CONTENTS




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Introduction
Globally, TB is a major cause of morbidity and mortality, affecting almost a third of the world’s population and causing an estimated 2.6 million death annually. In the year 2000, there were 8.2 million new TB cases worldwide and these occurred predominantly in the developing world.

The highest incidence rates, around 300 cases per 100000 population occurred in Sub-Saharan countries, but Asian countries had approximately 60% of cases. Twenty-two developing countries contain 80% of the global burden; many of these highest-burden countries are also experiencing a concurrent HIV epidemic. Almost 98% of deaths from TB occur in developing countries.

The burden of TB in children in developing countries is often underappreciated and neglected; due to limited resources, control programs have given priority to screening for active infectious cases, according to the «dogma»: «Stop TB at source by DOTS».

However, childhood TB constitutes a large proportion of the TB caseload in developing countries, accounting for approximately 15-20% of all cases. The WHO estimated that there were 1.3 million new TB cases and 450.000 deaths in children under 15 years of age in the year 1990. In developing countries, children with TB tend to present at a more advanced stage of disease compared to children in the developped world. The consequences of undiagnosed or untreated pediatric TB can be substantial. Furthermore, cases of childhood TB frequently reflect an undiagnosed adult infectious source case, thus the occurrence of TB in children often indicates failure of TB control programs.

We believe that childhood TB screening and control programs could work in parallel with or independent from adult TB control programs, as long as the former are in the hands of specialized personnel experienced in children (pediatricians, infectiologists, pediatric pulmonologists). Childhood TB screening programs may help a general TB control policy in two ways:

1. An infected child may lead to an adult patient who has escaped the adult control program
2. Prevention treatment in children (especially in developed countries) decreases the number of adults with tuberculosis in the long term. It is well established that in developed countries, tuberculosis cases are patients older than 60 years experiencing a reactivation of latent disease who could have received prevention treatment if diagnosed as children.

WHO official data for Greece report an incidence of sputum-positive patients of 9 per 100000 population in 1995 and 6,6 per 100000 population in 2000. The surveillance system in Greece is not reliable and we estimate that less than 40% of cases are reported.

As shown in the diagram, there is a decrease of the total number of children with infection or disease (and a greater decrease of children with disease). This is due to the extensive screening with TST taking place in the age of 15 months, on entering a kindergarten, on starting and completing elementary school. More than 1500 children with infection or disease, found by screening programs, have been referred to our clinic from 1995 to 2004. Our statistics for the years 2000-2003, along with patient nationality, are shown in the table below. It is very important to notice that, besides the total patient number decrease, early detection has also lead to a decrease in extrapulmonary tuberculosis and severe disease case numbers.

 

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Total

288

281

270

234

187

204

156

197

157

197

269

286

Disease

146

131

126

102

70

60

39

54

30

37

20

24

Infection

142

148

144

132

117

144

117

143

127

160

249

250

Greeks

234

187

165

120

92

85

78

78

56

52

128

152

Ex USSR

30

40

36

36

42

42

21

24

23

36

39

28

Albanians

13

24

36

46

28

50

41

48

56

71

69

70

Africa

4

12

9

14

18

13

2

16

5

12

6

4

Asia

2

0

0

0

0

2

4

5

10

5

8

16

Other balcan countries

1

7

6

6

5

5

7

23

4

0

0

0

Western Europe

2

8

10

8

2

6

3

1

2

4

2

0

Other developed countries

2

3

8

3

0

2

0

2

1

17

17

16


TUBERCULOSIS CLINIC
2ND PEDIATRIC DEPARTMENT
ATHENS UNIVERSITY

Childhood tuberculosis in Greece
from 1995 until 2006

Tuberculosis Clinic statistical data for 2006
297 patients were recorded (3983-4279). 11 with missing information

Diagnosis Number of patients
Infection 250
Disease 24
Chemoprophylaxis 9
Atypical mycob.infection 3
Total 286


Initial Diag. Infection Disease Chemoprophylaxis Atypical MB Total
Screening 190 13 1   204
Contact hx 41 8 7   56
Clinical 9 2   3 14
Total 250 24 9 3 286


Country Infection Disease Chemoprophylaxis Atypical Total
Greece 125 17 8 2 152
Albania 64 5   1 70
Ex USSR/td> 27 1     28
East Europe 15 1     16
West Europe         0
Asia 8       8
Africa 15   1   7
Other         0
Total 250 24 9 3 286


Tuberculosis Clinic statistical data for 2005
298 patients were recorded (no 3685-3982). 8 with missing information.

Diagnosis Number of patients
Infection 249
Disease 20
Chemoprophylaxis 15
Atypical mycob.infection 6
Total 290


Initial Diag. Infection Disease Chemoprophylaxis Atypical MB Total
Screening 181 8     189
Contact hx 56 7 15   78
Clinical 12 5   6 23
Total 249 20 15 6 290


Country Infection Disease Chemoprophylaxis Atypical Total
Greece 112 16 14 6 148
Albania 67 2     69
Ex USSR 39       39
East Europe 14 1     15
West Europe 2       2
Asia 8       8
Africa 6   1   7
Other 1 1     2
Total 249 20 15 6 290


Tuberculosis Clinic statistical data for 2004
232 patients were recorded (no 3452-3684).

Diagnosis Number of patients
Infection 160
Disease 37
Chemoprophylaxis 32
Atypical mycob.infection 11
Total 240


Initial Diag. Infection Disease Chemoprophylaxis Atypical MB Total
Screening 110 15     125
Contact hx 50 20 32   102
Clinical   2   11 13
Total 160 37 32 11 240


Country Infection Disease Chemoprophylaxis Atypical Total
Greece 38 14 17 10 79
Albania 66 5 1   72
Ex USSR 30 6 5   41
East Europe 9 4 2   15
West Europe 2 2 1   5
Asia 3 2 2 1 7
Africa 9 3 1   13
Other 3 1 4   8
Total 160 37 32 11 240


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