The Epidemiology of Tuberculosis in Children

Abstract

The epidemiology of tuberculosis, particularly in children, is highly intertwined with socio-political factors, such as poverty, access to healthcare, and migration. Growing evidence around the world shows that more children have tuberculosis (TB) than was previously thought, most of whom are undiagnosed and untreated, and that TB is a significant cause of morbidity and mortality in children in TB endemic areas. Since TB in young children results from recent transmission, the incidence of pediatric TB is a marker of epidemic control in a community and an indirect indicator of the effectiveness of TB control programs. It is estimated that pediatric TB represents between 4 and 21% of all TB cases, depending on the background prevalence in the country, and at least 10 to 20% of the total cases in areas with poor epidemic control. However, a precise estimate of the global burden of TB in children is difficult due to challenges in case ascertainment, diagnosis, and weak surveillance systems in many countries with a high burden of disease. Several recent estimates highlight these difficulties and provide a starting point to motivate further study. In addition, since drug-resistant TB in young children reflects transmission of resistant strains in the community and occurs with the same frequency as in treatment-naive adults, accurate monitoring of drug-susceptibility patterns in pediatric TB cases will inform optimal empiric treatment regimens in both adults and children, in the context of increasing rates of drug-resistant TB globally.