children and tuberculosis exposing a hidden epidemic

Children and TuberculosisExposing a Hidden Epidemic

Mandy SlutskerSeptember 21, 2011

TB basics• TB is an infectious disease caused by

bacteria that is spread through the air

• Latent TB infection vs. active TB disease

• 1/3 of world’s population has latent TB

• 9.4 million get active TB disease every year

• Drug resistance, link with HIV

Types of active TB• Pulmonary vs.

extrapulmonary

• Smear positive vs. smear negative

• Drug susceptible vs. drug resistant

How is TB different in children?• Most children are

smear-negative

• Difficult to diagnose

• Children are prone to severe types of TB such as TB meningitis

How many kids get TB?We’re not exactly sure. Here’s why:

• Most countries only report ‘smear positive cases’. Only 10-15% of children are smear positive

• Most cases go unreported

• Best numbers we have are from the WHO (2009): every year, over 1 million children get TB and ~176,000 die as a result

Can children get drug resistant TB?• Yes, children get MDR-TB. However, WHO surveys only

include adults

• Studies in South Africa show 9% of childhood TB cases are drug resistant

• It is curable, but takes medical care and extremely expensive treatment

• Far cheaper to prevent MDR-TB by ensuring kids are properly treated for drug-susceptible TB

Risk Factors• Poverty• Young Age• Malnutrition• Orphans and

Vulnerable Children• HIV• Maternal TB

Diagnosing TB in children• No gold standard;

diagnosing often done by trial and error.

• WHO has yet to approve Xpert MTB/RIF for use in children

• However, a preliminary study from July 2011 show the test may be effective in children

How do we treat children with TB?

• No child-specific TB drugs exist

• Often, health workers crush adult tablets and estimate doses for children

• We need a Fixed Dose Combination (FDC) for children

How can we prevent TB in children?

Answer: the Four I’s

• Intensified Case Finding

• Isoniazid Preventive Therapy

• Infection Control

• Integration

What do need to tackle childhood TB?

• Child-friendly diagnostics• Fixed Dose Combination treatment• TB vaccine• Children included in clinical trials

…All this requires increased resources!

A call to action• Fighting childhood TB must become a

global health priority• Universal access to current available tools• Integrate TB services with child health

primary care• Include children in clinical trials• Innovative research • Children with HIV should be placed on ART

Anthony’s story

Stories from India and Kenya

Education• Children with TB fall

behind in school

• Harms ability to earn good wages in the future

• When parents are sick, children leave school to earn money for the family

Poverty• Parents take time off

work to care for sick children, results in loss of family income

• High cost of health care may force families to sell belongings to pay for care and treatment

The End