Tuberculosis, chickenpox and scabies outbreaks in an orphanage for children with HIV/AIDS in Jamaica

OBJECTIVES: The aim of this study is to describe the investigation and management of outbreaks of acute tuberculosis, varicella zoster virus and scabies in a residential facility for children with HIV/AIDS. METHOD: A review of the results and management for diagnosed cases of acute TB (four between 2001 and 2002) as well as varicella zoster virus (15) and scabies (14) (concurrent in March--June 2003), in a residential facility housing 24 abandoned children with HIV/AIDS was conducted. Outbreak control methods and challenges are described The modified WHO criteria were used for TB diagnosis. The diagnoses of varicella and scabies were entirely clinical. RESULTS: Of the surviving 22 children, 12 (mean age 8 years 2 months) were female, and 10 (mean age 5 years 6 months) were male. Full immunization (primary series) was documented for 16 children, partial in one child, unknown status was documented in five children. One child had received varicella vaccine previously. Eleven (50) children had been receiving antiretroviral triple therapy since 2002 (all in Centers for Diseases Control immunological categories 2-3). Two of the four children with tuberculosis died between 2001 and 2002; these were not on antiretroviral therapy--the 2 survivors are still on antiretroviral therapy. All staff mantoux test results were negative. Fifteen (68) children developed chickenpox as well as three caregivers. The index case was a 13-year-old resident attending a nearby school with HIV negative children. This varicella outbreak went on to affect household members for the caregivers as well as other residential facilities nearby. Scabies affected 14 children (no caregivers); the index cases were most likely three new child residents who entered the institution in 2002 (from other homes) with histories of scabies infestation. Chickenpox and scabies dual infection occurred in seven (31) of residents. No cases of herpes zoster, disseminated varicella infection or death because of varicella occurred Diagnosed cases of chickenpox were treated with oral acyclovir Knowledge about these disease outbreaks and their control was generally lacking. CONCLUSIONS: Improvement in immunization coverage for children and staff as well as educating staff about infectious disease outbreaks, is necessary for effective control. Appropriate screening for infection/disease for all susceptible persons is essential along with timely reporting of outbreaks/reportable diseases. There is need for in

Tuberculosis and HIV co-infections in Jamaican children

BACKGROUND: There has been a worldwide increased prevalence of tuberculosis (TB) in recent years, with a similar trend observed in Jamaica and more recently in children admitted to the University Hospital of the West Indies, Jamaica. Data regarding paediatric TB, especially as it relates to all aspects of HIV co-infection, are needed from developing countries in diverse geographic settings to enhance prevention and treatment policies (National Institutes of Health, Office of AIDS Research, FY 2005 Budgetary Planning Meeting, March 11, 2003, Washington, DC). OBJECTIVE: To determine associated factors and outcomes of tuberculosis in HIV-infected and noninfected children in Jamaica. METHOD: We reviewed records of children aged 0 - 12 years attending the University Hospital of the West Indies during January 1999 to December 2002. Associated factors and outcomes in HIV-infected and HIV-negative cases with TB were compared using exact statistical methods to account for the small number of children and an adjustment for multiple testing. TB diagnosis was determined using modified World Health Organization (WHO) criteria. RESULTS: There was a significant increase of active TB cases from 1999 to 2002 with 24 children diagnosed over this period All 24 children (100) had received the Bacillus-Calmette-Guerin (BCG) vaccine. Eleven (46) of these were HIV-infected, all via mother-to-child transmission. HIV-infected children were statistically more likely to be older than non-infected children (mean 4.2 vs 2.6 years), and also to have failure to thrive, digital clubbing, hepatomegaly, splenomegaly, generalized adenopathy and negative Mantoux tests. Appropriate in-hospital anti-TB therapy was given. Hospital stay was longer (median 7.4 vs. 2.8 months) and death was more likely (7/11 vs 2/13) in HIV-infected vs non-infected children. Triple antiretroviral therapy was given in three of the 11 HIV-infected cases and this markedly improved outcome. Household family members with active TB were identified in twelve cases. CONCLUSIONS: HIV and TB co-infection is an increasing problem in Jamaican children. Severity of illness and death is greater in HIV-infected children, despite appropriate anti-TB therapy. Antiretroviral drugs must be made available to this population. Efforts must be enhanced to reduce mother-to-child-transmission of HIV/AIDS and to strengthen the public health management of TB (contact tracing and completion of TB therapy by directly observed therapy)