The burden of multidrug-resistant tuberculosis in children

Abstract

Background Childhood tuberculosis (TB) has been historically neglected, although in recent years there has been increased focus on this problem. In particular, there have been several efforts to estimate the pediatric multidrug-resistant TB (MDR-TB) burden. Methods We review current estimates of the global incidence of pediatric MDR-TB disease. We then combine pediatric MDR-TB treatment data from the World Health Organization and recently published case fatality ratio estimates for children with TB to produce mortality estimates for children with MDR-TB. Finally, we combine treatment data and estimates of household size and disease risk to estimate how many children could be treated for presumptive MDR-TB by carrying out household contact investigations around adult MDR-TB patients. Results Between 25,000 and 32,000 children develop MDR-TB disease annually, accounting for around 3% of all pediatric TB cases. Only 3-4% of these children likely receive MDR-TB treatment. We estimate that around 22% of children developing MDR-TB disease will die. We estimate that carrying out household contact investigations around adult MDR-TB patients could find twelve times as many pediatric MDR-TB cases as are currently being identified. Discussion The diagnosis and treatment of children with MDR-TB needs to be prioritized by TB programs.

Pediatric Multidrug-resistant Tuberculosis in Kyiv City, Ukraine

“…Therefore, despite the good outcomes in our study population, there are possibly several times as many undiagnosed children in Kyiv City and nationwide who are suffering-and dying [29]-from MDR-TB-a curable disease. To prevent this unnecessary morbidity and mortality, we urgently need more household contact investigations to find children with TB, increased use of preventive therapy for children who have been exposed to MDR-TB cases, and improved diagnostics for pediatric MDR-TB disease [28,29]. All these measures are particularly important in Ukraine, where around 27% of children with TB have MDR-TB [1,7].…”

“…As a result, the magnitude of under-diagnosis and under-treatment of MDR-TB is even greater for children than for adults [1]. Only 3-4% of the 25,000-32,000 pediatric MDR-TB cases estimated to occur each year globally are diagnosed and notified to the WHO [29]. Most likely, underdiagnosis and underreporting of pediatric MDR-TB in Ukraine are also high.…”

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“…In addition, MCV is cheap, readily available as part of the full blood count test and easy to perform. Introduction MDR-TB (Multidrug-Resistant Tuberculosis) impacts more than 3% of children affected by tuberculosis manifestations (Jenkins & Yuen, 2018) [9]. Approximately, 22% of MDR-TB children experience high predisposition for comorbidities and mortality.…”

Low enrollment and high treatment success in children with drug-resistant tuberculosis in Ethiopia: A ten years national retrospective cohort study

“…Diagnosis of DR-TB is the most challenging in resource limited countries due to limited laboratory infrastructure for DST and the long duration required for laboratory confirmation [4][5][6]. Even diagnosis of DR-TB in children is more difficult and it is rarely bacteriologically confirmed due to paucibacillary nature of the disease and the challenges in obtaining appropriate specimens [7]. A recent estimate indicates that about 25,000 to 32,000 of children develop DR-TB annually, which accounts for 3% of TB cases in children in the world [7].…”

“…Even diagnosis of DR-TB in children is more difficult and it is rarely bacteriologically confirmed due to paucibacillary nature of the disease and the challenges in obtaining appropriate specimens [7]. A recent estimate indicates that about 25,000 to 32,000 of children develop DR-TB annually, which accounts for 3% of TB cases in children in the world [7]. Children are also at greater risk of contracting DR-TB from adult cases due to their biological and social vulnerability.…”