Prevention, Treatment in Children Stressed on World TB Day

22 March 2012

Isolated behind a security gate, mothers and children wait for care at a TB clinic near Cape Town, South Africa.

Children with tuberculosis (TB) often go undiagnosed because they lack access to health care or because the health care workers they see lack training to detect the symptoms of TB in this young age group.

The Stop TB Partnership, including prominent health organizations such as the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC), released that finding March 21. The partnership is emphasizing the need to focus on children in the annual recognition of World TB Day March 24.

At least half a million babies and children become ill with TB each year, and as many as 70,000 are estimated to die of the disease. Children under 3 years of age and those with severe malnutrition or compromised immune systems are at greatest risk for developing TB.

“We have made progress on TB: Death rates are down 40 percent overall compared to 1990 and millions of lives have been saved," said Dr. Mario Raviglione, director of WHO's Stop TB Department. "But unfortunately, to a large extent, children have been left behind, and childhood TB remains a hidden epidemic in most countries. It is time to act and address it everywhere.”

About 9 million people a year become sick with TB, and most of those are people in poverty who know little about the disease, how to get care or how to protect their children from the disease. Most children catch TB from a parent or relative, so it's crucial to protect children from infection and to test them for exposure, according to the partnership statement.

If a child living with a TB patient presents a fever or a failure to thrive, they should be evaluated by a trained health care provider for TB, the partnership recommends. The drug isoniazid can protect children from infection by someone else in the household.

"It costs less than 3 cents a day to provide therapy that will prevent children from becoming ill with TB and 50 cents a day to provide treatment that will cure the disease,” said Dr. Lucica Ditiu, executive secretary of the Stop TB Partnership. “But before we can give prevention or treatment, we have to find the children at risk of TB, and this will only happen if governments, civil society and the private sector work together. From now on let us agree: It is unconscionable to let a single child die of TB.”

WHO and the Stop TB Partnership point to three key actions needed to improve TB care and prevent TB deaths in children:

• Examine all children who have been exposed to TB in their households.

• Provide preventive treatment with the drug isoniazid to all children who are at risk for TB.

• Train all health workers who care for pregnant women, babies and children to check patients for TB risk, signs and symptoms and refer them for TB preventive therapy or treatment.

CDC joins the partnership in marking World TB Day 2012 with the slogan "Stop TB in My Lifetime." Dr. Kenneth Castro, director of CDC's Division of Tuberculosis Elimination, says the slogan urges people to really think about the achievements that are possible.

"Today's children should expect to see a world where no one gets sick with TB," said Castro in a CDC podcast. "In their lifetime, adults should expect to see a world where no one dies from TB. We all have different hopes, such as faster treatment, a quick, inexpensive, low-technology TB test that is accessible to all, or a more effective vaccine."

TB most commonly affects the lungs, but it also can affect other parts of the body. Both children and adults can be exposed to infection with drug-resistant forms of TB that require a lengthy, costly treatment course with often severe side effects.

Multidrug-resistant tuberculosis (MDR-TB) is caused by bacteria that do not respond to the two most powerful, standard anti-TB drugs. The bacteria have developed resistance after decades of use of these medications. Poor use of the drugs is another reason for the emergence of MDR-TB.

Patients are known to stop the course of drug treatment before it is actually completed and the TB-causing bacteria have been completely eradicated. Patients may stop drug treatment prematurely for several possible reasons: They feel better and think they are well and no longer need the medicine; they are not properly monitored by health care workers to make sure they complete the course of treatment; or access to the medicine is difficult.

MDR-TB is treatable and curable by using a set of second-line drugs. But those treatment options are limited, and the medicines are not always available. The treatment — up to a two-year course — is also costly and can produce severe adverse drug reactions in patients.