October 1997

Grant Results

National Program

SUMMARY

The tuberculosis resurgence has been particularly acute for young children, especially those under the age of two. They progress from infection to active disease and death more rapidly than do other age groups, and are least able to escape the poverty and crowded housing conditions that typically foster tuberculosis.

A three-day scientific workshop on tuberculosis in children, co-sponsored with the Centers for Disease Control and Prevention (CDC) and 15 other government agencies and private health groups, was held in Atlanta, Ga., on August 1–3, 1994.

The participants — physicians, nurses, biomedical researchers, public health officials, and others interested in pediatric tuberculosis — sought to determine what is known and unknown about tuberculosis in children, to identify where more information is needed, and to develop an agenda that can serve as a guideline for public health officials, researchers, and medical practitioners.

Key Recommendations

  • There is an urgent need for research aimed at designing drug formulations specifically for children.
  • All pregnant women should be tuberculin tested and those who have tuberculosis should be treated following public health guidelines.
  • Research is needed to determine at what age children are able to generate sufficient droplets as they exhale or cough to transmit tuberculosis.
  • The CDC should undertake epidemiological studies of the relationship between HIV and tuberculosis in children, and consider requiring the reporting of tuberculosis infection (without active disease) in HIV-infected children.

Funding
The Robert Wood Johnson Foundation (RWJF) supported the conference with a $39,171 grant.

A separate grant to The Stein Group (ID# CP087) was awarded to produce a final conference report entitled, "Recommendations from a Workshop on A Growing Concern: Tuberculosis in Children," distributed to conference attendees.

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THE PROBLEM

The tuberculosis resurgence has been particularly acute for young children, especially those under the age of two. They progress from infection to active disease and death more rapidly than do other age groups, and are least able to escape the poverty and crowded housing conditions that typically foster tuberculosis. In 1994, TB affected three children per 100,000 under age 15, up from 2.4 in 1983. Nearly 7 percent of TB cases in the United States are among children. And, while the Centers for Disease Control and Prevention reported a 5 percent overall drop in the number of new cases in 1993, the rate for children actually increased by 1 percent.

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THE PROJECT

The three day scientific workshop on tuberculosis in children was held in Atlanta, GA, on August 1–3, 1994. It was co-sponsored by the Centers for Disease Control and Prevention, The Robert Wood Johnson Foundation, and 15 other government agencies and private health groups. (See Appendix 2 for a complete list of co-sponsors.) The workshop brought together physicians, nurses, biomedical researchers, public health officials, and others interested in pediatric tuberculosis. The participants sought to determine what is known and unknown about tuberculosis in children, to identify where more information is needed, and to develop an agenda that can serve as a guideline for public health officials, researchers, and medical practitioners.

A separate grant to The Stein Group (ID# CP087) was awarded to produce a final conference report entitled, "Recommendations from a Workshop on A Growing Concern: Tuberculosis in Children," distributed to conference attendees.

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CONCLUSIONS AND RECOMMENDATIONS

Conclusions related to 13 topics: diagnosing pediatric tuberculosis, treating children with tuberculosis, treating pregnant women, contact investigations, infection control and prevention, screening for tuberculosis, screening the foreign born, HIV and tuberculosis, vaccine efficacy, data management and analysis, epidemiology, education, and legal issues. Primary conclusions and recommendations follow:

  • There is an urgent need for research aimed at designing drug formulations specifically for children.
  • All pregnant women should be tuberculin tested and those who have tuberculosis should be treated following public health guidelines.
  • Research is needed to determine at what age children are able to generate sufficient droplets as they exhale or cough to transmit tuberculosis.
  • Centers for Disease Control and Prevention should undertake epidemiological studies of the relationship between HIV and tuberculosis in children, and consider requiring the reporting of tuberculosis infection (without active disease) in HIV-infected children.

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AFTER THE GRANT

According to the National Program Office, no follow-up work has resulted from this meeting.

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GRANT DETAILS & CONTACT INFORMATION

Project

A Growing Concern: Tuberculosis in Children

Grantee

American Lung Association (New York,  NY)

  • Amount: $ 39,171
    Dates: July 1994 to January 1995
    ID#:  024643

Contact

Project Director: John R. Garrison
(212) 315-8700

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

National Advisory Committee

Lee B. Reichman, M.D., M.P.H. (Chairman)
Director
New Jersey Medical School
National Tuberculosis Center
University of Medicine and Dentistry
150 Bergen Street, University Heights
Newark, NJ 07103-2406

Nancy N. Dubler, L.L.B.
Division of Bioethics
Department of Epidemiology and Social Medicine
Montefiore Medical Center
111 E. 210 Street
Bronx, NY 10467

Miguel Escobedo, M.D., M.P.H.
Director of Health
Community Disease Services
El Paso City- County Health District
222 S. Campbell St.
El Paso, TX 76107

Paula Fujiwara, M.D.
Medical Epidemiologist
Bureau of Tuberculosis
New York City Department of Public Health
125 Worth Street, Box 74
New York, NY 10013

Jim Hadler, M.D., M.P.H.
State Epidemiologist
Epidemiology Section
Connecticut Department of Health Services
150 Washington Street
Hartford, CT 06106

Michael D. Iseman, M.D.
Chief, Clinical Mycobacteriology Service
Division of Infectious Disease
National Jewish Center for Immunology and Respiratory Medicine
Rm. J-201 Annex Bldg.
1400 Jackson Street
Denver, CO 80206

Doris Lewis, R.N.
TB Control
New Jersey State Department of Health
University Office Plaza CN 369
Trenton, NJ 08625-0369

Carl Schieffelbein
Associate Director for Operations
Division of TB Elimination
National Center for Prevention Service
Centers for Disease Control
1600 Clifton Road (E-10)
Atlanta, GA 30333

Hank Wilson
Community Activist
55 Mason Street
San Francisco, CA 94102

Rebecca Wurtz, M.D.
Director, Hospital Infectious Disease
Cook County Hospital
Room 1028 CCSN
1835 West Harrison
Chicago, IL 60612


Appendix 2

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Project Co-Sponsors

  • American Academy of Pediatrics
  • American College of Chest Physicians
  • American College of Obstetricians and Gynecologists
  • American Lung Association
  • American Medical Association
  • American Thoracic Association
  • Association of Practitioners in Infection Control
  • Centers for Disease Control and Prevention
  • Conference of State and Territorial Epidemiologists
  • Food and Drug Administration
  • Infectious Diseases Society of America
  • National Institutes of Health
  • National Medical Association
  • Pediatric AIDS Foundation
  • The Robert Wood Johnson Foundation
  • Society of Hospital Epidemiologists of America

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Presentations and Testimony

Agar, Michael, and Owen Murdoch. "Definitional Divergence in the Implementation of a Tuberculosis Prevention Program." Annual Meeting of the Society for Applied Anthropology, Seattle, Wash., March 1997.

Agar, Michael, and Owen Murdoch. "Town and Gown: A University-Based Tuberculosis Intervention in an Urban Neighborhood." Annual Meeting of the American Anthropological Association, San Francisco, Calif., November 1996.

Fishman, Claudia. "Community Tuberculosis Coalitions: Can the Gap be Closed?" Annual Meeting of the Society for Applied Anthropology, Seattle, Wash., March 1997.

Fishman, Claudia. "Tuberculosis Coalition in Atlanta: Virtual and Real." Annual Meeting of the American Anthropological Association, San Francisco, Calif., November 1996.

Guillette, Elizabeth. "Overcoming Distrust for a Meaningful Evaluation of Tuberculosis Services to Migrant Farmers." Annual Meeting of the American Anthropological Association, San Francisco, Calif., November 1996.

Guillette, Elizabeth. "Tuberculosis: Decreasing Migrant Vulnerability through Provider Empowerment." Annual Meeting of the Society for Applied Anthropology, Seattle, Wash., March 1997.

Justice, Judith. "Ethnography as Evaluation: Problems and Opportunities." Annual Meeting of the American Anthropological Association, San Francisco, Calif., November 1996.

Justice, Judith. "Meeting the Challenge of Coalition Building: Lessons from Tuberculosis in the 1990s." Annual Meeting of the Society for Applied Anthropology, Seattle, Wash., March 1997.

Marakowitz, Ellen. "Ethnographer and Evaluator — A Challenging Union." Annual Meeting of the American Anthropological Association, San Francisco, Calif., November 1996.

Marakowitz, Ellen. "The Mechanics of Collaboration: The Shared Responsibility Project." Annual Meeting of the Society for Applied Anthropology, Seattle, Wash., March 1997.

Von Glascoe, Christina. "Cultural Barriers to the Non-transmission of Tuberculosis on the Mexico/US Border." Annual Meeting of the American Anthropological Association, San Francisco, Calif., November 1996.

Von Glascoe, Christina. "The Role of Inter-Agency Coordination in the Creation of a Cross Border Tuberculosis Program." Annual Meeting of the Society for Applied Anthropology, Seattle, Wash., March 1997.

Publications

Recommendations from a Workshop on A Growing Concern: Tuberculosis in Children (pamphlet). Princeton, N.J.: The Robert Wood Johnson Foundation, March 1995.

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Report prepared by: Marie P. Lyons
Reviewed by: Marian Bass
Program Officer: Marilyn Aguirre-Molina
Evaluation Program Officer: James Knickman

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