Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings

Abstract

In low tuberculosis-burden countries, children and adolescents with the highest incidence of tuberculosis (TB) infection or disease are usually those who have immigrated from high-burden countries. It is, therefore, essential that low-burden countries provide healthcare services to immigrant and refugee families, to assure that their children can receive proper testing, evaluation, and treatment for TB. Active case-finding through contact tracing is a critical element of TB prevention in children and in finding TB disease at an early, easily treated stage. Passive case-finding by evaluating an ill child is often delayed, as other, more common infections and conditions are suspected initially. While high-quality laboratory services to detect Mycobacterium tuberculosis are generally available, they are often underutilized in the diagnosis of childhood TB, further delaying diagnosis in some cases. Performing research on TB disease is difficult because of the low number of cases that are spread over many locales, but critical research on the evaluation and treatment of TB infection has been an important legacy of low-burden countries. The continued education of medical providers and the involvement of educational, professional, and non-governmental organizations is a key element of maintaining awareness of the presence of TB. This article provides the perspective from North America and Western Europe but is relevant to many low-endemic settings. TB in children and adolescents will persist in low-burden countries as long as it persists throughout the rest of the world, and these wealthy countries must increase their financial commitment to end TB everywhere.

Multidrug-Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB) Among Children: Where We Stand Now

“…The lowest rate was observed in Western Pacific Region (25%), followed by South East Asia (35%) [ 105 ]. Thereby, increased participation in the management of pediatric TB requires more national and international attention with additional financial support [ 106 , 107 ]. Despite inadequate coverage, response to treatment is far better with the first-line anti-TB regimen (88%) in 2020, which was highest in Southeast Asia.…”

Unraveling tuberculosis patient cluster transmission chains: integrating WGS-based network with clinical and epidemiological insights

“…Notably, an index patient is not necessarily a source case, who transmitted TB infection to one or more individuals ( 4 – 6 ). An opposite process—reverse contact investigation, also known as source case investigation, —is often conducted mostly to identify a source case for a TB-infected child ( 6 , 7 ). However, established epidemiological links need to be complemented by molecular Mtb typing results demonstrating that Mtb isolates obtained from these patients share the same genotyping pattern.…”

Tuberculosis in Children and Adolescents: Progress and Perseverance

“…However, efforts are still, often, at an early gestational stage, lacking 'critical mass' and broad program support in many endemic settings. Even in well-resourced countries, challenges remain to improving the delivery of comprehensive TB care to children and adolescents, requiring persistent attention and advocacy [11]. A multisectoral approach is critical to close the wide policy-practice gaps that hamper service delivery.…”