Overview

It is estimated that one third of the world’s population is infected with Mycobacterium tuberculosis (the bacterium that causes tuberculosis (TB)), and that each year, about 9 million people develop TB, of whom about 2 million die. Of the 9 million annual TB cases, about 1 million (11%) occur in children (under 15 years of age). Of these childhood cases, 75% occur annually in 22 high-burden countries that together account for 80% of the world’s estimated incident cases.

In countries worldwide, the reported percentage of all TB cases occurring in children varies from 3% to more than 25%. The Stop TB Strategy, which builds on the DOTS strategy developed by the World Health Organization (WHO) and the International Union Against TB and Lung Disease, has a critical role in reducing the worldwide burden of disease and thus in protecting children from infection and disease.

The management of children with TB should be in line with the Stop TB Strategy, taking into consideration the particular epidemiology and clinical presentation of TB in children. These consensus guidelines were produced to help the National Tuberculosis Programmes on the management of tuberculosis in children.

Contents

• Preface
• Declarations of Interest
• Acknowledgements
• Abbreviations and acronyms
• Definitions and distinctions
• Executive summary
• 1. Introduction
  • 1.1 Chapter objectives
  • 1.2 Purpose of the guidance for TB in children
  • 1.3 Target audience
  • 1.4 How does management of TB in children and adolescents differ from that in adults?
  • 1.5 Ethical issues
  • 1.6 The burden of TB in children
  • References
• 2. Methodology
  • 2.1 Chapter objectives
  • 2.2 Process of updating the 2006 edition
  • 2.3 Expiry date
  • References
• 3. Diagnosis of TB in children
  • 3.1 Chapter objectives
  • 3.2 Introduction to diagnosis of TB in children
  • 3.3 Recent improvements in diagnostics
  • 3.4 Recommended approach to diagnosis of TB in children
  • References
• 4. Treatment of TB in children
  • 4.1 Chapter objectives
  • 4.2 Principles of treatment in children
  • 4.3 Recommended dosages
  • 4.4 Recommended treatment regimens
  • 4.5 Implementation considerations
  • References
• 5. Prevention of TB in children
  • 5.1 Chapter objectives
  • 5.2 BCG vaccination
  • 5.3 Contact screening and management
  • 5.4 TB infection control
  • References
• 6. Management of TB in children living with HIV
  • 6.1 Chapter objectives
  • 6.2 Introduction
  • 6.3 Approach to diagnosis
  • 6.4 Prevention of TB
  • 6.5 Treatment of TB (in children living with HIV)
  • References
• 7. Management of drug-resistant TB in children
  • 7.1 Chapter objectives
  • 7.2 Introduction
  • 7.3 Diagnosis
  • 7.4 Prevention of TB disease in child contacts of drug-resistant TB
  • 7.5 Treatment
  • 7.6 Implementation considerations
  • References
• 8. Implementation and management by NTP; integrated care
  • 8.1 Chapter objectives
  • 8.2 Action at the global level
  • 8.3 Next steps at national level
  • 8.4 Integrated care
  • 8.5 An integrated family-oriented approach to addressing TB in children
  • References
• 9. Suggestions for future research
  • 9.1 Chapter objectives
  • 9.2 Suggestions for future research
  • References
• Annex 1 Summary of evidence and considerations underlying the recommendations
• Annex 2 TB case and treatment outcome definitions
• Annex 3 Administering, reading and interpreting a tuberculin skin test
• Annex 4 Procedures for obtaining clinical samples for smear microscopy
• Annex 5 Interim guidelines for treatment of TB in young children (less than 25 kg) using currently available FDCs (RHZ 60/30/150) and dosages achieved per weight

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