Missed Opportunities in Tuberculosis (TB) Prevention in Pediatric Population: A Retrospective Observational Study From North India

Background Contact investigation, particularly Household contact tracing (HHC), is a cornerstone of tuberculosis (TB) control programs globally. However, the implementation of contact tracing and TB preventive treatment (TPT) in India remains suboptimal, especially in the pediatric age group. This study aimed to determine the missed opportunities of disease identification and prevention among pediatric TB cases with a documented history of household exposure to a TB index case. Primary objective To determine the proportion of microbiologically confirmed pediatric TB cases with documented household exposure in whom contact tracing was not performed. Methodology This retrospective observational study was conducted among pediatric TB patients of age up to 12 years with microbiological evidence of the disease, enrolled from the pediatric and microbiology departments of the institute and five other satellite hospitals during the study period of two years from Jan 2023 to December 2024. Results Of 1,375 presumptive pediatric TB cases, 133 [9.67%; 95% confidence interval (CI): 8.1-11.2} were microbiologically confirmed, of which 132 were enrolled. Household TB exposure was documented in 71 cases (53.8%; 95% CI: 45.3-62.3). Exposure to pulmonary TB index cases occurred in 58 cases (43.9%; 95% CI: 35.5-52.4) and 139 of 169 pediatric household contacts (82.2%; 95% CI: 76.4-88.0). Contact tracing was performed for 30 of 58 exposed cases (51.7%; 95% CI: 38.9-64.5) and 48 of 139 pediatric household contacts (34.5%; 95% CI: 26.6-42.4). TPT was initiated in only 5 of 34 eligible children (14.7%; 95% CI: 2.8-26.6). Rifampicin resistance status was indeterminate in 36 of 132 cases (27.3%; 95% CI: 19.7-34.9), and resistance to it was observed in 5 out of 100 (5%) cases. Conclusion Significant programmatic gaps exist in pediatric TB prevention, particularly in contact tracing, TPT uptake, and drug-resistance testing. While these findings highlight missed preventive opportunities, further analytical studies are needed to identify determinants and evaluate their impact on transmission dynamics.