After years of neglect, childhood tuberculosis — which accounts for over six per cent of the global TB burden — is finally getting due attention. WHO recently published its first-ever targeted road map outlining the steps needed to move towards zero childhood TB deaths. The report comes close on the heels of the organisation including for the first time the estimates of the global TB burden in children below 15 years in its 2012 global tuberculosis report. Last year also saw childhood TB getting special focus in the World TB Day theme. Though over half-a-million new cases are reported every year from across the world in those who are HIV negative, the actual TB burden must be much higher. The reasons are pretty obvious. Most of what is reported are only the cases of sputum smear-positive pulmonary TB. However, sputum smear-negative disease is most frequent even in pulmonary TB. Most often, all cases of extra-pulmonary TB go unreported even though this category of TB accounts for “approximately 20-30 per cent.” Unlike adolescents, children under five may not produce sputum for examination. In the absence of sputum samples, there is no highly reliable and easily usable diagnostic tool to confirm the disease, especially in developing countries where TB is endemic and malnourishment is high. Hence, developing reliable and affordable tests has become a great research priority.
As a result, high burden countries like India, where 10-20 per cent of all TB occurs in children, need to find alternative strategies to target vulnerable children who are more prone to becoming infected and diseased. Implementing the WHO’s close contact screening of children under five from households where an adult has been newly diagnosed with sputum smear-positive pulmonary TB would go a long way in achieving the desired results. Adults would have spread the infection to children in the same household before seeking treatment. A clinical examination of children combined with laboratory confirmation in suspicious cases would go a long way in revealing their TB status. This approach has twin advantages. While the diseased would be put on treatment without delay, the asymptomatic children would end up getting a preventive therapy. A prophylactic treatment using a single drug — isoniazid — once daily for six months would cut down the number of young ones who may become diseased. It would reduce the TB load and the mortality rate. Yet, in India’s TB control programme, contact screening is way down in the priority list. There are challenges, but training health workers and adopting minor changes to the existing system alone can yield good results. What’s the government waiting for?