Consolidated Guidelines

This chapter includes current WHO recommendations that apply to children and adolescents on TB prevention. They have been consolidated from current WHO guidelines on TB infection, prevention and control, a BCG position paper and guidelines on TPT, namely the WHO guidelines on tuberculosis infection prevention and control, 2019 update (12), the BCG vaccines: WHO position paper (published in the Weekly Epidemiological Record) (13) and the WHO consolidated guidelines on tuberculosis. Module 1: prevention - tuberculosis preventive treatment (14).

This chapter includes current WHO recommendations that apply to children and adolescents on TB screening and contact investigation. They have been consolidated from current WHO guidelines on systematic screening for TB disease and contact investigation, namely the WHO consolidated guidelines on tuberculosis. Module 2: screening - systematic screening for tuberculosis disease (11) and Guidance for national tuberculosis programmes on the management of tuberculosis in children (second edition) (8).

a. What is the socioeconomic impact of TB on children and adolescents and their families?

b. How can adolescents with TB or eligible for TPT be optimally engaged in their care?

Children and young adolescents (aged below 15 years) represent about 11% of all people with TB globally. This means that close to 1.1 million children become ill with TB every year, almost half of them below five years of age. National TB programmes (NTPs) only notify less than half of these children, meaning that there is a large case detection gap (1).

The recommendations and the text of the WHO consolidated guidelines on tuberculosis. Module 1: Prevention – tuberculosis preventive treatment, second edition are the result of collaboration among professionals in various specialties with extensive expertise and experience in public health policy, tuberculosis (TB) programme management and the clinical care of TB patients. The recommendations in these guidelines were developed by successive guideline development groups (GDGs) convened by WHO, the latest of which met in December 2023.

Tuberculosis infection (TBI) is defined as a state of persistent immune response to stimulation by M. tuberculosis antigens with no evidence of clinically manifest TB disease. It is estimated that about one fourth of the world’s population has been infected with TB. TB preventive treatment (TPT) is one of the key interventions recommended by WHO to achieve the End TB Strategy targets, as upheld by the United Nations High-level Meeting on TB in September 2023.

The second edition of the WHO guidelines on TPT provides a comprehensive set of recommendations for PMTPT for implementers of the WHO End TB Strategy and also for countries working towards TB elimination (8,9). The guidelines are to be used primarily in national TB and HIV and maternal and child health programmes or their equivalents in ministries of health and by other policy-makers working on TB, HIV, infectious diseases and maternal and child health.

Several clinical characteristics, conditions and comorbidities can indicate an increased risk for developing TB disease or suffering worse outcomes from the disease, or both. Individuals identified as having untreated fibrotic lesions on CXR and who are not diagnosed with TB disease are at increased risk of developing TB disease (34–37). These individuals are often identified through TB screening or clinical evaluation or during a clinical evaluation done for other reasons.

The production of the WHO consolidated guidelines on tuberculosis. Module 2: screening was coordinated and written by Cecily Miller, with support from Annabel Baddeley, Dennis Falzon and Matteo Zignol, under the overall direction of Tereza Kasaeva, Director of the World Health Organization (WHO) Global Tuberculosis Programme. The WHO Global Tuberculosis Programme gratefully acknowledges the contribution of all experts involved in producing these guidelines¹.