injection medicine against tuberculosis to children

Tuberculosis in children
& diagnosis challenges

femme qui tient son enfant dans les bras

Burden of tuberculosis disease

WHO estimates that 1.1 million children aged 0-14 years develop tuberculosis (TB) every year. TB is an airborne infectious disease caused by a bacteria, Mycobacterium tuberculosis, also called TB bacilli or Koch’s bacilli, that is transmitted through the air exhaled and breathed. This bacteria affects mostly the lungs (pulmonary tuberculosis) but it can also affect other organs. If not treated, TB can lead to death in 20-50% of children.

In adults, the disease can be diagnosed through microscopy, culture or molecular tests performed on expectorated sputum (mucus coughed up from the lungs/airways). In children, the diagnosis is more complicated (sample collection more difficult, clinical presentation less obvious than adult TB, fewer bacilli produced). Young children, especially those <5 years of age, have a high risk of developing TB following exposure to Mycobacterium tuberculosis, and of progression to more severe forms of TB. Most children (>75%) with TB will develop pulmonary disease, in non-severe forms.

As a result of these diagnosis challenges, children with TB are massively underdiagnosed.

In 2020, tuberculosis-related mortality in children below 15 years of age was estimated at 226,000.  and the vast majority among children under 5 years of age and that almost all of these children did not access treatment.

Improved diagnosis of tuberculosis in children and more child-friendly regimens are critically important to close this diagnostic and treatment gap.

medecin examine enfant
medecin proteger ecoute respiration enfant

Treatment

TB is a treatable disease if the appropriate drug regimen is provided. The standard treatment for drug-sensitive TB typically involves a combination of (first-line) drugs, that include isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA), and ethambutol (EMB), depending on countries’ guideline. This treatment regimen is typically administered over a period of six months.

In the past, paediatric TB treatment recommendations have generally been extrapolated from treatment studies conducted in adults. It was recently hypothesized that most non-severe forms of TB disease in children could be treated with shorter treatment regimens.
The SHINE study showed that four months of TB treatment using first-line drugs was as good as the standard six months of TB treatment in children with non-severe TB.
In addition to drug-sensitive tuberculosis, there are also drug-resistant forms of tuberculosis in children that are more difficult to treat and involve using second-line drugs, which may have more side effects and require a longer duration of treatment. Studies are underway to shorten the duration.

Use of treatment decision algorithms to improve diagnosis of childhood tuberculosis

In an effort to bridge the diagnostic gap of childhood tuberculosis, a combination of several diagnostic approaches have previously been developed to guide clinical decision-making such as evaluation of clinical symptoms, TB exposure history, chest X-rays & microbiological analysis of samples. Recently more data-driven approaches have been used for the development of treatment decision algorithms (TDAs). This is done by using high-quality data from paediatric diagnostic studies to develop a scoring system for clinical, radiographical and microbiological features associated with tuberculosis. The aim of these TDAs is to improve the diagnosis of tuberculosis in children and support healthcare providers in recognizing the clinical signs and symptoms of tuberculosis, potentially leading to earlier identification of the disease. Recently, the World Health Organization conditionally approved a TDA for childhood tuberculosis to be validated in primary care level.

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