Let's end childhood tuberculosis
The World Health Organization (WHO) recently released its current estimates for global childhood tuberculosis (TB) and the numbers are startling. WHO estimates that 1 million children develop TB and 136,000 children die from this treatable and preventable disease each year. It also announced the number of deaths globally from TB now exceed that for HIV, the worst and best of public health in the same sentence.
One problem is that childhood TB is difficult to diagnose with existing laboratory tests; the diagnosis is made in most cases by a combination of clinical symptoms, abnormal physical exam and/or X-rays, and knowing that the child was recently in contact with an adult with contagious TB.
TB is also difficult to treat; the patient has to take 3 to 6 medications for at least 6 months. Another problem is all currently available medications for TB are pills made for adults; there have been no pediatric dosage forms available anywhere, including in the U.S. To treat a child with TB, the parents have to crush pills and make suspensions that are difficult to administer and of uncertain effectiveness. I have great admiration for families who can successfully treat their child with TB.
In 2011, an international Call To Action for childhood TB called for enhanced efforts to combat this scourge. In 2013, WHO and several other organizations published the Roadmap for Childhood Tuberculosis that outlined the steps that would be required to address the disease (I had the privilege of being one of its authors).
In December 2015, a new campaign called “Acting on the Call: Bring Childhood TB Out of the Shadows” was started with a petition calling for action. The basic points of this campaign are:
- Empowering children, their families and communities to use their voices to advocate for improved access to TB prevention, diagnosis and care.
- Stepping up programmatic efforts to identify children and adolescents most at risk of TB to prevent, diagnose and treat them with the best diagnostic tools and medicines available.
- Strengthening health systems at all levels, recognizing the fact that TB contributes substantially to the global burden of child morbidity and mortality. Integrating, where possible, TB programming with programming focusing on maternal and child health, HIV/AIDS and nutrition.
- Including, as early as possible, children and adolescents in research activities, accelerating the development of appropriate diagnostics and treatments.
- Facilitating by governments of case registration and adoption of improved treatments and interventions for children.
- Ensuring affordable supply of treatments and diagnostics from manufacturers.
- Scaling up donor investments in the long-term development of appropriate childhood TB medicines, diagnostics and vaccines, and the health systems that use them.
One important issue has been a lack of professional education about childhood TB. To help address this, one South African colleague and I have edited a book, due out in February, called “Handbook of Child and Adolescent Tuberculosis.” The chapters in this unique book are written by the leading childhood TB clinicians and researchers in the world and it is intended to provide practical and evidence-based advice for clinicians all over the world who care for children with TB. We hope it will contribute to the Call To Action for childhood TB.