children and tuberculosis exposing a hidden epidemic
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Children and Tuberculosis Exposing a Hidden Epidemic. Mandy Slutsker September 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 - PowerPoint PPT PresentationTRANSCRIPT
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