Background: In 2015, US TB cases increased for the first time since 1992. About 13 million persons in the US have LTBI; 10% will progress to active disease. Progression risks are extremes of ages & recent acquisition, highlighting importance of identifying/treating these individuals. CDC estimates <50% completion of LTBI treatment (tx) in pts identified as contacts of TB cases. We sought to 1) compare identification, tx initiation & completion rates in contact children compared vs adults with LTBI; 2) identify strategies to improve contact management.
Methods: The Philadelphia Dept of Public Health (PDPH) performs contact investigations of all active TB cases. The Pennsylvania Dept of Health National Electronic Disease Surveillance System (PA-NEDDS) was used to identify TB exposed residents (2010-15). Patient demographics, TST or IGRA results, chest radiographs & tx data were collected from convenience sample of 346 children (0-17 yrs) & 273 adults. Chart review was performed when available.
Results: 521 TB disease cases occurred over 6 yrs. Mean of 6.2 contacts were evaluated/case, totaling 3254 contacts (4.4 adult vs 1.8 child contacts/case). Cohort age & race/ethnicity in Fig 1. Cohort had >98% compliance with initial evaluation for adults & children. Of contacts, 58% of adults & 28% of children were diagnosed with LTBI (p=<0.001); 1 adult had TB disease. Of 108 TST-neg contacts<5 yrs old, 43 received bridge chemoprophylaxis. Of TST-pos adults & children (LTBI), more than half (64% vs 72%, resp) initiated tx (Fig 2). Of these, children had better LTBI therapy completion rates than adults (96% vs 75%, resp; p=<0.001). 92% of children received home or school direct observed prophylactic therapy (DOPT) & were followed by PDPH. Most adults were self-administered & received medications at required monthly PDPH visits. Non-adherence was most common reason for failure to start or complete tx (Fig 3).
Conclusion: In Philadelphia, children were significantly more likely than adults to complete LTBI therapy, likely related to DOPT. Our data highlight the vital and successful role that public health depts can play in TB control/elimination. Since 1/3 of LTBI cohort did not initiate therapy and identified contact numbers were low, efforts must be enhanced.
S. S. Long, None
C. Dogbey, None
J. M. Gould, None