High Prevalence of Active and Latent Tuberculosis in Children and Adolescents in Tibetan Schools in India: The Zero TB Kids Initiative in Tibetan Refugee Children

Kunchok Dorjee, Sonam Topgyal, Chungdak Dorjee, Tenzin Tsundue, Tenzin Namdol, Tenzin Tsewang, Tenzin Nangsel, Dekyi Lhadon, Tsering Choetso, Tenzin Dawa, Tenzin Phentok, Andrea Deluca, Lobsang Tsering, Dawa Phunkyi, Tsetan D. Sadutshang, Elizabeth J Bonomo, Zorba Paster, Richard E Chaisson

Research output: Contribution to journalArticle

Abstract

Background: Tuberculosis (TB) prevalence is high among Tibetan refugees in India, with almost half of cases occurring in congregate facilities, including schools. A comprehensive program of TB case finding and treatment of TB infection (TBI) was undertaken in schools for Tibetan refugee children. Methods: Schoolchildren and staff in Tibetan schools in Himachal Pradesh, India, were screened for TB with an algorithm using symptoms, chest radiography, molecular diagnostics, and tuberculin skin testing. Individuals with active TB were treated and those with TBI were offered isoniazid-rifampicin preventive therapy for 3 months. Results: From April 2017 to March 2018, we screened 5391 schoolchildren (median age, 13 years) and 786 staff in 11 Tibetan schools. Forty-six TB cases, including 1 with multidrug resistance, were found in schoolchildren, for a prevalence of 853 per 100 000. Extensively drug-resistant TB was diagnosed in 1 staff member. The majority of cases (66%) were subclinical. TBI was detected in 930 of 5234 (18%) schoolchildren and 334 of 634 (53%) staff who completed testing. Children in boarding schools had a higher prevalence of TBI than children in day schools (915/5020 [18%] vs 15/371 [4%]; P <. 01). Preventive therapy was provided to 799 of 888 (90%) schoolchildren and 101 of 332 (30%) staff with TBI; 857 (95%) people successfully completed therapy. Conclusions: TB prevalence is extremely high among Tibetan schoolchildren. Effective active case finding and a high uptake and completion of preventive therapy for children were achieved. With leadership and community mobilization, TB control is implementable on a population level.

Original languageEnglish (US)
Article numberciy987
Pages (from-to)760-768
Number of pages9
JournalClinical Infectious Diseases
Volume69
Issue number5
DOIs
StatePublished - Aug 16 2019

Fingerprint

Latent Tuberculosis
Refugees
India
Tuberculosis
Infection
Extensively Drug-Resistant Tuberculosis
Therapeutics
Molecular Pathology
Tuberculin
Isoniazid
Multiple Drug Resistance
Rifampin
Radiography
Thorax
Skin

Keywords

  • case finding
  • pediatrics
  • preventive therapy
  • Tibet
  • tuberculosis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

High Prevalence of Active and Latent Tuberculosis in Children and Adolescents in Tibetan Schools in India : The Zero TB Kids Initiative in Tibetan Refugee Children. / Dorjee, Kunchok; Topgyal, Sonam; Dorjee, Chungdak; Tsundue, Tenzin; Namdol, Tenzin; Tsewang, Tenzin; Nangsel, Tenzin; Lhadon, Dekyi; Choetso, Tsering; Dawa, Tenzin; Phentok, Tenzin; Deluca, Andrea; Tsering, Lobsang; Phunkyi, Dawa; Sadutshang, Tsetan D.; J Bonomo, Elizabeth; Paster, Zorba; Chaisson, Richard E.

In: Clinical Infectious Diseases, Vol. 69, No. 5, ciy987, 16.08.2019, p. 760-768.

Research output: Contribution to journalArticle

Dorjee, K, Topgyal, S, Dorjee, C, Tsundue, T, Namdol, T, Tsewang, T, Nangsel, T, Lhadon, D, Choetso, T, Dawa, T, Phentok, T, Deluca, A, Tsering, L, Phunkyi, D, Sadutshang, TD, J Bonomo, E, Paster, Z & Chaisson, RE 2019, 'High Prevalence of Active and Latent Tuberculosis in Children and Adolescents in Tibetan Schools in India: The Zero TB Kids Initiative in Tibetan Refugee Children', Clinical Infectious Diseases, vol. 69, no. 5, ciy987, pp. 760-768. https://doi.org/10.1093/cid/ciy987
Dorjee, Kunchok ; Topgyal, Sonam ; Dorjee, Chungdak ; Tsundue, Tenzin ; Namdol, Tenzin ; Tsewang, Tenzin ; Nangsel, Tenzin ; Lhadon, Dekyi ; Choetso, Tsering ; Dawa, Tenzin ; Phentok, Tenzin ; Deluca, Andrea ; Tsering, Lobsang ; Phunkyi, Dawa ; Sadutshang, Tsetan D. ; J Bonomo, Elizabeth ; Paster, Zorba ; Chaisson, Richard E. / High Prevalence of Active and Latent Tuberculosis in Children and Adolescents in Tibetan Schools in India : The Zero TB Kids Initiative in Tibetan Refugee Children. In: Clinical Infectious Diseases. 2019 ; Vol. 69, No. 5. pp. 760-768.
@article{58eb44e9b40244fb8b164837713c459e,
title = "High Prevalence of Active and Latent Tuberculosis in Children and Adolescents in Tibetan Schools in India: The Zero TB Kids Initiative in Tibetan Refugee Children",
abstract = "Background: Tuberculosis (TB) prevalence is high among Tibetan refugees in India, with almost half of cases occurring in congregate facilities, including schools. A comprehensive program of TB case finding and treatment of TB infection (TBI) was undertaken in schools for Tibetan refugee children. Methods: Schoolchildren and staff in Tibetan schools in Himachal Pradesh, India, were screened for TB with an algorithm using symptoms, chest radiography, molecular diagnostics, and tuberculin skin testing. Individuals with active TB were treated and those with TBI were offered isoniazid-rifampicin preventive therapy for 3 months. Results: From April 2017 to March 2018, we screened 5391 schoolchildren (median age, 13 years) and 786 staff in 11 Tibetan schools. Forty-six TB cases, including 1 with multidrug resistance, were found in schoolchildren, for a prevalence of 853 per 100 000. Extensively drug-resistant TB was diagnosed in 1 staff member. The majority of cases (66{\%}) were subclinical. TBI was detected in 930 of 5234 (18{\%}) schoolchildren and 334 of 634 (53{\%}) staff who completed testing. Children in boarding schools had a higher prevalence of TBI than children in day schools (915/5020 [18{\%}] vs 15/371 [4{\%}]; P <. 01). Preventive therapy was provided to 799 of 888 (90{\%}) schoolchildren and 101 of 332 (30{\%}) staff with TBI; 857 (95{\%}) people successfully completed therapy. Conclusions: TB prevalence is extremely high among Tibetan schoolchildren. Effective active case finding and a high uptake and completion of preventive therapy for children were achieved. With leadership and community mobilization, TB control is implementable on a population level.",
keywords = "case finding, pediatrics, preventive therapy, Tibet, tuberculosis",
author = "Kunchok Dorjee and Sonam Topgyal and Chungdak Dorjee and Tenzin Tsundue and Tenzin Namdol and Tenzin Tsewang and Tenzin Nangsel and Dekyi Lhadon and Tsering Choetso and Tenzin Dawa and Tenzin Phentok and Andrea Deluca and Lobsang Tsering and Dawa Phunkyi and Sadutshang, {Tsetan D.} and {J Bonomo}, Elizabeth and Zorba Paster and Chaisson, {Richard E}",
year = "2019",
month = "8",
day = "16",
doi = "10.1093/cid/ciy987",
language = "English (US)",
volume = "69",
pages = "760--768",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "5",

}

TY - JOUR

T1 - High Prevalence of Active and Latent Tuberculosis in Children and Adolescents in Tibetan Schools in India

T2 - The Zero TB Kids Initiative in Tibetan Refugee Children

AU - Dorjee, Kunchok

AU - Topgyal, Sonam

AU - Dorjee, Chungdak

AU - Tsundue, Tenzin

AU - Namdol, Tenzin

AU - Tsewang, Tenzin

AU - Nangsel, Tenzin

AU - Lhadon, Dekyi

AU - Choetso, Tsering

AU - Dawa, Tenzin

AU - Phentok, Tenzin

AU - Deluca, Andrea

AU - Tsering, Lobsang

AU - Phunkyi, Dawa

AU - Sadutshang, Tsetan D.

AU - J Bonomo, Elizabeth

AU - Paster, Zorba

AU - Chaisson, Richard E

PY - 2019/8/16

Y1 - 2019/8/16

N2 - Background: Tuberculosis (TB) prevalence is high among Tibetan refugees in India, with almost half of cases occurring in congregate facilities, including schools. A comprehensive program of TB case finding and treatment of TB infection (TBI) was undertaken in schools for Tibetan refugee children. Methods: Schoolchildren and staff in Tibetan schools in Himachal Pradesh, India, were screened for TB with an algorithm using symptoms, chest radiography, molecular diagnostics, and tuberculin skin testing. Individuals with active TB were treated and those with TBI were offered isoniazid-rifampicin preventive therapy for 3 months. Results: From April 2017 to March 2018, we screened 5391 schoolchildren (median age, 13 years) and 786 staff in 11 Tibetan schools. Forty-six TB cases, including 1 with multidrug resistance, were found in schoolchildren, for a prevalence of 853 per 100 000. Extensively drug-resistant TB was diagnosed in 1 staff member. The majority of cases (66%) were subclinical. TBI was detected in 930 of 5234 (18%) schoolchildren and 334 of 634 (53%) staff who completed testing. Children in boarding schools had a higher prevalence of TBI than children in day schools (915/5020 [18%] vs 15/371 [4%]; P <. 01). Preventive therapy was provided to 799 of 888 (90%) schoolchildren and 101 of 332 (30%) staff with TBI; 857 (95%) people successfully completed therapy. Conclusions: TB prevalence is extremely high among Tibetan schoolchildren. Effective active case finding and a high uptake and completion of preventive therapy for children were achieved. With leadership and community mobilization, TB control is implementable on a population level.

AB - Background: Tuberculosis (TB) prevalence is high among Tibetan refugees in India, with almost half of cases occurring in congregate facilities, including schools. A comprehensive program of TB case finding and treatment of TB infection (TBI) was undertaken in schools for Tibetan refugee children. Methods: Schoolchildren and staff in Tibetan schools in Himachal Pradesh, India, were screened for TB with an algorithm using symptoms, chest radiography, molecular diagnostics, and tuberculin skin testing. Individuals with active TB were treated and those with TBI were offered isoniazid-rifampicin preventive therapy for 3 months. Results: From April 2017 to March 2018, we screened 5391 schoolchildren (median age, 13 years) and 786 staff in 11 Tibetan schools. Forty-six TB cases, including 1 with multidrug resistance, were found in schoolchildren, for a prevalence of 853 per 100 000. Extensively drug-resistant TB was diagnosed in 1 staff member. The majority of cases (66%) were subclinical. TBI was detected in 930 of 5234 (18%) schoolchildren and 334 of 634 (53%) staff who completed testing. Children in boarding schools had a higher prevalence of TBI than children in day schools (915/5020 [18%] vs 15/371 [4%]; P <. 01). Preventive therapy was provided to 799 of 888 (90%) schoolchildren and 101 of 332 (30%) staff with TBI; 857 (95%) people successfully completed therapy. Conclusions: TB prevalence is extremely high among Tibetan schoolchildren. Effective active case finding and a high uptake and completion of preventive therapy for children were achieved. With leadership and community mobilization, TB control is implementable on a population level.

KW - case finding

KW - pediatrics

KW - preventive therapy

KW - Tibet

KW - tuberculosis

UR - http://www.scopus.com/inward/record.url?scp=85065847582&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065847582&partnerID=8YFLogxK

U2 - 10.1093/cid/ciy987

DO - 10.1093/cid/ciy987

M3 - Article

C2 - 30462191

AN - SCOPUS:85065847582

VL - 69

SP - 760

EP - 768

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 5

M1 - ciy987

ER -