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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2008.143271v1 AJPH.2008.143271v2 99/8/1486    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schaaf, H. S. Articles by Donald, P. R. Search for Related Content PubMed PubMed Citation Articles by Schaaf, H. S. Articles by Donald, P. R. Related Collections Community Health Epidemiology Global Health HIV/AIDS Tuberculosis Other Child and Adolescent Health Surveys

H. Simon Schaaf, MD Paed, Ben J. Marais, PhD, MRCP, FCP, Anneke C. Hesseling, MBChB, MSc, Wendy Brittle, BTech and Peter R. Donald, MD, FRCP, FCP

The authors are with the Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa. H. Simon Schaaf, Ben J. Marais, and Peter R. Donald are also with Tygerberg Children's Hospital, Cape Town. Anneke C. Hesseling is also with the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, England.

Correspondence: Correspondence should be sent to H. Simon Schaaf, MD (Paed), MMed (Paed), Department of Paediatrics and Child Health, PO Box 19063, Tygerberg, 7505, South Africa (e-mail: hss{at}sun.ac.za). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link.

Objectives. We assessed the prevalence of antituberculosis drug resistance among children with tuberculosis (TB) in the Western Cape Province of South Africa.

Methods. Drug susceptibility testing for isoniazid and rifampin was prospectively done on all children with culture-confirmed TB at Tygerberg Children's Hospital, Cape Town, from March 2005 through February 2007. Survey results were compared with results from 2 previous surveys.

Results. We found 291 children had culture-confirmed TB. Resistance to isoniazid or rifampin increased from 21 of 306 (6.9%) to 41 of 319 (12.9%) and 43 of 285 (15.1%) in the first to third surveys (P = .005) and multidrug resistance from 7 of 306 (2.3%) to 18 of 319 (5.6%) and 19 of 285 (6.7%; P = .033). Although previously treated children had significantly more drug resistance than did new TB cases (19 of 66 [28.8%] vs 24 of 225 [10.7%]; odds ratio = 3.39; 95% confidence interval = 1.62, 7.05), evidence suggests transmission rather than acquisition of resistance. HIV infection was not significantly associated with drug resistance.

Conclusions. Results indicate a high and rising prevalence of anti-TB drug resistance among children in the Western Cape, which suggests ongoing transmission of drug-resistant strains within the community. Improved control of TB in adults, including early identification and treatment of drug-resistant cases, is necessary to reduce transmission to children.