Combating tuberculosis in children
Tuberculosis (TB) often goes undiagnosed in children from birth to 15 years old because they lack access to health services - or because the health workers who care for them are unprepared to recognize the signs and symptoms of TB in this age group.
With better training and harmonization of the different programmes that provide health services for children, serious illness and death from TB could be prevented in thousands of children every year.
The extent of childhood tuberculosis is unknown and is estimated to constitute about 6% out of all incident cases, with the majority of cases occurring in high TB burden countries. Among many challenges to estimate the burden of TB in children, the following could be listed:
- the difficulty in establishing a definitive diagnosis;
- the presence of extra-pulmonary disease (requiring specialist consultation);
- the lower public health priority (childhood TB rarely presents as smear positive); and
- the lack of linkages between private sector paediatricians and the national TB programme.
Children can present with TB at any age, but the most common age is between 1 and 4 years. Case notifications of childhood TB depend on the intensity of the epidemic, the age structure of the population, the available diagnostic tools, and the extent of routine contact investigation.
WHO's Stop TB Strategy
The Stop TB Strategy, which builds on the DOTS strategy developed by the World Health Organization (WHO) and the International Union Against TB and Lung Disease (The Union), has a critical role in reducing the worldwide burden of disease and thus in protecting children from infection and disease. The management of children with TB should be in line with the Stop TB Strategy, taking into consideration the particular epidemiology and clinical presentation of TB in children.
Key interventions to address TB in children
- Mobilizing commitment at global and national levels to address childhood TB.
- Promoting strategic partnerships and synergies across the health system, especially between TB, maternal and child health, and immunization programmes and relevant stakeholders, to prioritize and facilitate early detection and management of children with TB.
- Advocating for increased research and development of new diagnostics, drugs and vaccines for childhood TB.
- Implementing contact investigation and provide IPT to children under 5 years, through training and awareness building of health workers and the community on childhood TB.
- Advocating for family-based approaches to be integrated into TB and HIV activities.
The Childhood TB Subgroup of the DOTS Expansion Working Group (DEWG) was established in 2003 to promote research, policy development, the formulation and implementation of guidelines, the mobilization of human and financial resources, and collaboration with partners working in relevant fields (including maternal and child health, immunization and HIV) to achieve the goal of decreased childhood TB mortality and morbidity
Selected childhood TB documents
- Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings
- Guidance for national tuberculosis programmes on the management of tuberculosis in children [pdf 325kb]
- Russian [pdf 678kb]
- Ethambutol efficacy and toxicity: literature review and recommendations for daily and intermittent dosage in children [pdf 1.5Mb]
Dosing instructions for the use of currently available fixed-dose combination TB medicines for children
- Evaluation of Tuberculosis Diagnostics in Children: 1. Proposed Clinical Case Definitions for Classification of Intrathoracic Tuberculosis Disease. Consensus From an Expert Panel
- Evaluation of Tuberculosis Diagnostics in Children:2. Methodological Issues for Conducting and Reporting Research Evaluations of Tuberculosis Diagnostics for Intrathoracic Tuberculosis in Children. Consensus From an Expert Panel