Childhood TB

The extent of childhood tuberculosis is unknown and is estimated to
constitute between 9,6% and 11% 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), and the lower public health priority (childhood TB rarely presents as smear positive).

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 tracing.

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.

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.

Young children have a high risk of progression to disease following infection, and are much more likely to develop severe or disseminated TB. Children with latent tuberculosis infection (LTBI) become the reservoir of future disease in adulthood, perpetuating the epidemic. The HIV epidemic, which disproportionately affects young adults, many of whom are co-infected with TB, may also put their children at particularly high risk of infection. Observational data do suggest a disproportionately higher paediatric caseload where deteriorating socioeconomic conditions are accompanied by a higher overall incidence of TB, and children account for more than 20% of TB cases in some high-burden settings.

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