infec;on/disease   Designated  funding  needs  to  be  idenCfied  to  move  this  project  forwards  substanCally   In  the  shorter  term,  we  will  invesCgate  exisCng  plaTorms   and  compile  the  data  fields  that  we  would  like  to  include   (potenCal  data  protecCon  issues  in  our  individual  countries)      
  • 23. Future  plans  of  the  ptbnet   2.  Defining  research  prioriCes   Immuno-­‐assays  in  children   Longitudinal  studies,  age  related,  MDR  monitoring,  site-­‐specific,  in  immunocompromised   PharmacokineCcs   New  and  old  TB  drugs   MDR  TB   Risk  factors,  management  (exposed  and  cases)   Members  with  exisCng  studies  will  liaise     to  share  data  and  compare  experience  and  recommendaCons  as  well  as     prepare  shared  data  for  joint  publicaCons   (f.ex.:  Bamford  et  al,  ptbnet  (UK),  Arch  Dis  Child  2009)   Protocol  sharing  in  labs/training  
  • 24. Where  from  here   Logo       website          www.ptbnet.org   Database  nego;a;ons  with  TBNET-­‐  in  process,  needs  to  be  intensified   Funding  opportuni;es  ?  within  EU-­‐  FP7  calls   Descrip;ve  manuscript  of  childhood  TB  in  Europe  to  be  prepared   ptbnet    members  contribu;ng  to  TBNET  an;-­‐TNF  and  IGRA  consensus  statement     Expansion  of  the  group  to  include  clinician,  laboratory  and  epidemiologist  in  each  place   Close  collaboraCons  with  TBNET  (www.tb-­‐net.org)          Database                Website  space          MDR  study      Paediatric  aspects  of  other  studies  
  • 25. How  can  you  help?   •   Consider  TB  as  a  family  disease  and  set  up  your  clinics  in  this  way   •   Ensure  that  paediatric  informa;on  is  collected  specifically/iden;fiable   •   Collect  informa;on  on  contact  screening   •   Collect  informa;on  on  chemoprophylaxis  and  outcome   •   Join  paediatric  research  studies          -­‐  Diagnos;cs          -­‐  TB/HIV  coinfec;on-­‐  test  the  cases  also  in  children          -­‐  be  aware  of  drug  formula;ons  for  children    Join  the  
  • 26. Muchas  graçias  de  su  atençión   Hay  preguntas???          b.kampmann@imperial.ac.uk   www1.imperial.ac.uk/medicine/people/b.kampmann  

×