Investigation of a cluster of pediatric pulmonary tuberculosis cases in Gilgit-Baltistan (GB) Pakistan 2019

Background: On 27th January 2019, a hospital in Chilass city reported 20 suspected pediatric cases of pulmonary tuberculosis. Provincial TB control Program conducted an investigation to identify associated risk factors and recommend measures to prevent future control Methods and materials: A cases control study was conducted between Jan-May, 2019. A case was defined as any child who is resident of district Diamer presented with fever and cough for more than two weeks and clinically evaluated by pediatrition between January–May 2019. Patients records were reviewed and information was collected on clinical sign/symptoms and suspected risk factors. Results: Total 83 cases were identified and among the cases 63% were male and 37% were female children. Median age was 4.4 years (range 7 months–14 years), the most affected age group was 0–4 years (AR 0.164%) with an overall AR 0.09%. Most frequently reported sign/symptoms were; fever 95%(n = 79),cough 93%(n = 77), hemoptysis 5%(n = 4), anorexia 97%(n = 81) and weight loss 63%(n = 52), Only 41%(n = 34) children had BCG scar. Parents of cases had very low knowledge (24%) about preventive measure of TB spread to others. Siblings having diagnosed TB (OR 8.21, CI 6.744–14.554, p-value 0.005), parents with TB (OR 6.55, CI 2.156–9.245, p-value 0.001), TB case in house (OR 5.70, CI 2.048–12.54, p-value 0.0004) and close relatives having TB (OR 4.14, CI 2.02–9.40, p-value 0.0007) found to be associated risk factors for the disease. Conclusion: Non-practicing of preventive measures by diagnosed adult TB cases and subsequent exposure of young children was the most probable cause of this outbreak. expanded contact investigations and putting siblings of diagnosed TB cases on prophylaxis as immediate measure recommended and Advocacy meetings were conducted with the village notables and religious leaders, parents on infection transmission prevention practice.