Dengue virus, measles, TBI and TB disease: Are they being overlooked because of the pandemic?

ABSTRACT

[...]many elementary and secondary schools were closed in 2020;when they reopened in 2021, masks and social distancing were in place. [...]these factors may have significantly reduced children and unvaccinated families from contracting and spreading the measles virus. Pediatric tuberculosis A diagnosis of pediatric tuberculosis (TB), for either latent TB (referred to as tuberculosis infection [TBI]7) or TB disease (active TB), is made for patients aged less than 15 years who have either a positive tuberculin skin test or a positive interferongamma release assay.7,8 Both tests have a high positive predictive value when used for children who have had a direct contact exposure to an adult with TB disease.7 Infants and young children are at increased risk of developing life-threatening forms of the disease, including TB meningitis and disseminated TB, compared with older children and adults.8 The greatest numbers of TB cases occur in children under 5 years old, with 38% of pediatric cases occurring within this age range.7 In addition, in 2020, 28% of the 10- to 14-year-old population had a diagnosis of pediatric TB.8 Data from TB cases in children aged less than 18 years living in the United States from 2010 to 2017 revealed that 32% of children with TB disease were born in other countries.9 Adults who have the TB bacterium, Mycobacterium tuberculosis, spread the organism via airborne transmission by coughing, speaking, or singing. [...]children with pediatric TB do not spread the organism as readily as adults, because pediatric TB is less infectious than the adult form.8 Children may present with a cough, weakness, weight loss, fever, change in playtime behaviors, and/or night sweats.8 Children younger than 4 years are at the highest riskof progressing from TBI to TB disease, with data showing a risk of 40% to 50% for infants less than 1 year old and 25% for 1- to 2-year-olds.8 However, children with a diagnosis of TBI who receive drug therapy and whose parents adhere to the regimen have a 90% reduced risk of developing TB disease.8 Adolescents older than 12 years have a risk of progression to adult-type TB disease. Providers need to be aware that the Centers for Disease Control and Prevention does not recommend the 4-month rifapentine-moxifloxacin TB regimen for children younger than 12 years.8 Best practices for pediatric providers include consulting a TB expert prior to beginning the treatment course, based on the available data showing that young children have a high risk of developing life-threatening TB disease.8 Conclusions Pediatric health care providers are on the frontlines for identifying infectious diseases and, to prevent poor outcomes, must react quickly to diagnose and treat cases in children and adolescents.